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Packageihe.iti.fais
Resource TypeClaim
IdClaim-ex-claim-cancelled-3.json
FHIR VersionR4

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Narrative

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

Generated Narrative: Claim ex-claim-cancelled-3

Request Status Reason: Service not completed.

status: Cancelled

type: Institutional

use: Claim

patient: Purity Atieno Female, DoB: 2000-05-04

created: 2024-07-16 03:00:00+0000

enterer: Practitioner Kalu Kalu

insurer: Organization National Health Insurance Scheme

provider: Practitioner Kalu Kalu

priority: Normal

Payees

-TypeParty
*ProviderOrganization National Health Hospital System

facility: Location Local Hospital

Diagnoses

-SequenceDiagnosis[x]
*1Hybrid oncocytic chromophobe tumour

Procedures

-SequenceProcedure[x]
*1Chemotherapy treatment Cancer

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active; type = public healthcare; subscriberId = 05710b56-4448-11ef-b676-774a043da147; relationship = Self; period = 2024-01-01 --> 2024-12-31

Source1

{
  "resourceType": "Claim",
  "id": "ex-claim-cancelled-3",
  "meta": {
    "profile": [
      "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/request-statusReason",
      "valueCodeableConcept": {
        "text": "Service not completed."
      }
    }
  ],
  "status": "cancelled",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "institutional"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/ex-beneficiary-1"
  },
  "created": "2024-07-16T03:00:00Z",
  "enterer": {
    "reference": "Practitioner/ex-doctor-2"
  },
  "insurer": {
    "reference": "Organization/ex-insurer-1"
  },
  "provider": {
    "reference": "Practitioner/ex-doctor-2"
  },
  "priority": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/processpriority",
        "code": "normal"
      }
    ]
  },
  "payee": {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/payeetype",
          "code": "provider"
        }
      ]
    },
    "party": {
      "reference": "Organization/ex-network-1"
    }
  },
  "facility": {
    "reference": "Location/ex-hospital-2"
  },
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "system": "http://id.who.int/icd/release/11/mms",
            "code": "XH1VB1",
            "display": "Hybrid oncocytic chromophobe tumour"
          }
        ]
      }
    }
  ],
  "procedure": [
    {
      "sequence": 1,
      "procedureCodeableConcept": {
        "coding": [
          {
            "system": "http://loinc.org",
            "code": "21946-9",
            "display": "Chemotherapy treatment Cancer"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/ex-coverage-1"
      }
    }
  ]
}