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Narrative

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Source1

{
  "resourceType": "Claim",
  "id": "ECLM-SUR-001",
  "meta": {
    "profile": [
      "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-surgicalpreauth"
    ],
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/common-tags",
        "code": "actionable",
        "display": "Actionable"
      }
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-anaesthesia-type",
      "valueString": "General"
    },
    {
      "url": "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-chief-complaint",
      "valueString": "Acute right iliac fossa pain, nausea, low-grade fever for 24 hours"
    },
    {
      "url": "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-clinical-indications",
      "valueString": "Acute appendicitis confirmed on clinical examination and USS"
    },
    {
      "url": "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-vital-signs",
      "valueString": "Temp: 38.2°C; BP: 118/76 mmHg; HR: 96 bpm"
    }
  ],
  "identifier": [
    {
      "system": "https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number",
      "value": "CLAIM-SUR-001"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-type-cs",
        "code": "institutional",
        "display": "Institutional"
      }
    ]
  },
  "use": "preauthorization",
  "patient": {
    "reference": "Patient/ECLM-PT-001"
  },
  "billablePeriod": {
    "start": "2025-11-20",
    "end": "2025-11-22"
  },
  "created": "2025-11-19T18:00:00+03:00",
  "insurer": {
    "reference": "Organization/ECLM-INS-001"
  },
  "provider": {
    "reference": "Organization/ECLM-ORG-001"
  },
  "priority": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/processpriority",
        "code": "stat",
        "display": "Immediate"
      }
    ]
  },
  "payee": {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/payeetype",
          "code": "provider",
          "display": "Provider"
        }
      ]
    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/ECLM-PRA-001"
      },
      "role": {
        "coding": [
          {
            "system": "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-care-team-role-cs",
            "code": "PRIMARY",
            "display": "Primary provider"
          }
        ]
      },
      "qualification": {
        "coding": [
          {
            "system": "https://nshr-uat.sha.go.ke/fhir/CodeSystem/eclaims-provider-qualification-cs",
            "code": "MBChB",
            "display": "Bachelor of Medicine and Bachelor of Surgery (MBChB)"
          }
        ]
      }
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "system": "https://nshr-uat.sha.go.ke/fhir/CodeSystem/icd11-codes-cs",
            "code": "DC80",
            "display": "Appendicitis"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/ECLM-COV-001"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
            "code": "2",
            "display": "Surgical"
          }
        ]
      },
      "productOrService": {
        "coding": [
          {
            "system": "https://nshr-uat.sha.go.ke/fhir/CodeSystem/KenyaSocialHealthAuthorityInterventionCS",
            "code": "SHA-19",
            "display": "Surgical Services"
          }
        ]
      },
      "quantity": {
        "value": 1
      },
      "unitPrice": {
        "value": 85000,
        "currency": "KES"
      },
      "net": {
        "value": 85000,
        "currency": "KES"
      }
    }
  ]
}