a fhir:Claim;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "100156"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "A human-readable rendering of the Oral Health Claim
"
];
fhir:DomainResource.contained [
a fhir:Device;
fhir:index 0;
fhir:Resource.id [ fhir:value "device-bridge" ]
], [
a fhir:ServiceRequest;
fhir:index 1;
fhir:Resource.id [ fhir:value "referral" ];
fhir:ServiceRequest.status [ fhir:value "active" ];
fhir:ServiceRequest.intent [ fhir:value "order" ];
fhir:ServiceRequest.subject [
fhir:link ;
fhir:Reference.reference [ fhir:value "Patient/1" ]
]
];
fhir:Claim.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://happyvalley.com/claim" ];
fhir:Identifier.value [ fhir:value "123466" ]
];
fhir:Claim.status [ fhir:value "active"];
fhir:Claim.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
fhir:Coding.code [ fhir:value "oral" ]
]
];
fhir:Claim.use [ fhir:value "claim"];
fhir:Claim.patient [
fhir:link ;
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:Claim.created [ fhir:value "2014-08-16"^^xsd:date];
fhir:Claim.insurer [
fhir:link ;
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:Claim.provider [
fhir:link ;
fhir:Reference.reference [ fhir:value "Organization/1" ]
];
fhir:Claim.priority [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "normal" ]
]
];
fhir:Claim.related [
fhir:index 0;
fhir:Claim.related.claim [
fhir:link ;
fhir:Reference.reference [ fhir:value "Claim/100151" ]
];
fhir:Claim.related.relationship [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship" ];
fhir:Coding.code [ fhir:value "associated" ]
]
];
fhir:Claim.related.reference [
fhir:Identifier.value [ fhir:value "CASE156746B" ]
]
];
fhir:Claim.payee [
fhir:Claim.payee.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payeetype" ];
fhir:Coding.code [ fhir:value "other" ]
]
];
fhir:Claim.payee.party [
fhir:link ;
fhir:Reference.reference [ fhir:value "RelatedPerson/peter" ]
]
];
fhir:Claim.referral [
fhir:Reference.reference [ fhir:value "#referral" ]
];
fhir:Claim.careTeam [
fhir:index 0;
fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.careTeam.provider [
fhir:link ;
fhir:Reference.reference [ fhir:value "Practitioner/example" ]
]
];
fhir:Claim.supportingInfo [
fhir:index 0;
fhir:Claim.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "prosthesis" ]
]
];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ex-oralprostho" ];
fhir:Coding.code [ fhir:value "2" ];
fhir:Coding.display [ fhir:value "Maryland Bridge" ]
]
];
fhir:Claim.supportingInfo.timingDate [ fhir:value "2001-04-07"^^xsd:date ]
];
fhir:Claim.procedure [
fhir:index 0;
fhir:Claim.procedure.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.procedure.date [ fhir:value "2014-07-04"^^xsd:date ];
fhir:Claim.procedure.procedureCodeableConcept [
fhir:CodeableConcept.text [ fhir:value "Resection of gum to increase exposed tooth." ]
]
];
fhir:Claim.insurance [
fhir:index 0;
fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
fhir:Claim.insurance.coverage [
fhir:link ;
fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]
]
];
fhir:Claim.item [
fhir:index 0;
fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.item.careTeamSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0
];
fhir:Claim.item.informationSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0
];
fhir:Claim.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
fhir:Coding.code [ fhir:value "67221" ];
fhir:Coding.display [ fhir:value "Maryland Bridge" ]
]
];
fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
fhir:Claim.item.locationCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace" ];
fhir:Coding.code [ fhir:value "11" ]
]
];
fhir:Claim.item.unitPrice [
fhir:Money.value [ fhir:value "1400.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.factor [ fhir:value "0.75"^^xsd:decimal ];
fhir:Claim.item.net [
fhir:Money.value [ fhir:value "1050.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.udi [
fhir:index 0;
fhir:Reference.reference [ fhir:value "#device-bridge" ]
];
fhir:Claim.item.bodySite [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ];
fhir:Coding.code [ fhir:value "01" ]
]
]
], [
fhir:index 1;
fhir:Claim.item.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.item.careTeamSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0
];
fhir:Claim.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
fhir:Coding.code [ fhir:value "21211" ]
]
];
fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
fhir:Claim.item.locationCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace" ];
fhir:Coding.code [ fhir:value "11" ]
]
];
fhir:Claim.item.unitPrice [
fhir:Money.value [ fhir:value "105.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.net [
fhir:Money.value [ fhir:value "105.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.bodySite [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ];
fhir:Coding.code [ fhir:value "21" ]
]
];
fhir:Claim.item.subSite [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oralsurfacecodes" ];
fhir:Coding.code [ fhir:value "L" ]
]
]
], [
fhir:index 2;
fhir:Claim.item.sequence [ fhir:value "3"^^xsd:positiveInteger ];
fhir:Claim.item.careTeamSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0
];
fhir:Claim.item.procedureSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0
];
fhir:Claim.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
fhir:Coding.code [ fhir:value "27211" ]
]
];
fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
fhir:Claim.item.locationCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace" ];
fhir:Coding.code [ fhir:value "11" ]
]
];
fhir:Claim.item.unitPrice [
fhir:Money.value [ fhir:value "1100.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.net [
fhir:Money.value [ fhir:value "1100.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.bodySite [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ];
fhir:Coding.code [ fhir:value "24" ]
]
];
fhir:Claim.item.detail [
fhir:index 0;
fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.item.detail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
fhir:Coding.code [ fhir:value "27211" ]
]
];
fhir:Claim.item.detail.unitPrice [
fhir:Money.value [ fhir:value "1000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.factor [ fhir:value "0.75"^^xsd:decimal ];
fhir:Claim.item.detail.net [
fhir:Money.value [ fhir:value "750.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 1;
fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.item.detail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
fhir:Coding.code [ fhir:value "lab" ]
]
];
fhir:Claim.item.detail.unitPrice [
fhir:Money.value [ fhir:value "350.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.net [
fhir:Money.value [ fhir:value "350.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
]
];
fhir:Claim.total [
fhir:Money.value [ fhir:value "2255.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
] .
a fhir:Patient .
a fhir:Organization .
a fhir:Organization .
a fhir:Claim .
a fhir:RelatedPerson .
a fhir:Practitioner .
a fhir:Coverage .
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI .
# -------------------------------------------------------------------------------------