FHIR IG analytics| Package | il.core.fhir.r4 |
| Resource Type | Claim |
| Id | Claim-dental-claim.json |
| FHIR Version | R4 |
No resources found
No resources found
No narrative content found in resource
{
"resourceType": "Claim",
"id": "dental-claim",
"meta": {
"profile": [
"http://fhir.health.gov.il/StructureDefinition/il-core-claim"
]
},
"identifier": [
{
"system": "http://happyvalley.com/claim",
"value": "12345"
}
],
"status": "active",
"type": {
"coding": [
{
"code": "oral",
"system": "http://terminology.hl7.org/CodeSystem/claim-type"
}
]
},
"use": "claim",
"originalPrescription": {
"reference": "ILCoreMedicationRequest/metamizole-for-gangreenous-tonsolitis"
},
"patient": {
"reference": "Patient/ptient-israeli"
},
"created": "2014-08-16",
"insurer": {
"reference": "Organization/ministry-of-health"
},
"provider": {
"reference": "Organization/meir-hospital"
},
"payee": {
"party": {
"reference": "Organization/meir-hospital"
},
"type": {
"coding": [
{
"code": "provider"
}
]
}
},
"priority": {
"coding": [
{
"code": "normal"
}
]
},
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "Practitioner/md"
},
"responsible": true
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "123456"
}
]
},
"type": [
{
"coding": [
{
"code": "principal",
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"display": "Principal Diagnosis"
}
]
}
]
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"identifier": {
"system": "http://happyvalley.com/claim",
"value": "12345"
},
"coverage": {
"reference": "Coverage/9876B1"
}
}
],
"item": [
{
"sequence": 1,
"careTeamSequence": [
1
],
"productOrService": {
"coding": [
{
"code": "1200"
}
]
},
"servicedDate": "2014-08-16",
"unitPrice": {
"value": 135.57,
"currency": "USD"
},
"net": {
"value": 135.57,
"currency": "USD"
}
}
],
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info",
"display": "Information"
}
]
},
"valueReference": {
"reference": "Condition/obesity"
},
"timingDate": "2014-08-15"
}
]
}