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Packageorg.dhin-hie.sandbox
Resource TypeClaim
IdClaim-NgClaim-001.json
FHIR VersionR4

Resources that use this resource

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Resources that this resource uses

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Narrative

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

Generated Narrative: Claim NgClaim-001

Profile: NG Claim

identifier: https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry/CLM-2025-0001

status: Active

type: Pharmacy

use: Claim

patient: Musa Abdullahi Male, DoB: 1987-07-06 ( nin)

created: 2025-11-04 12:30:00+0000

provider: Organization Asokoro District Hospital

priority: Normal

Payees

-TypeParty
*ProviderPractitioner Nkiru Okeke

Insurances

-SequenceFocalIdentifierCoverageBusinessArrangementPreAuthRef
*654truehttps://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry/NHIA-0011223344Coverage: status = active; period = 2025-01-01 --> 2025-12-31NHIA-PlanA-2025PA-2025-ABC123

item

sequence: 1

diagnosisSequence: 1

productOrService: Exam, comp, primary

quantity: 30

UnitPrices

-ValueCurrency
*500Nigerian naira

Nets

-ValueCurrency
*15000Nigerian naira

Totals

-ValueCurrency
*15000Nigerian naira

Source1

{
  "resourceType": "Claim",
  "id": "NgClaim-001",
  "meta": {
    "profile": [
      "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-claim"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "identifier": [
    {
      "system": "https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry",
      "value": "CLM-2025-0001"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "pharmacy"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/NgPatient-002"
  },
  "created": "2025-11-04T12:30:00Z",
  "provider": {
    "reference": "Organization/00134455-e5f6-4789-a123-456789abcdef"
  },
  "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": "Practitioner/NgPractitioner-002"
    }
  },
  "insurance": [
    {
      "sequence": 654,
      "focal": true,
      "identifier": {
        "system": "https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry",
        "value": "NHIA-0011223344"
      },
      "coverage": {
        "reference": "Coverage/NgCoverage-001"
      },
      "businessArrangement": "NHIA-PlanA-2025",
      "preAuthRef": [
        "PA-2025-ABC123"
      ]
    }
  ],
  "item": [
    {
      "sequence": 1,
      "diagnosisSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
            "code": "1101"
          }
        ]
      },
      "quantity": {
        "value": 30
      },
      "unitPrice": {
        "value": 500,
        "currency": "NGN"
      },
      "net": {
        "value": 15000,
        "currency": "NGN"
      }
    }
  ],
  "total": {
    "value": 15000,
    "currency": "NGN"
  }
}