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-pharmacy-medication.ttl

Example Claim/760151 (Turtle)

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

Raw Turtle (+ also see Turtle/RDF Format Specification )

Simple Pharmacy Medication Claim 

@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 -------------------------------------------------------------------

<http://hl7.org/fhir/Claim/760151> a fhir:Claim;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "760151"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Pharmacy Claim</div>"
  ];
  fhir:Claim.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://happypharma.com/claim" ];
     fhir:Identifier.value [ fhir:value "7612345" ]
  ];
  fhir:Claim.status [ fhir:value "active"];
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "pharmacy" ]
     ]
  ];
  fhir:Claim.use [ fhir:value "claim"];
  fhir:Claim.patient [
     fhir:link <http://hl7.org/fhir/Patient/1>;
     fhir:Reference.reference [ fhir:value "Patient/1" ]
  ];
  fhir:Claim.created [ fhir:value "2014-08-16"^^xsd:date];
  fhir:Claim.insurer [
     fhir:link <http://hl7.org/fhir/Organization/2>;
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ];
  fhir:Claim.provider [
     fhir:link <http://hl7.org/fhir/Organization/1>;
     fhir:Reference.reference [ fhir:value "Organization/1" ]
  ];
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.code [ fhir:value "stat" ]
     ]
  ];
  fhir:Claim.prescription [
     fhir:link <http://pharmacy.org/MedicationRequest/AB1234G>;
     fhir:Reference.reference [ fhir:value "http://pharmacy.org/MedicationRequest/AB1234G" ]
  ];
  fhir:Claim.originalPrescription [
     fhir:link <http://pharmacy.org/MedicationRequest/AB1202B>;
     fhir:Reference.reference [ fhir:value "http://pharmacy.org/MedicationRequest/AB1202B" ]
  ];
  fhir:Claim.payee [
     fhir:Claim.payee.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.code [ fhir:value "provider" ]
       ]

[a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "760151"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Pharmacy Claim</div>"
  ] ; # 
  fhir:identifier ( [
     fhir:system [ fhir:v "http://happypharma.com/claim"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "7612345" ]
  ] ) ; # 
  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 "pharmacy" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:patient [
     fhir:reference [ fhir:v "Patient/1" ]
  ] ; # 
  fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # 
  fhir:insurer [
     fhir:reference [ fhir:v "Organization/2" ]
  ] ; # 
  fhir:provider [
     fhir:reference [ fhir:v "Organization/1" ]
  ] ; # 
  fhir:priority [
     fhir:coding ( [
       fhir:code [ fhir:v "stat" ]
     ] )
  ] ; # 
  fhir:prescription [
     fhir:link <http://pharmacy.org/MedicationRequest/AB1234G> ;
     fhir:reference [ fhir:v "http://pharmacy.org/MedicationRequest/AB1234G" ]
  ] ; # 
  fhir:originalPrescription [
     fhir:link <http://pharmacy.org/MedicationRequest/AB1202B> ;
     fhir:reference [ fhir:v "http://pharmacy.org/MedicationRequest/AB1202B" ]
  ] ; # 
  fhir:payee [
     fhir:type [
       fhir:coding ( [
         fhir:code [ fhir:v "provider" ]
       ] )

     ]
  ];
  fhir:Claim.careTeam [
     fhir:index 0;
     fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.careTeam.provider [
       fhir:link <http://hl7.org/fhir/Practitioner/example>;
       fhir:Reference.reference [ fhir:value "Practitioner/example" ]

  ] ; # 
  fhir:careTeam ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:provider [
       fhir:reference [ fhir:v "Practitioner/example" ]

     ]
  ];
  fhir:Claim.supportingInfo [
     fhir:index 0;
     fhir:Claim.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.code [ fhir:value "pharmacyrefill" ]
       ]
     ];
     fhir:Claim.supportingInfo.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/pharmacy-refill" ];
         fhir:Coding.code [ fhir:value "new" ]
       ]

  ] ) ; # 
  fhir:supportingInfo ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:code [ fhir:v "pharmacyrefill" ]
       ] )
     ] ;
     fhir:code [
       fhir:coding ( [
         fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/pharmacy-refill"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "new" ]
       ] )

     ]
  ], [
     fhir:index 1;
     fhir:Claim.supportingInfo.sequence [ fhir:value "2"^^xsd:positiveInteger ];
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.code [ fhir:value "pharmacyinformation" ]
       ]
     ];
     fhir:Claim.supportingInfo.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/pharmacy-information" ];
         fhir:Coding.code [ fhir:value "refillsremaining" ]
       ]
     ];
     fhir:Claim.supportingInfo.valueQuantity [
       fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ]

  ] [
     fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:code [ fhir:v "pharmacyinformation" ]
       ] )
     ] ;
     fhir:code [
       fhir:coding ( [
         fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/pharmacy-information"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "refillsremaining" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Quantity ;
       fhir:value [ fhir:v "2"^^xsd:decimal ]

