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Narrative

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Source1

{
  "resourceType": "Claim",
  "id": "MedicalServicesAuthorizationExample",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "identifier": [
    {
      "system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
      "value": "111099",
      "assigner": {
        "identifier": {
          "system": "http://example.org/USER_ASSIGNED",
          "value": "9012345678"
        }
      }
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "professional"
      }
    ]
  },
  "use": "preauthorization",
  "patient": {
    "reference": "Patient/SubscriberExample"
  },
  "created": "2005-05-02T11:01:00+05:00",
  "insurer": {
    "reference": "Organization/InsurerExample"
  },
  "provider": {
    "reference": "Organization/UMOExample"
  },
  "priority": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/processpriority",
        "code": "normal"
      }
    ]
  },
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/InsuranceExample"
      }
    }
  ],
  "item": [
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "https://codesystem.x12.org/005010/1525",
                "code": "IN",
                "display": "Initial Medical Services Reservation"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "https://codesystem.x12.org/005010/1322",
                "code": "I",
                "display": "Initial"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber",
          "valueString": "1122344"
        },
        {
          "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber",
          "valueString": "33441122"
        }
      ],
      "sequence": 1,
      "category": {
        "coding": [
          {
            "system": "https://codesystem.x12.org/005010/1365",
            "code": "1",
            "display": "Medical Care"
          }
        ]
      },
      "productOrService": {
        "coding": [
          {
            "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
            "code": "99212",
            "display": "Established Office Visit"
          }
        ]
      },
      "servicedDate": "2005-05-10",
      "locationCodeableConcept": {
        "coding": [
          {
            "system": "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
            "code": "11"
          }
        ]
      }
    }
  ]
}