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This is the Continuous Integration Build of FHIR (will be incorrect/inconsistent at times).
See the Directory of published versions

Example Claim/660152 (Turtle)

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

Raw Turtle (+ also see Turtle/RDF Format Specification)

Glasses Claim, 3 Tier, Secondary Coverage

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

[a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "660152"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Vision Claim for Glasses</div>"
  ] ; # 
  fhir:contained ( [
     a fhir:Device ;
     fhir:id [ fhir:v "device-frame" ]
  ] [
     a fhir:Device ;
     fhir:id [ fhir:v "device-lens" ]
  ] ) ; # 
  fhir:identifier ( [
     fhir:system [ fhir:v "http://happysight.com/claim"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "6612347" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "vision" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:patient [
     fhir:reference [ fhir:v "Patient/1" ]
  ] ; # 
  fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # 
  fhir:insurer [
     fhir:reference [ fhir:v "Organization/2" ]
  ] ; # 
  fhir:provider [
     fhir:reference [ fhir:v "Organization/1" ]
  ] ; # 
  fhir:priority [
     fhir:coding ( [
       fhir:code [ fhir:v "normal" ]
     ] )
  ] ; # 
  fhir:prescription [
     fhir:link <http://www.optdocs.com/prescription/12345> ;
     fhir:reference [ fhir:v "http://www.optdocs.com/prescription/12345" ]
  ] ; # 
  fhir:payee [
     fhir:type [
       fhir:coding ( [
         fhir:code [ fhir:v "provider" ]
       ] )
     ]
  ] ; # 
  fhir:careTeam ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:provider [
       fhir:reference [ fhir:v "Practitioner/example" ]
     ]
  ] ) ; # 
  fhir:diagnosis ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:code [ fhir:v "654321" ]
       ] )
     ]
  ] ) ; # 
  fhir:insurance ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; #   Patient's own coverage - primary  
     fhir:focal [ fhir:v "false"^^xsd:boolean ] ;
     fhir:coverage [
       fhir:reference [ fhir:v "Coverage/9876B1" ]
     ] ;
     fhir:preAuthRef ( [ fhir:v "PR7652387237" ] ) ;
     fhir:claimResponse [
       fhir:reference [ fhir:v "ClaimResponse/R3500" ]
     ]
  ] [
     fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; #   Spouses's own coverage - secondary  
     fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
     fhir:coverage [
       fhir:reference [ fhir:v "Coverage/9876B1" ]
     ] ;
     fhir:preAuthRef ( [ fhir:v "AB543GTD7567" ] )
  ] ) ; # 
  fhir:item ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:revenue [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "0010" ] ;
         fhir:display [ fhir:v "Vision Clinic" ]
       ] )
     ] ;
     fhir:category [
       fhir:coding ( [
         fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "F6" ] ;
         fhir:display [ fhir:v "Vision Coverage" ]
       ] )
     ] ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "glasses" ]
       ] )
     ] ;
     fhir:modifier ( [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/modifiers"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "rooh" ]
       ] )
     ] ) ;
     fhir:programCode ( [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-programcode"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "none" ]
       ] )
     ] ) ;
     fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
     fhir:unitPrice [
       fhir:value [ fhir:v "235.40"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:net [
       fhir:value [ fhir:v "235.40"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:detail ( [
       fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
       fhir:revenue [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "0010" ] ;
           fhir:display [ fhir:v "Vision Clinic" ]
         ] )
       ] ;
       fhir:category [
         fhir:coding ( [
           fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "F6" ] ;
           fhir:display [ fhir:v "Vision Coverage" ]
         ] )
       ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "frame" ]
         ] )
       ] ;
       fhir:modifier ( [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/modifiers"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "rooh" ]
         ] )
       ] ) ;
       fhir:unitPrice [
         fhir:value [ fhir:v "100.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ;
       fhir:factor [ fhir:v "1.1"^^xsd:decimal ] ;
       fhir:net [
         fhir:value [ fhir:v "110.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ; #   10% surcharge for out of hours work  
       fhir:udi ( [
         fhir:reference [ fhir:v "#device-frame" ]
       ] )
     ] [
       fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
       fhir:revenue [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "0010" ] ;
           fhir:display [ fhir:v "Vision Clinic" ]
         ] )
       ] ;
       fhir:category [
         fhir:coding ( [
           fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "F6" ] ;
           fhir:display [ fhir:v "Vision Coverage" ]
         ] )
       ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "lens" ]
         ] )
       ] ;
       fhir:programCode ( [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-programcode"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "none" ]
