0.1.0 - ci-build
kenyaClaimsIG - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
{
"resourceType" : "Claim",
"id" : "ClaimProfileExample",
"meta" : {
"profile" : [
🔗 "https://shr.tiberbuapps.com/fhir/StructureDefinition/ClaimProfile"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim ClaimProfileExample</b></p><a name=\"ClaimProfileExample\"> </a><a name=\"hcClaimProfileExample\"> </a><a name=\"ClaimProfileExample-en-US\"> </a><p><b>identifier</b>: <code>http://example.org/fhir/claims</code>/123456</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>subType</b>: <span title=\"Codes:{http://example.org/fhir/claim-subtypes emergency}\">emergency</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-SHAPatientExample.html\">Eliud Kipchoge Kiptun Male, DoB: 1984-11-05 ( Unique Patient Identifier: 123456\u00a0(use:\u00a0official,\u00a0))</a></p><p><b>billablePeriod</b>: 2023-01-01 --> 2023-01-31</p><p><b>created</b>: 2023-02-01</p><p><b>insurer</b>: <a href=\"Organization-SHAOrganizationExample.html\">Organization Kenyatta National Hospital</a></p><p><b>provider</b>: <a href=\"Practitioner-PractitionerExample.html\">Practitioner John Doe </a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Relateds</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Claim</b></td><td><b>Relationship</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Claim-ClaimExample.html\">Claim: status = active; type = Professional; use = claim; created = 2020-06-15; priority = Normal</a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-claimrelationship associated}\">associated</span></td></tr></table><p><b>prescription</b>: <a href=\"MedicationRequest-MedicationRequestExample.html\">MedicationRequest: status = active; intent = order; medication[x] = ->Medication Codeine phosphate</a></p><p><b>originalPrescription</b>: <a href=\"MedicationRequest-MedicationRequestExample.html\">MedicationRequest: status = active; intent = order; medication[x] = ->Medication Codeine phosphate</a></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td></tr></table><p><b>referral</b>: <a href=\"ServiceRequest-ServiceRequestExample.html\">ServiceRequest: status = active; intent = order</a></p><p><b>facility</b>: <a href=\"Location-LocationExample.html\">Location Kenya Medical Research Institute</a></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-PractitionerExample.html\">Practitioner John Doe </a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claimcareteamrole primary}\">Primary provider</span></td></tr></table><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Code</b></td><td><b>Timing[x]</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claiminformationcategory info}\">Information</span></td><td><span title=\"Codes:{http://example.org/fhir/supporting-info additional-info}\">additional-info</span></td><td>2023-01-15</td><td>Supporting information value</td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 I}\">DIAG-1a</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/diagnosis-type principal}\">principal</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td><td><b>ClaimResponse</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"CoverageExample\">CoverageExample</a></td><td><a href=\"ClaimResponse-ClaimResponseExample.html\">ClaimResponse: status = active; type = Professional; use = claim; created = 2020-06-15; outcome = complete</a></td></tr></table><h3>Accidents</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Date</b></td><td><b>Type</b></td><td><b>Location[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>2023-01-20</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode MVA}\">MVA</span></td><td>1234 Elm Street, Somewhere, ST 12345</td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/item-codes exam}\">exam</span></p><p><b>serviced</b>: 2023-01-21</p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td></tr></table><p><b>udi</b>: <a href=\"Device-DeviceExample.html\">Device: status = active</a></p><p><b>bodySite</b>: <span title=\"Codes:{http://example.org/fhir/bodysites forehead}\">forehead</span></p><p><b>subSite</b>: <span title=\"Codes:{http://example.org/fhir/subsites left}\">left</span></p><blockquote><p><b>detail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/item-detail-codes service}\">service</span></p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>50</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>50</td></tr></table><p><b>udi</b>: <a href=\"Device-DeviceExample.html\">Device: status = active</a></p><blockquote><p><b>subDetail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/billings Billing}\">Billing</span></p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>25</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>25</td></tr></table><p><b>udi</b>: <a href=\"Device-DeviceExample.html\">Device: status = active</a></p></blockquote></blockquote></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>175</td></tr></table></div>"
},
"identifier" : [
{
"system" : "http://example.org/fhir/claims",
"value" : "123456"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "institutional"
}
]
},
"subType" : {
"coding" : [
{
"system" : "http://example.org/fhir/claim-subtypes",
"code" : "emergency"
}
]
},
"use" : "claim",
"patient" : {
🔗 "reference" : "Patient/SHAPatientExample"
},
"billablePeriod" : {
"start" : "2023-01-01",
"end" : "2023-01-31"
},
"created" : "2023-02-01",
"insurer" : {
🔗 "reference" : "Organization/SHAOrganizationExample"
},
"provider" : {
🔗 "reference" : "Practitioner/PractitionerExample"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"related" : [
{
"claim" : {
🔗 "reference" : "Claim/ClaimExample"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-claimrelationship",
"code" : "associated"
}
]
}
}
],
"prescription" : {
🔗 "reference" : "MedicationRequest/MedicationRequestExample"
},
"originalPrescription" : {
🔗 "reference" : "MedicationRequest/MedicationRequestExample"
},
"payee" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider"
}
]
}
},
"referral" : {
🔗 "reference" : "ServiceRequest/ServiceRequestExample"
},
"facility" : {
🔗 "reference" : "Location/LocationExample"
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
🔗 "reference" : "Practitioner/PractitionerExample"
},
"role" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code" : "primary"
}
]
}
}
],
"supportingInfo" : [
{
"sequence" : 1,
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code" : "info"
}
]
},
"code" : {
"coding" : [
{
"system" : "http://example.org/fhir/supporting-info",
"code" : "additional-info"
}
]
},
"timingDate" : "2023-01-15",
"valueString" : "Supporting information value"
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10",
"code" : "I",
"display" : "Certain infectious and parasitic diseases"
}
],
"text" : "DIAG-1a"
},
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/diagnosis-type",
"code" : "principal"
}
]
}
]
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "CoverageExample"
},
"claimResponse" : {
🔗 "reference" : "ClaimResponse/ClaimResponseExample"
}
}
],
"accident" : {
"date" : "2023-01-20",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode",
"code" : "MVA"
}
]
},
"locationAddress" : {
"text" : "1234 Elm Street, Somewhere, ST 12345"
}
},
"item" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/item-codes",
"code" : "exam"
}
]
},
"servicedDate" : "2023-01-21",
"quantity" : {
"value" : 1
},
"unitPrice" : {
"value" : 100
},
"net" : {
"value" : 100
},
"udi" : [
{
🔗 "reference" : "Device/DeviceExample"
}
],
"bodySite" : {
"coding" : [
{
"system" : "http://example.org/fhir/bodysites",
"code" : "forehead"
}
]
},
"subSite" : [
{
"coding" : [
{
"system" : "http://example.org/fhir/subsites",
"code" : "left"
}
]
}
],
"detail" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/item-detail-codes",
"code" : "service"
}
]
},
"quantity" : {
"value" : 1
},
"unitPrice" : {
"value" : 50
},
"net" : {
"value" : 50
},
"udi" : [
{
🔗 "reference" : "Device/DeviceExample"
}
],
"subDetail" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/billings",
"code" : "Billing"
}
]
},
"quantity" : {
"value" : 1
},
"unitPrice" : {
"value" : 25
},
"net" : {
"value" : 25
},
"udi" : [
{
🔗 "reference" : "Device/DeviceExample"
}
]
}
]
}
]
}
],
"total" : {
"value" : 175
}
}