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Packagehl7.fhir.us.carin-rtpbc
Resource TypeClaim
IdClaim-rtpbc-claim-01.json
FHIR VersionR4

Resources that use this resource

No resources found

Resources that this resource uses

No resources found

Narrative

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

Generated Narrative: Claim rtpbc-claim-01

Language: en

Profile: RTPBC Request Using Claim

identifier: rtpbc-01

status: Active

type: Pharmacy

use: Predetermination

patient: Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)

created: 2019-11-01 11:20:54-0500

provider: Organization Hometown Drug

priority: Normal

prescription: MedicationRequest: status = draft; intent = proposal; reported[x] = true; medication[x] = fluoxetine 10 MG Oral Capsule [Prozac]; authoredOn = 2019-11-01

CareTeams

-SequenceProvider
*1Practitioner Johnson

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active; subscriberId = 121212; relationship = Self

Items

-SequenceCareTeamSequenceProductOrServiceQuantity
*11fluoxetine 10 MG Oral Capsule [Prozac]60 {Each}

Source1

{
  "resourceType": "Claim",
  "id": "rtpbc-claim-01",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim"
    ]
  },
  "language": "en",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "identifier": [
    {
      "value": "rtpbc-01"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "pharmacy",
        "display": "Pharmacy"
      }
    ]
  },
  "use": "predetermination",
  "patient": {
    "reference": "Patient/rtpbc-patient-01"
  },
  "created": "2019-11-01T11:20:54-05:00",
  "provider": {
    "reference": "Organization/rtpbc-organization-01"
  },
  "priority": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/processpriority",
        "code": "normal",
        "display": "Normal"
      }
    ]
  },
  "prescription": {
    "reference": "MedicationRequest/rtpbc-medicationrequest-01"
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/rtpbc-practitioner-01"
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/rtpbc-coverage-01"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
            "code": "205535",
            "display": "fluoxetine 10 MG Oral Capsule [Prozac]"
          }
        ]
      },
      "quantity": {
        "value": 60,
        "unit": "{Each}"
      }
    }
  ]
}