Release 4B 5

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0: R5 - STU ). The This is the current published version which supercedes in it's permanent home (it will always be available at this version is 5.0.0 . URL). For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R5 R4B R4 R3

Claim-example-oral-identifier.xml

Example Claim/100154 (XML)

Financial Management Work Group Maturity Level : N/A Standards Status : Informative Compartments : Device , Encounter , Patient , Practitioner , RelatedPerson

Raw XML ( canonical form + also see XML Format Specification )

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SOA Dental Claim using identifiers (id = "100154") 

<?xml version="1.0" encoding="UTF-8"?>


  
  
    
    This example assumes a national health care scheme where patients, providers and organizations
       have known business identifiers.
  

  
    
    
  

  

  
    
      
      
    
  

  

  
    
      
      
    
  

  

  
    
      
      
    
  

  
    
      
      
    
  

  
    
      
    
  

  
    
      
        
      
    
  

  
    
    
      
        
        
      
    
  

  
    
    
      
        
      
    
  

  
    
    
    
      
        
        
      
    
  

  
    
    
    
      
        
      
    
    
    
      
      
    
    
      
      
    
  

<Claim xmlns="http://hl7.org/fhir">
  <id value="100154"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">This example assumes a national health care scheme where patients, providers and
       organizations have known business identifiers.</div> 
  </text>   <identifier>     <system value="http://happyvalley.com/claim"/>     <value value="12347"/>   </identifier>   <status value="active"/>   <type>     <coding>       <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>       <code value="oral"/>     </coding>   </type>   <use value="claim"/>   <patient>     <identifier>       <system value="http://www.jurisdiction.com/nationalId"/>       <value value="123AB345"/>     </identifier>   </patient>   <created value="2014-08-16"/>   <insurer>     <identifier>       <system value="http://www.jurisdiction.com/insurers"/>       <value value="123456"/>     </identifier>   </insurer>   <provider>     <identifier>       <system value="http://www.jurisdiction.com/careorganizations"/>       <value value="HOSP12345"/>     </identifier>   </provider>   <priority>     <coding>       <code value="normal"/>     </coding>   </priority>   <payee>     <type>       <coding>         <code value="provider"/>       </coding>     </type>   </payee>   <careTeam>     <sequence value="1"/>     <provider>       <identifier>         <system value="http://www.jurisdiction.com/providerId"/>         <value value="MD98765"/>       </identifier>     </provider>   </careTeam>   <diagnosis>     <sequence value="1"/>     <diagnosisCodeableConcept>       <coding>         <code value="123456"/>       </coding>     </diagnosisCodeableConcept>   </diagnosis>   <insurance>     <sequence value="1"/>     <focal value="true"/>     <coverage>       <identifier>         <system value="http://www.jurisdiction.com/nationalplan"/>         <value value="123AB345"/>       </identifier>     </coverage>   </insurance>   <item>     <sequence value="1"/>     <careTeamSequence value="1"/>     <productOrService>       <coding>         <code value="1200"/>       </coding>     </productOrService>     <servicedDate value="2014-08-16"/>     <unitPrice>       <value value="135.57"/>       <currency value="USD"/>     </unitPrice>     <net>       <value value="135.57"/>       <currency value="USD"/>     </net>   </item> 


</

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.