# rtpbc-claim-01 - Consumer Real-Time Pharmacy Benefit Check FHIR IG v2.0.0-ballot

## Example Claim: rtpbc-claim-01

Language: en

Profile: [RTPBC Request Using Claim](StructureDefinition-rtpbc-request-claim.md)

**identifier**: rtpbc-01

**status**: Active

**type**: Pharmacy

**use**: Predetermination

**patient**: [Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)](Patient-rtpbc-patient-01.md)

**created**: 2019-11-01 11:20:54-0500

**provider**: [Organization Hometown Drug](Organization-rtpbc-organization-01.md)

**priority**: Normal

**prescription**: [MedicationRequest: status = draft; intent = proposal; reported[x] = true; medication[x] = fluoxetine 10 MG Oral Capsule [Prozac]; authoredOn = 2019-11-01](MedicationRequest-rtpbc-medicationrequest-01.md)

### CareTeams

| | | |
| :--- | :--- | :--- |
| - | **Sequence** | **Provider** |
| * | 1 | [Practitioner Johnson ](Practitioner-rtpbc-practitioner-01.md) |

### Insurances

| | | | |
| :--- | :--- | :--- | :--- |
| - | **Sequence** | **Focal** | **Coverage** |
| * | 1 | true | [Coverage: status = active; subscriberId = 121212; relationship = Self](Coverage-rtpbc-coverage-01.md) |

### Items

| | | | | |
| :--- | :--- | :--- | :--- | :--- |
| - | **Sequence** | **CareTeamSequence** | **ProductOrService** | **Quantity** |
| * | 1 | 1 | fluoxetine 10 MG Oral Capsule [Prozac] | 60 {Each} |



## Resource Content

```json
{
  "resourceType" : "Claim",
  "id" : "rtpbc-claim-01",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim"]
  },
  "language" : "en",
  "identifier" : [{
    "value" : "rtpbc-01"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "pharmacy",
      "display" : "Pharmacy"
    }]
  },
  "use" : "predetermination",
  "patient" : {
    "reference" : "Patient/rtpbc-patient-01"
  },
  "created" : "2019-11-01T11:20:54-05:00",
  "provider" : {
    "reference" : "Organization/rtpbc-organization-01"
  },
  "priority" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
      "code" : "normal",
      "display" : "Normal"
    }]
  },
  "prescription" : {
    "reference" : "MedicationRequest/rtpbc-medicationrequest-01"
  },
  "careTeam" : [{
    "sequence" : 1,
    "provider" : {
      "reference" : "Practitioner/rtpbc-practitioner-01"
    }
  }],
  "insurance" : [{
    "sequence" : 1,
    "focal" : true,
    "coverage" : {
      "reference" : "Coverage/rtpbc-coverage-01"
    }
  }],
  "item" : [{
    "sequence" : 1,
    "careTeamSequence" : [1],
    "productOrService" : {
      "coding" : [{
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "205535",
        "display" : "fluoxetine 10 MG Oral Capsule [Prozac]"
      }]
    },
    "quantity" : {
      "value" : 60,
      "unit" : "{Each}"
    }
  }]
}

```
