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
<Claim xmlns="http://hl7.org/fhir">
<id value="ClaimProfileExample"/>
<meta>
<profile
value="https://shr.tiberbuapps.com/fhir/StructureDefinition/ClaimProfile"/>
</meta>
<text>
<status value="generated"/>
<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 (use: official, ))</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>
</text>
<identifier>
<system value="http://example.org/fhir/claims"/>
<value value="123456"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="institutional"/>
</coding>
</type>
<subType>
<coding>
<system value="http://example.org/fhir/claim-subtypes"/>
<code value="emergency"/>
</coding>
</subType>
<use value="claim"/>
<patient>🔗
<reference value="Patient/SHAPatientExample"/>
</patient>
<billablePeriod>
<start value="2023-01-01"/>
<end value="2023-01-31"/>
</billablePeriod>
<created value="2023-02-01"/>
<insurer>🔗
<reference value="Organization/SHAOrganizationExample"/>
</insurer>
<provider>🔗
<reference value="Practitioner/PractitionerExample"/>
</provider>
<priority>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
<code value="normal"/>
</coding>
</priority>
<related>
<claim>🔗
<reference value="Claim/ClaimExample"/>
</claim>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/ex-claimrelationship"/>
<code value="associated"/>
</coding>
</relationship>
</related>
<prescription>🔗
<reference value="MedicationRequest/MedicationRequestExample"/>
</prescription>
<originalPrescription>🔗
<reference value="MedicationRequest/MedicationRequestExample"/>
</originalPrescription>
<payee>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/payeetype"/>
<code value="provider"/>
</coding>
</type>
</payee>
<referral>🔗
<reference value="ServiceRequest/ServiceRequestExample"/>
</referral>
<facility>🔗
<reference value="Location/LocationExample"/>
</facility>
<careTeam>
<sequence value="1"/>
<provider>🔗
<reference value="Practitioner/PractitionerExample"/>
</provider>
<role>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claimcareteamrole"/>
<code value="primary"/>
</coding>
</role>
</careTeam>
<supportingInfo>
<sequence value="1"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
<code value="info"/>
</coding>
</category>
<code>
<coding>
<system value="http://example.org/fhir/supporting-info"/>
<code value="additional-info"/>
</coding>
</code>
<timingDate value="2023-01-15"/>
<valueString value="Supporting information value"/>
</supportingInfo>
<diagnosis>
<sequence value="1"/>
<diagnosisCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/sid/icd-10"/>
<code value="I"/>
<display value="Certain infectious and parasitic diseases"/>
</coding>
<text value="DIAG-1a"/>
</diagnosisCodeableConcept>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/diagnosis-type"/>
<code value="principal"/>
</coding>
</type>
</diagnosis>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>
<reference value="CoverageExample"/>
</coverage>
<claimResponse>🔗
<reference value="ClaimResponse/ClaimResponseExample"/>
</claimResponse>
</insurance>
<accident>
<date value="2023-01-20"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode"/>
<code value="MVA"/>
</coding>
</type>
<locationAddress>
<text value="1234 Elm Street, Somewhere, ST 12345"/>
</locationAddress>
</accident>
<item>
<sequence value="1"/>
<productOrService>
<coding>
<system value="http://example.org/fhir/item-codes"/>
<code value="exam"/>
</coding>
</productOrService>
<servicedDate value="2023-01-21"/>
<quantity>
<value value="1"/>
</quantity>
<unitPrice>
<value value="100"/>
</unitPrice>
<net>
<value value="100"/>
</net>
<udi>🔗
<reference value="Device/DeviceExample"/>
</udi>
<bodySite>
<coding>
<system value="http://example.org/fhir/bodysites"/>
<code value="forehead"/>
</coding>
</bodySite>
<subSite>
<coding>
<system value="http://example.org/fhir/subsites"/>
<code value="left"/>
</coding>
</subSite>
<detail>
<sequence value="1"/>
<productOrService>
<coding>
<system value="http://example.org/fhir/item-detail-codes"/>
<code value="service"/>
</coding>
</productOrService>
<quantity>
<value value="1"/>
</quantity>
<unitPrice>
<value value="50"/>
</unitPrice>
<net>
<value value="50"/>
</net>
<udi>🔗
<reference value="Device/DeviceExample"/>
</udi>
<subDetail>
<sequence value="1"/>
<productOrService>
<coding>
<system value="http://example.org/fhir/billings"/>
<code value="Billing"/>
</coding>
</productOrService>
<quantity>
<value value="1"/>
</quantity>
<unitPrice>
<value value="25"/>
</unitPrice>
<net>
<value value="25"/>
</net>
<udi>🔗
<reference value="Device/DeviceExample"/>
</udi>
</subDetail>
</detail>
</item>
<total>
<value value="175"/>
</total>
</Claim>