Generated Narrative: Claim ClaimProfileExample
identifier: http://example.org/fhir/claims
/123456
status: Active
type: Institutional
subType: emergency
use: Claim
patient: Eliud Kipchoge Kiptun Male, DoB: 1984-11-05 ( Unique Patient Identifier: 123456 (use: official, ))
billablePeriod: 2023-01-01 --> 2023-01-31
created: 2023-02-01
insurer: Organization Kenyatta National Hospital
provider: Practitioner John Doe
priority: Normal
- | Claim | Relationship |
* | Claim: status = active; type = Professional; use = claim; created = 2020-06-15; priority = Normal | associated |
prescription: MedicationRequest: status = active; intent = order; medication[x] = ->Medication Codeine phosphate
originalPrescription: MedicationRequest: status = active; intent = order; medication[x] = ->Medication Codeine phosphate
- | Type |
* | Provider |
referral: ServiceRequest: status = active; intent = order
facility: Location Kenya Medical Research Institute
- | Sequence | Provider | Role |
* | 1 | Practitioner John Doe | Primary provider |
- | Sequence | Category | Code | Timing[x] | Value[x] |
* | 1 | Information | additional-info | 2023-01-15 | Supporting information value |
- | Sequence | Diagnosis[x] | Type |
* | 1 | DIAG-1a | principal |
- | Sequence | Focal | Coverage | ClaimResponse |
* | 1 | true | CoverageExample | ClaimResponse: status = active; type = Professional; use = claim; created = 2020-06-15; outcome = complete |
- | Date | Type | Location[x] |
* | 2023-01-20 | MVA | 1234 Elm Street, Somewhere, ST 12345 |
item
sequence: 1
productOrService: exam
serviced: 2023-01-21
quantity: 1
UnitPrices
- Value * 100 Nets
- Value * 100 bodySite: forehead
subSite: left
detail
sequence: 1
productOrService: service
quantity: 1
UnitPrices
- Value * 50 Nets
- Value * 50 subDetail
sequence: 1
productOrService: Billing
quantity: 1
UnitPrices
- Value * 25 Nets
- Value * 25
- | Value |
* | 175 |