openIMIS FHIR R4 Implementation Guide - Local Development build (v1.0.0). See the Directory of published versions

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: Claim001 - XML Representation

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<Claim xmlns="http://hl7.org/fhir">
  <id value="Claim001"/>
  <meta>
    <profile
             value="https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/openimis-claim"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource "Claim001" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-openimis-claim.html">openIMIS Claim</a></p></div><p><b>identifier</b>: Unique code: Code001</p><p><b>status</b>: active</p><p><b>type</b>: Other <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-claim-visit-type.html">Visit Type (Claim)</a>#O)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href="Patient-john-doe.html">Patient/john-doe</a> " DOE"</p><p><b>billablePeriod</b>: 2021-09-15 --&gt; 2021-09-15</p><p><b>created</b>: 2021-09-16</p><p><b>enterer</b>: <a href="Practitioner-Rushila-Dani-CA.html">Practitioner/Rushila-Dani-CA</a> " RUSHILA"</p><p><b>provider</b>: <a href="Organization-RaptaDistrictHospital.html">Organization/RaptaDistrictHospital</a> "Rapta District Hospital"</p><p><b>priority</b>: Normal <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.1.0/CodeSystem-processpriority.html">Process Priority Codes</a>#normal)</span></p><h3>SupportingInfos</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>1</td><td>Explanation <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-claim-supporting-info-category.html">Category of the supporting info (Claim)</a>#explanation)</span></td><td>The patient was complaining of head pain</td></tr></table><h3>Diagnoses</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td>*</td><td>1</td><td>Other headache syndromes <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-diagnosis-ICD10-level1.html">ICD 10 Level 1 diagnosis (Claim)</a>#G44)</span></td></tr></table><h3>Insurances</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><a href="Coverage-JoeDoeCoverage.html">Coverage/JoeDoeCoverage</a></td></tr></table><blockquote><p><b>item</b></p><p><b>Item Reference (Claim)</b>: <a href="ActivityDefinition-GeneralConsultationService.html">ActivityDefinition/GeneralConsultationService</a> "A1"</p><p><b>sequence</b>: 1</p><p><b>category</b>: Service <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-claim-item-category.html">Category of the item (Claim)</a>#service)</span></p><p><b>productOrService</b>: General Consultation <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>quantity</b>: 1</p></blockquote><blockquote><p><b>item</b></p><p><b>Item Reference (Claim)</b>: <a href="Medication-AspirinMedication.html">Medication/AspirinMedication</a></p><p><b>sequence</b>: 2</p><p><b>category</b>: Item <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-claim-item-category.html">Category of the item (Claim)</a>#item)</span></p><p><b>productOrService</b>: ACETYLSALICYLIC ACID (ASPIRIN) TABS 300MG <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>quantity</b>: 2</p></blockquote></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system
                value="https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/openimis-identifiers"/>
        <code value="Code"/>
      </coding>
    </type>
    <value value="Code001"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system
              value="https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-visit-type"/>
      <code value="O"/>
      <display value="Other"/>
    </coding>
  </type>
  <use value="claim"/>
  <patient>
    <reference value="Patient/john-doe"/>
  </patient>
  <billablePeriod>
    <start value="2021-09-15"/>
    <end value="2021-09-15"/>
  </billablePeriod>
  <created value="2021-09-16"/>
  <enterer>
    <reference value="Practitioner/Rushila-Dani-CA"/>
  </enterer>
  <provider>
    <reference value="Organization/RaptaDistrictHospital"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="normal"/>
      <display value="Normal"/>
    </coding>
  </priority>
  <supportingInfo>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category"/>
        <code value="explanation"/>
      </coding>
    </category>
    <valueString value="The patient was complaining of head pain"/>
  </supportingInfo>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <system
                value="https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/diagnosis-ICD10-level1"/>
        <code value="G44"/>
        <display value="Other headache syndromes"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/JoeDoeCoverage"/>
    </coverage>
  </insurance>
  <item>
    <extension
               url="https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/claim-item-reference">
      <valueReference>
        <reference value="ActivityDefinition/GeneralConsultationService"/>
      </valueReference>
    </extension>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-item-category"/>
        <code value="service"/>
        <display value="Service"/>
      </coding>
    </category>
    <productOrService>
      <text value="General Consultation"/>
    </productOrService>
    <quantity>
      <value value="1"/>
    </quantity>
    <unitPrice>
      <value value="40"/>
      <currency value="EUR"/>
    </unitPrice>
  </item>
  <item>
    <extension
               url="https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/claim-item-reference">
      <valueReference>
        <reference value="Medication/AspirinMedication"/>
      </valueReference>
    </extension>
    <sequence value="2"/>
    <category>
      <coding>
        <system
                value="https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-item-category"/>
        <code value="item"/>
        <display value="Item"/>
      </coding>
    </category>
    <productOrService>
      <text value="ACETYLSALICYLIC ACID (ASPIRIN) TABS 300MG"/>
    </productOrService>
    <quantity>
      <value value="2"/>
    </quantity>
    <unitPrice>
      <value value="10"/>
      <currency value="EUR"/>
    </unitPrice>
  </item>
  <total>
    <value value="60"/>
    <currency value="EUR"/>
  </total>
</Claim>