FHIR © HL7.org  |  FHIRsmith 4.0.1  |  Server Home  |  XIG Home  |  XIG Stats  | 

FHIR IG analytics

Packageil.core.fhir.r4
Resource TypeClaim
IdClaim-dental-claim.json
FHIR VersionR4

Resources that use this resource

No resources found


Resources that this resource uses

No resources found


Narrative

No narrative content found in resource


Source1

{
  "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"
    }
  ]
}