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

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: rtpbc-claim-non-phi-1

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{
  "resourceType" : "Claim",
  "id" : "rtpbc-claim-non-phi-1",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim-non-phi"
    ]
  },
  "language" : "en",
  "text" : {
    "status" : "extensions",
    "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-non-phi-1</b></p><a name=\"rtpbc-claim-non-phi-1\"> </a><a name=\"hcrtpbc-claim-non-phi-1\"> </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-non-phi-1</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>: Pharmacies in ZIP Code 55401 (Preferred pharmacy postal code: 55401)</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>"
  },
  "identifier" : [
    {
      "value" : "rtpbc-non-phi-1"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "pharmacy",
        "display" : "Pharmacy"
      }
    ]
  },
  "use" : "predetermination",
  "patient" : {
    "extension" : [
      {
        "url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
        "valueCode" : "masked"
      }
    ]
  },
  "created" : "2025-11-01T11:20:54-05:00",
  "provider" : {
    "extension" : [
      {
        "url" : "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferredPharmacyPostalCode",
        "valueString" : "55401"
      }
    ],
    "display" : "Pharmacies in ZIP Code 55401"
  },
  "priority" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
        "code" : "normal",
        "display" : "Normal"
      }
    ]
  },
  "insurance" : [
    {
      "sequence" : 1,
      "focal" : false,
      "coverage" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
            "valueCode" : "masked"
          }
        ]
      }
    }
  ],
  "item" : [
    {
      "sequence" : 1,
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
            "code" : "205535",
            "display" : "fluoxetine 10 MG Oral Capsule [Prozac]"
          }
        ],
        "text" : "Prozac 10mg Capsule"
      },
      "quantity" : {
        "value" : 60,
        "unit" : "{Each}"
      }
    }
  ]
}