DSTU2 FHIR Release 3 (STU)

This page is part of the FHIR Specification (v1.0.2: DSTU (v3.0.2: STU 2). 3). 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 R3 R2

Claim-example-institutional.json

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

Raw JSON ( canonical form )

Simple Institutional Service Claim 

{
  "resourceType": "Claim",
  "id": "960150",
  "text": {
    "status": "generated",
    "div": "<div>A human-readable rendering of the Claim</div>"

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

  },
  "type": "institutional",

  "identifier": [
    {
      "system": "http://happyhospital.com/claim",
      "value": "9612345"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/ex-claimtype",
        "code": "institutional"
      }
    ]
  },
  "subType": [
    {
      "coding": [
        {
          "system": "http://hl7.org/fhir/ex-claimsubtype",
          "code": "emergency"
        }
      ]
    }
  ],
  "use": "complete",
  "patient": {
    "reference": "Patient/1"
  },

  "created": "2014-08-16",
  "target": {

  "enterer": {
    "identifier": {
      "system": "http://jurisdiction.org/facilities/HOSP1234/users",
      "value": "UC1234"
    }
  },
  "insurer": {

    "reference": "Organization/2"
  },
  "organization": {
    "reference": "Organization/1"
  },
  "use": "complete",

  "priority": {
    "code": "normal"

    "coding": [
      {
        "code": "normal"
      }
    ]

  },
  "payee": {
    "type": {
      "code": "provider"

      "coding": [
        {
          "code": "provider"
        }
      ]
    }
  },
  "facility": {
    "identifier": {
      "system": "http://jurisdiction.org/facilities",
      "value": "HOSP1234"

    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      }
    }
  ],

  "diagnosis": [
    {
      "sequence": 1,
      "diagnosis": {
        "code": "654456"

      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "654456"
          }
        ]

      }
    }
  ],
  "patient": {
    "reference": "Patient/1"
  },
  "coverage": [

  "insurance": [

    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/9876B1"
      },
      "relationship": {
        "code": "self"

      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "type": {
        "code": "service"
      },
      "provider": {
        "reference": "Practitioner/example"
      },

      "careTeamLinkId": [
        1
      ],

      "service": {
        "system": "http://hl7.org/fhir/ex-serviceproduct",
        "code": "exam"

        "coding": [
          {
            "system": "http://hl7.org/fhir/ex-serviceproduct",
            "code": "exam"
          }
        ]

      },
      "serviceDate": "2014-08-16",

      "servicedDate": "2014-08-16",

      "unitPrice": {
        "value": 125.00,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "net": {
        "value": 125.00,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }

      },
      "encounter": [
        {
          "reference": "Encounter/example"
        }
      ]

    }
  ]

  ],
  "total": {
    "value": 125.00,
    "system": "urn:iso:std:iso:4217",
    "code": "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.