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Narrative

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Source1

{
  "resourceType": "Claim",
  "id": "PCT-GFE-Summary-MRI",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-summary"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse",
        "code": "estimate-summary",
        "display": "Estimate Summary"
      }
    ]
  },
  "use": "predetermination",
  "patient": {
    "reference": "Patient/patient1001"
  },
  "billablePeriod": {
    "start": "2021-10-31"
  },
  "created": "2021-10-05",
  "insurer": {
    "reference": "Organization/org1001"
  },
  "provider": {
    "extension": [
      {
        "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
        "valueCode": "not-applicable"
      }
    ]
  },
  "priority": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/processpriority",
        "code": "normal"
      }
    ]
  },
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/sid/icd-10-cm",
            "code": "S06.30",
            "display": "Unspecified focal traumatic brain injury"
          }
        ]
      },
      "type": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/diagnosistype",
              "code": "principal"
            }
          ]
        }
      ],
      "packageCode": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup",
            "code": "400",
            "display": "Head trauma - concussion"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/coverage1001"
      }
    }
  ],
  "total": {
    "value": 200,
    "currency": "USD"
  }
}