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Example Claim/760150 (XML)

Financial Management Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Raw XML (canonical form + also see XML Format Specification)

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Simple Pharmacy Service Claim (id = "760150")

<?xml version="1.0" encoding="UTF-8"?>

<Claim xmlns="http://hl7.org/fhir">
  <id value="760150"/> 

    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Pharmacy Claim</div> 

    <system value="http://happypharma.com/claim"/> 
    <value value="7612345"/> 

  <status value="active"/> 

      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/> 
      <code value="pharmacy"/> 

  <use value="claim"/> 

    <reference value="Patient/1"/> 

  <created value="2014-08-16"/> 

    <reference value="Organization/2"/> 

    <reference value="Organization/1"/> 

      <code value="stat"/> 

        <code value="provider"/> 

    <sequence value="1"/> 
      <reference value="Practitioner/example"/> 

    <sequence value="1"/> 
        <code value="654456"/> 

    <sequence value="1"/> 
    <focal value="true"/> 
      <reference value="Coverage/9876B1"/> 

    <sequence value="1"/> 
    <careTeamSequence value="1"/> 
        <system value="http://hl7.org/fhir/ex-pharmaservice"/> 
        <code value="smokecess"/>    <!--   smoking cessation consult   -->
    <servicedDate value="2014-08-16"/> 
      <value value="60.00"/> 
      <currency value="USD"/>  
      <value value="60.00"/> 
      <currency value="USD"/>  


Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.