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

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: Claim001 - JSON Representation

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{
  "resourceType" : "Claim",
  "id" : "Claim001",
  "meta" : {
    "profile" : [
      "https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/openimis-claim"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<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>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/openimis-identifiers",
            "code" : "Code"
          }
        ]
      },
      "value" : "Code001"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-visit-type",
        "code" : "O",
        "display" : "Other"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/john-doe"
  },
  "billablePeriod" : {
    "start" : "2021-09-15",
    "end" : "2021-09-15"
  },
  "created" : "2021-09-16",
  "enterer" : {
    "reference" : "Practitioner/Rushila-Dani-CA"
  },
  "provider" : {
    "reference" : "Organization/RaptaDistrictHospital"
  },
  "priority" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
        "code" : "normal",
        "display" : "Normal"
      }
    ]
  },
  "supportingInfo" : [
    {
      "sequence" : 1,
      "category" : {
        "coding" : [
          {
            "system" : "https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category",
            "code" : "explanation"
          }
        ]
      },
      "valueString" : "The patient was complaining of head pain"
    }
  ],
  "diagnosis" : [
    {
      "sequence" : 1,
      "diagnosisCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/diagnosis-ICD10-level1",
            "code" : "G44",
            "display" : "Other headache syndromes"
          }
        ]
      }
    }
  ],
  "insurance" : [
    {
      "sequence" : 1,
      "focal" : true,
      "coverage" : {
        "reference" : "Coverage/JoeDoeCoverage"
      }
    }
  ],
  "item" : [
    {
      "extension" : [
        {
          "url" : "https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/claim-item-reference",
          "valueReference" : {
            "reference" : "ActivityDefinition/GeneralConsultationService"
          }
        }
      ],
      "sequence" : 1,
      "category" : {
        "coding" : [
          {
            "system" : "https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-item-category",
            "code" : "service",
            "display" : "Service"
          }
        ]
      },
      "productOrService" : {
        "text" : "General Consultation"
      },
      "quantity" : {
        "value" : 1
      },
      "unitPrice" : {
        "value" : 40,
        "currency" : "EUR"
      }
    },
    {
      "extension" : [
        {
          "url" : "https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/claim-item-reference",
          "valueReference" : {
            "reference" : "Medication/AspirinMedication"
          }
        }
      ],
      "sequence" : 2,
      "category" : {
        "coding" : [
          {
            "system" : "https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-item-category",
            "code" : "item",
            "display" : "Item"
          }
        ]
      },
      "productOrService" : {
        "text" : "ACETYLSALICYLIC ACID (ASPIRIN) TABS 300MG"
      },
      "quantity" : {
        "value" : 2
      },
      "unitPrice" : {
        "value" : 10,
        "currency" : "EUR"
      }
    }
  ],
  "total" : {
    "value" : 60,
    "currency" : "EUR"
  }
}