EOB for an Claim that had errors

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

[a fhir:ExplanationOfBenefit ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "EB3501"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ExplanationOfBenefit for a claim that had errors, various other attributes (such as accident and hospitalization) are also completed.</div>"
  ] ; # 
  fhir:identifier ( [
     fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/explanationofbenefit"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "error-1" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "oral" ]
     ] )
  ] ; # 
  fhir:subType [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-claimsubtype"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "emergency" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:patient [
     fhir:reference [ fhir:v "Patient/pat1" ]
  ] ; # 
  fhir:billablePeriod [
     fhir:start [ fhir:v "2014-02-01"^^xsd:date ] ;
     fhir:end [ fhir:v "2014-03-01"^^xsd:date ]
  ] ; # 
  fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # 
  fhir:enterer [
     fhir:reference [ fhir:v "Practitioner/1" ]
  ] ; # 
  fhir:insurer [
     fhir:reference [ fhir:v "Organization/2" ]
  ] ; # 
  fhir:provider [
     fhir:reference [ fhir:v "Organization/2" ]
  ] ; # 
  fhir:related ( [
     fhir:reference [
       fhir:system [ fhir:v "http://www.BenefitsInc.com/case-number"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "23-56Tu-XX-47-20150M14" ]
     ]
  ] ) ; # 
  fhir:prescription [
     fhir:reference [ fhir:v "MedicationRequest/medrx002" ]
  ] ; # 
  fhir:originalPrescription [
     fhir:reference [ fhir:v "MedicationRequest/medrx0301" ]
  ] ; # 
  fhir:facility [
     fhir:reference [ fhir:v "Location/1" ]
  ] ; # 
  fhir:claim [
     fhir:reference [ fhir:v "Claim/100150" ]
  ] ; # 
  fhir:claimResponse [
     fhir:reference [ fhir:v "ClaimResponse/R3500" ]
  ] ; # 
  fhir:outcome [ fhir:v "error"] ; # 
  fhir:disposition [ fhir:v "Could not process."] ; # 
  fhir:supportingInfo ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "employmentimpacted" ]
       ] )
     ] ;
     fhir:timing [
       a fhir:Period ;
       fhir:start [ fhir:v "2014-02-14"^^xsd:date ] ;
       fhir:end [ fhir:v "2014-02-28"^^xsd:date ]
     ]
  ] [
     fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "hospitalized" ]
       ] )
     ] ;
     fhir:timing [
       a fhir:Period ;
       fhir:start [ fhir:v "2014-02-14"^^xsd:date ] ;
       fhir:end [ fhir:v "2014-02-16"^^xsd:date ]
     ]
  ] ) ; # 
  fhir:procedure ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:date [ fhir:v "2014-02-14"^^xsd:date ] ;
     fhir:procedure [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [ fhir:v "http://hl7.org/fhir/sid/ex-icd-10-procedures"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "123001" ]
       ] )
     ] ;
     fhir:udi ( [
       fhir:reference [ fhir:v "Device/example" ]
     ] )
  ] ) ; # 
  fhir:precedence [ fhir:v "2"^^xsd:positiveInteger] ; # 
  fhir:insurance ( [
     fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
     fhir:coverage [
       fhir:reference [ fhir:v "Coverage/9876B1" ]
     ]
  ] ) ; # 
  fhir:accident [
     fhir:date [ fhir:v "2014-02-14"^^xsd:date ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "SPT" ]
       ] )
     ] ;
     fhir:location [
       a fhir:Reference ;
       fhir:reference [ fhir:v "Location/ph" ]
     ]
  ] ; # 
  fhir:total ( [
     fhir:category [
       fhir:coding ( [
         fhir:code [ fhir:v "submitted" ]
       ] )
     ] ;
     fhir:amount [
       fhir:value [ fhir:v "2478.57"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:category [
       fhir:coding ( [
         fhir:code [ fhir:v "benefit" ]
       ] )
     ] ;
     fhir:amount [
       fhir:value [ fhir:v "0.00"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] ) ; # 
  fhir:formCode [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/forms-codes"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "2" ]
     ] )
  ] ; # 
  fhir:processNote ( [
     fhir:number [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://hl7.org/fhir/note-type"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "display" ]
       ] )
     ] ;
     fhir:text [ fhir:v "Invalid claim" ] ;
     fhir:language [
       fhir:coding ( [
         fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "en-CA" ]
       ] )
     ]
  ] )] . # 

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