     ]
  ], [
     fhir:index 2;
     fhir:Claim.supportingInfo.sequence [ fhir:value "3"^^xsd:positiveInteger ];
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.code [ fhir:value "pharmacyinformation" ]
       ]
     ];
     fhir:Claim.supportingInfo.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/pharmacy-information" ];
         fhir:Coding.code [ fhir:value "dayssupply" ]
       ]
     ];
     fhir:Claim.supportingInfo.valueQuantity [
       fhir:Quantity.value [ fhir:value "90"^^xsd:decimal ]

  ] [
     fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:code [ fhir:v "pharmacyinformation" ]
       ] )
     ] ;
     fhir:code [
       fhir:coding ( [
         fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/pharmacy-information"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "dayssupply" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Quantity ;
       fhir:value [ fhir:v "90"^^xsd:decimal ]

     ]
  ];
  fhir:Claim.diagnosis [
     fhir:index 0;
     fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.code [ fhir:value "654456" ]
       ]

  ] ) ; # 
  fhir:diagnosis ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:code [ fhir:v "654456" ]
       ] )

     ]
  ];
  fhir:Claim.insurance [
     fhir:index 0;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:Claim.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/9876B1>;
       fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]

  ] ) ; # 
  fhir:insurance ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
     fhir:coverage [
       fhir:reference [ fhir:v "Coverage/9876B1" ]

     ]
  ];
  fhir:Claim.item [
     fhir:index 0;
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0
     ];
     fhir:Claim.item.informationSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0
     ], [
       fhir:value "2"^^xsd:positiveInteger;
       fhir:index 1
     ], [
       fhir:value "3"^^xsd:positiveInteger;
       fhir:index 2
     ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://www.nlm.nih.gov/research/umls/rxnorm" ];
         fhir:Coding.code [ fhir:value "562721" ];
         fhir:Coding.display [ fhir:value "Alprazolam 0.25mg (Xanax)" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Claim.item.quantity [
       fhir:Quantity.value [ fhir:value "90"^^xsd:decimal ];
       fhir:Quantity.unit [ fhir:value "TAB" ];
       fhir:Quantity.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm" ];
       fhir:Quantity.code [ fhir:value "TAB" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "90.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.detail [
       fhir:index 0;
       fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ex-pharmaservice" ];
           fhir:Coding.code [ fhir:value "drugcost" ]
         ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "45.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]

  ] ) ; # 
  fhir:item ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:informationSequence ( [ fhir:v "1"^^xsd:positiveInteger ] [ fhir:v "2"^^xsd:positiveInteger ] [ fhir:v "3"^^xsd:positiveInteger ] ) ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [ fhir:v "http://www.nlm.nih.gov/research/umls/rxnorm"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "562721" ] ;
         fhir:display [ fhir:v "Alprazolam 0.25mg (Xanax)" ]
       ] )
     ] ; #   type=packagemedication  
     fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
     fhir:quantity [
       fhir:value [ fhir:v "90"^^xsd:decimal ] ;
       fhir:unit [ fhir:v "TAB" ] ;
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "TAB" ]
     ] ;
     fhir:net [
       fhir:value [ fhir:v "90.00"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:detail ( [
       fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:system [ fhir:v "http://hl7.org/fhir/ex-pharmaservice"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "drugcost" ]
         ] )
       ] ; #   type=costitem  
       fhir:net [
         fhir:value [ fhir:v "45.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]

       ]
     ], [
       fhir:index 1;
       fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ex-pharmaservice" ];
           fhir:Coding.code [ fhir:value "markup" ]
         ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "9.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]

     ] [
       fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:system [ fhir:v "http://hl7.org/fhir/ex-pharmaservice"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "markup" ]
         ] )
       ] ; #   type=costitem  
       fhir:net [
         fhir:value [ fhir:v "9.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]

       ]
     ], [
       fhir:index 2;
       fhir:Claim.item.detail.sequence [ fhir:value "3"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ex-pharmaservice" ];
           fhir:Coding.code [ fhir:value "dispensefee" ]
         ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "36.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]

     ] [
       fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:system [ fhir:v "http://hl7.org/fhir/ex-pharmaservice"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "dispensefee" ]
         ] )
       ] ; #   type=costitem  
       fhir:net [
         fhir:value [ fhir:v "36.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]

       ]
     ]
  ];
  fhir:Claim.total [
     fhir:Money.value [ fhir:value "90.00"^^xsd:decimal ];
     fhir:Money.currency [ fhir:value "USD" ]
  ] .

<http://hl7.org/fhir/Patient/1> a fhir:Patient .

<http://hl7.org/fhir/Organization/2> a fhir:Organization .

<http://hl7.org/fhir/Organization/1> a fhir:Organization .

<http://hl7.org/fhir/Practitioner/example> a fhir:Practitioner .

<http://hl7.org/fhir/Coverage/9876B1> a fhir:Coverage .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Claim/760151.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/Claim/760151.ttl> .

     ] )
  ] ) ; # 
  fhir:total [
     fhir:value [ fhir:v "90.00"^^xsd:decimal ] ;
     fhir:currency [ fhir:v "USD" ]
  ]] . # 


# -------------------------------------------------------------------------------------

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.