This page is part of the FHIR Specification (v0.0.82: DSTU 1). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions Paymentreconciliation.questionnaire This is an example form generated from the questionnaire. See also the XML or JSON format. Paymentreconciliation.questionnaire - FHIR v0.4.0                           div.fhir-code-form { background-color: Lemonchiffon; border-bottom: 1px solid #778899; border-right: 1px solid #778899; padding: 10px 10px 0px 10px; margin: 0px 0px 0px 0px; position: fixed; width: 520px; top: 0; left: 0; opacity: 1.0; z-order: 50; } div.fhir-code-form,div.fhir-reference-form { background-color: Lemonchiffon; border-bottom: 1px solid #778899; border-right: 1px solid #778899; padding: 10px 10px 0px 10px; margin: 0px 0px 0px 0px; position: fixed; width: 520px; top: 0; left: 0; opacity: 1.0; z-order: 50; } .combo {position:relative;width:310px;text-align:left;padding:0;margin:0;} .combo * {padding:0;margin:0;} .combo label {display:block;float:left;width:92px;text-align:right;} .combo input {width:300px; height:1.5em;z-index:50;} .combo ul {padding:1px;border:2px solid #ccc;width: 600px;background-color:#fff;position:absolute;left:3px;top:1.8em;display:none;z-index:51;} .combo li {display:block; width: 100%;} Form Development Version FHIR Home Documentation Implementation Resources Clinical Administrative Infrastructure Financial Home Financial PaymentReconciliation Generated Questionnaire This is an example form generated from the questionnaire. See also the XML or JSON format PaymentReconciliation resource PaymentReconciliation PaymentReconciliation.id PaymentReconciliation.id.value Logical id of this artefact PaymentReconciliation.id 1 Metadata about the resource PaymentReconciliation.meta PaymentReconciliation.meta 1 PaymentReconciliation.implicitRules PaymentReconciliation.implicitRules.value A set of rules under which this content was created PaymentReconciliation.implicitRules 1 PaymentReconciliation.language PaymentReconciliation.language.value language PaymentReconciliation.language 1 Text summary of the resource, for human interpretation PaymentReconciliation.text PaymentReconciliation.text 1 Contained, inline Resources PaymentReconciliation.contained PaymentReconciliation.contained 1 Business Identifier PaymentReconciliation.identifier PaymentReconciliation.identifier.label label: PaymentReconciliation.identifier.system system: PaymentReconciliation.identifier.value value: PaymentReconciliation.identifier 1 PaymentReconciliation.request PaymentReconciliation.request.value Claim reference Edit PaymentReconciliation.request 1 PaymentReconciliation.outcome PaymentReconciliation.outcome.value outcome PaymentReconciliation.outcome 1 PaymentReconciliation.disposition PaymentReconciliation.disposition.value Disposition Message PaymentReconciliation.disposition 1 PaymentReconciliation.ruleset PaymentReconciliation.ruleset.value Resource version PaymentReconciliation.ruleset 1 PaymentReconciliation.originalRuleset PaymentReconciliation.originalRuleset.value Original version PaymentReconciliation.originalRuleset 1 PaymentReconciliation.created PaymentReconciliation.created.value Creation date PaymentReconciliation.created 1 Period covered PaymentReconciliation.period PaymentReconciliation.period.low start: PaymentReconciliation.period.end end: PaymentReconciliation.period 1 PaymentReconciliation.organization PaymentReconciliation.organization.value Insurer Edit PaymentReconciliation.organization 1 PaymentReconciliation.requestProvider PaymentReconciliation.requestProvider.value Responsible practitioner Edit PaymentReconciliation.requestProvider 1 PaymentReconciliation.requestOrganization PaymentReconciliation.requestOrganization.value Responsible organization Edit PaymentReconciliation.requestOrganization 1 Details PaymentReconciliation.detail PaymentReconciliation.detail.id PaymentReconciliation.detail.id.value xml:id (or equivalent in JSON) PaymentReconciliation.detail.id 1 PaymentReconciliation.detail.type PaymentReconciliation.detail.type.value Type code PaymentReconciliation.detail.type 1 PaymentReconciliation.detail.request PaymentReconciliation.detail.request.value Claim Edit PaymentReconciliation.detail.request 1 PaymentReconciliation.detail.responce PaymentReconciliation.detail.responce.value Claim Response Edit PaymentReconciliation.detail.responce 1 PaymentReconciliation.detail.submitter PaymentReconciliation.detail.submitter.value Submitter Edit PaymentReconciliation.detail.submitter 1 PaymentReconciliation.detail.payee PaymentReconciliation.detail.payee.value Payee Edit PaymentReconciliation.detail.payee 1 PaymentReconciliation.detail.date PaymentReconciliation.detail.date.value Invoice date PaymentReconciliation.detail.date 1 Detail amount PaymentReconciliation.detail.amount PaymentReconciliation.detail.amount.value value: PaymentReconciliation.detail.amount.currency currency: PaymentReconciliation.detail.amount 1 PaymentReconciliation.detail 1 PaymentReconciliation.form PaymentReconciliation.form.value Printed Form Identifier PaymentReconciliation.form 1 Total amount of Payment PaymentReconciliation.total PaymentReconciliation.total.value value: PaymentReconciliation.total.currency currency: PaymentReconciliation.total 1 Note text PaymentReconciliation.note PaymentReconciliation.note.id PaymentReconciliation.note.id.value xml:id (or equivalent in JSON) PaymentReconciliation.note.id 1 PaymentReconciliation.note.type PaymentReconciliation.note.type.value display | print | printoper PaymentReconciliation.note.type 1 PaymentReconciliation.note.text PaymentReconciliation.note.text.value Notes text PaymentReconciliation.note.text 1 PaymentReconciliation.note 1 PaymentReconciliation 1 Save as Draft Save as Complete © HL7.org 2011+. FHIR DSTU (v0.4.0-4902) generated on Fri, Mar 27, 2015 00:22+1100. Links: What's a DSTU? | Version History | Specification Map | Compare to DSTU1 | | Propose a change   © HL7.org 2011+. FHIR DSTU (v0.4.0-4902) generated on Fri, Mar 27, 2015 00:22+1100. Links: What's a DSTU? | Version History | Specification Map | Compare to DSTU1 | | Propose a change