Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot

Consumer Real-Time Pharmacy Benefit Check FHIR IG, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-rtpbc/ and changes regularly. See the Directory of published versions

## : rtpbc-claim-non-phi-2

Page standards status: Informative

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    <Claim xmlns="http://hl7.org/fhir">
      <id value="rtpbc-claim-non-phi-2"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim-non-phi"/>
      </meta>
      <language value="en"/>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"><p class="res-header-id"><b>Generated Narrative: Claim rtpbc-claim-non-phi-2</b></p><a name="rtpbc-claim-non-phi-2"> </a><a name="hcrtpbc-claim-non-phi-2"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Language: en</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-request-claim-non-phi.html">RTPBC Request Using Claim - Non-PHI</a></p></div><p><b>identifier</b>: rtpbc-claim-non-phi-2</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}">Pharmacy</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: ?rref?</p><p><b>created</b>: 2025-11-01 11:20:54-0500</p><p><b>provider</b>: <a href="Organization-rtpbc-organization-01.html">Organization Hometown Drug</a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><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></tr><tr><td style="display: none">*</td><td>1</td><td>false</td><td>?rref?</td></tr></table><h3>Items</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>ProductOrService</b></td><td><b>Quantity</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 205535}">Prozac 10mg Capsule</span></td><td>60 {Each}</td></tr></table></div>
      </text>
      <identifier>
        <value value="rtpbc-claim-non-phi-2"/>
      </identifier>
      <status value="active"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
          <code value="pharmacy"/>
          <display value="Pharmacy"/>
        </coding>
      </type>
      <use value="predetermination"/>
      <patient>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
          <valueCode value="masked"/>
        </extension>
      </patient>
      <created value="2025-11-01T11:20:54-05:00"/>
      <provider>🔗
        <reference value="Organization/rtpbc-organization-01"/>
      </provider>
      <priority>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
          <code value="normal"/>
          <display value="Normal"/>
        </coding>
      </priority>
      <insurance>
        <sequence value="1"/>
        <focal value="false"/>
        <coverage>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
            <valueCode value="masked"/>
          </extension>
        </coverage>
      </insurance>
      <item>
        <sequence value="1"/>
        <productOrService>
          <coding>
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
            <code value="205535"/>
            <display value="fluoxetine 10 MG Oral Capsule [Prozac]"/>
          </coding>
          <text value="Prozac 10mg Capsule"/>
        </productOrService>
        <quantity>
          <value value="60"/>
          <unit value="{Each}"/>
        </quantity>
      </item>
    </Claim>