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FHIR IG analytics

Packagefhir.ph.core
Resource TypeClaim
IdClaim-claim-single-example.json
FHIR VersionR4

Resources that use this resource

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Resources that this resource uses

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Narrative

Note: links and images are rebased to the (stated) source

Claim: PhilHealth Outpatient Consultation

Status: Active

Patient: Juan Dela Cruz (PhilHealth ID: 63-584789845-5)

Created: March 15, 2024

Insurer: Philippine Health Insurance Corporation (PhilHealth)

Provider: Dr. Maria Clara Santos

Diagnosis: Type 2 Diabetes Mellitus (Principal)

Service: Outpatient Consultation on March 15, 2024 - PHP 500.00

Source1

{
  "resourceType": "Claim",
  "id": "claim-single-example",
  "meta": {
    "profile": [
      "https://fhir.doh.gov.ph/phcore/StructureDefinition/ph-core-claim",
      "http://doh.gov.ph/fhir/ph-core/StructureDefinition/ph-core-claim"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "professional",
        "display": "Professional"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/patient-single-example"
  },
  "created": "2024-03-15",
  "insurer": {
    "reference": "Organization/organization-single-example"
  },
  "provider": {
    "reference": "Practitioner/practitioner-single-example"
  },
  "priority": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/processpriority",
        "code": "normal",
        "display": "Normal"
      }
    ]
  },
  "payee": {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/payeetype",
          "code": "provider",
          "display": "Provider"
        }
      ]
    },
    "party": {
      "reference": "Practitioner/practitioner-single-example"
    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/practitioner-single-example"
      },
      "responsible": true,
      "role": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
            "code": "primary",
            "display": "Primary Provider"
          }
        ]
      }
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisReference": {
        "reference": "Condition/condition-single-example"
      },
      "type": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
              "code": "principal",
              "display": "Principal Diagnosis"
            }
          ]
        }
      ]
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "identifier": {
        "system": "http://philhealth.gov.ph/fhir/Identifier/philhealth-id",
        "value": "63-584789845-5"
      },
      "coverage": {
        "reference": "Coverage/philhealth-coverage-example"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "diagnosisSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "11429006",
            "display": "Consultation"
          }
        ],
        "text": "Outpatient Consultation"
      },
      "servicedDate": "2024-03-15",
      "quantity": {
        "value": 1
      },
      "unitPrice": {
        "value": 500,
        "currency": "PHP"
      },
      "net": {
        "value": 500,
        "currency": "PHP"
      }
    }
  ]
}