         ] )
       ] ) ;
       fhir:quantity [
         fhir:value [ fhir:v "2"^^xsd:decimal ]
       ] ;
       fhir:unitPrice [
         fhir:value [ fhir:v "55.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ;
       fhir:net [
         fhir:value [ fhir:v "110.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ;
       fhir:subDetail ( [
         fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
         fhir:revenue [
           fhir:coding ( [
             fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "0010" ] ;
             fhir:display [ fhir:v "Vision Clinic" ]
           ] )
         ] ;
         fhir:category [
           fhir:coding ( [
             fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "F6" ] ;
             fhir:display [ fhir:v "Vision Coverage" ]
           ] )
         ] ;
         fhir:productOrService [
           fhir:coding ( [
             fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "lens" ]
           ] )
         ] ;
         fhir:modifier ( [
           fhir:coding ( [
             fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/modifiers"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "rooh" ]
           ] )
         ] ) ;
         fhir:programCode ( [
           fhir:coding ( [
             fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-programcode"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "none" ]
           ] )
         ] ) ;
         fhir:quantity [
           fhir:value [ fhir:v "2"^^xsd:decimal ]
         ] ;
         fhir:unitPrice [
           fhir:value [ fhir:v "30.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ] ;
         fhir:factor [ fhir:v "1.1"^^xsd:decimal ] ;
         fhir:net [
           fhir:value [ fhir:v "66.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ] ; #   10% surchage for out of hours work  
         fhir:udi ( [
           fhir:reference [ fhir:v "#device-lens" ]
         ] )
       ] [
         fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
         fhir:revenue [
           fhir:coding ( [
             fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "0010" ] ;
             fhir:display [ fhir:v "Vision Clinic" ]
           ] )
         ] ;
         fhir:category [
           fhir:coding ( [
             fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "F6" ] ;
             fhir:display [ fhir:v "Vision Coverage" ]
           ] )
         ] ;
         fhir:productOrService [
           fhir:coding ( [
             fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "hardening" ]
           ] )
         ] ;
         fhir:modifier ( [
           fhir:coding ( [
             fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/modifiers"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "rooh" ]
           ] )
         ] ) ;
         fhir:quantity [
           fhir:value [ fhir:v "2"^^xsd:decimal ]
         ] ;
         fhir:unitPrice [
           fhir:value [ fhir:v "15.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ] ;
         fhir:factor [ fhir:v "1.1"^^xsd:decimal ] ;
         fhir:net [
           fhir:value [ fhir:v "33.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ] #   10% surchage for out of hours work  
       ] [
         fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
         fhir:revenue [
           fhir:coding ( [
             fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "0010" ] ;
             fhir:display [ fhir:v "Vision Clinic" ]
           ] )
         ] ;
         fhir:category [
           fhir:coding ( [
             fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "F6" ] ;
             fhir:display [ fhir:v "Vision Coverage" ]
           ] )
         ] ;
         fhir:productOrService [
           fhir:coding ( [
             fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "UV coating" ]
           ] )
         ] ;
         fhir:modifier ( [
           fhir:coding ( [
             fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/modifiers"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "rooh" ]
           ] )
         ] ) ;
         fhir:quantity [
           fhir:value [ fhir:v "2"^^xsd:decimal ]
         ] ;
         fhir:unitPrice [
           fhir:value [ fhir:v "5.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ] ;
         fhir:factor [ fhir:v "1.1"^^xsd:decimal ] ;
         fhir:net [
           fhir:value [ fhir:v "11.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ] #   10% surchage for out of hours work  
       ] )
     ] [
       fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
       fhir:revenue [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "0010" ] ;
           fhir:display [ fhir:v "Vision Clinic" ]
         ] )
       ] ;
       fhir:category [
         fhir:coding ( [
           fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "F6" ] ;
           fhir:display [ fhir:v "Vision Coverage" ]
         ] )
       ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "fst" ]
         ] )
       ] ;
       fhir:unitPrice [
         fhir:value [ fhir:v "220.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ;
       fhir:factor [ fhir:v "0.07"^^xsd:decimal ] ;
       fhir:net [
         fhir:value [ fhir:v "15.40"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "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.