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-01

Page standards status: Informative

Raw json | Download

    {
      "resourceType" : "Claim",
      "id" : "rtpbc-claim-01",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim"
        ]
      },
      "language" : "en",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: Claim rtpbc-claim-01</b></p><a name=\"rtpbc-claim-01\"> </a><a name=\"hcrtpbc-claim-01\"> </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.html\">RTPBC Request Using Claim</a></p></div><p><b>identifier</b>: rtpbc-01</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>: <a href=\"Patient-rtpbc-patient-01.html\">Jane Doe  Female, DoB: 1975-12-05 ( Patient internal identifier:\u00a030455)</a></p><p><b>created</b>: 2019-11-01 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><p><b>prescription</b>: <a href=\"MedicationRequest-rtpbc-medicationrequest-01.html\">MedicationRequest: status = draft; intent = proposal; reported[x] = true; medication[x] = fluoxetine 10 MG Oral Capsule [Prozac]; authoredOn = 2019-11-01</a></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-rtpbc-practitioner-01.html\">Practitioner Johnson </a></td></tr></table><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>true</td><td><a href=\"Coverage-rtpbc-coverage-01.html\">Coverage: status = active; subscriberId = 121212; relationship = Self</a></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>ProductOrService</b></td><td><b>Quantity</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>1</td><td><span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 205535}\">fluoxetine 10 MG Oral Capsule [Prozac]</span></td><td>60 {Each}</td></tr></table></div>"
      },
      "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}"
          }
        }
      ]
    }