DSTU2

This page is part of the FHIR Specification (v0.0.82: (v1.0.2: DSTU 1). 2). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

Claim-example-institutional.xml

Raw XML ( canonical form )

Simple Institutional Service Claim (id = "960150")

Raw XML 

  
  
    
    
  
  
  
    
    
  
  
  
    
  
  
    
  
  
  
    
  
  
    
      
    
  
  
    
    
      
    
  
  
    
  
  
    
    
    
      
    
    
      
    
  
  
    
    
      
    
    
      
    
    
      
      
    
    
    
      
      
      
    
    
      
      
      
    
  

<Claim xmlns="http://hl7.org/fhir">
 <id value="960150"/>

 <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Claim</div>
  </text>


  <type value="institutional"/>

  
  <identifier>
    <system value="http://happyhospital.com/claim"/>
    <value value="9612345"/>
 </identifier>

 
  <created value="2014-08-16"/>


 <target>
  <reference value="Organization/2"/>
</target>


 <organization>
    <reference value="Organization/1"/>
 </organization>


 <use value="complete"/>


 <priority>
    <code value="normal"/>
 </priority>


 <payee>
   <type>
     <code value="provider"/>
   </type>
 </payee>

 
  <diagnosis>
    <sequence value="1"/>
  <diagnosis>
    <code value="654456"/>
    </diagnosis>
  </diagnosis>

 
 <patient>
   <reference value="Patient/1"/>
 </patient>

 
 <coverage>
   <sequence value="1"/>
   <focal value="true"/>
   <coverage>
     <reference value="Coverage/9876B1"/>
   </coverage>
   <relationship>
     <code value="self"/>
   </relationship>
 </coverage>

  
 <item>
   <sequence value="1"/>
   <type>
     <code value="service"/>
   </type>
   <provider>
     <reference value="Practitioner/example"/>
   </provider>
   <service>
     <system value="http://hl7.org/fhir/ex-serviceproduct"/>
     <code value="exam"/> 
   </service>
   <serviceDate value="2014-08-16"/>
   <unitPrice>
      <value value="125.00"/>
    <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/> 
   </unitPrice> 
   <net>
      <value value="125.00"/>
    <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/> 
   </net> 
  </item>





</Claim>

</

Claim

>

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.