@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

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

<http://hl7.org/fhir/us/davinci-pct/Claim/PCT-GFE-Institutional-1> a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "PCT-GFE-Institutional-1"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional>
     ] )
  ] ; # 
  fhir:text [
     fhir:status [ fhir:v "extensions" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim PCT-GFE-Institutional-1</b></p><a name=\"PCT-GFE-Institutional-1\"> </a><a name=\"hcPCT-GFE-Institutional-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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-gfe-institutional.html\">PCT Good Faith Estimate Institutional</a></p></div><p><b>ProviderEventMethodology</b>: EEMM1021</p><p><b>GFEDisclaimer</b>: For estimation purposes only</p><blockquote><p><b>GFEServiceLinkingInfo</b></p><ul><li>linkingIdentifier: <code>http://example.org/Claim/identifiers</code>/223452-2342-2435-008001</li><li>plannedPeriodOfService: 2021-10-31</li></ul></blockquote><p><b>identifier</b>: Placer Identifier/GFEProviderAssignedID0001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>created</b>: 2021-10-05</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><p><b>provider</b>: <a href=\"Organization-Submitter-Org-1.html\">Organization GFE Service Help INC.</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td></tr></table><p><b>referral</b>: Referral Number</p><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType typeofbill}\">Type of Bill</span></td><td><span title=\"Codes:{https://www.nubc.org/CodeSystem/TypeOfBill 011X}\">Hospital Inpatient (Part A)</span></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td><td><b>PackageCode</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm S06.30}\">Unspecified focal traumatic brain injury</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/diagnosistype principal}\">Principal Diagnosis</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup 400}\">Head trauma - concussion</span></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-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --&gt; 2022-01-01</a></td></tr></table><blockquote><p><b>item</b></p><p><b>Service Description</b>: Imaging</p><p><b>sequence</b>: 1</p><p><b>revenue</b>: <span title=\"Codes:{https://www.nubc.org/CodeSystem/RevenueCodes 0611}\">Magnetic Resonance Technology (MRT) - Brain/brain stem</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 70551}\">Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material</span></p><p><b>modifier</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 70551}\">Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material</span></p><p><b>serviced</b>: 2021-10-31</p><p><b>quantity</b>: 1</p><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:extension ( [
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology>
     ] ;
     fhir:value [
       a fhir:String ;
       fhir:v "EEMM1021"
     ]
  ] [
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer>
     ] ;
     fhir:value [
       a fhir:String ;
       fhir:v "For estimation purposes only"
     ]
  ] [
     fhir:extension ( [
       fhir:url [
         fhir:v "linkingIdentifier"^^xsd:anyURI ;
         fhir:l fhir:linkingIdentifier
       ] ;
       fhir:value [
         a fhir:Identifier ;
         fhir:system [
           fhir:v "http://example.org/Claim/identifiers"^^xsd:anyURI ;
           fhir:l <http://example.org/Claim/identifiers>
         ] ;
         fhir:value [ fhir:v "223452-2342-2435-008001" ]
       ]
     ] [
       fhir:url [
         fhir:v "plannedPeriodOfService"^^xsd:anyURI ;
         fhir:l fhir:plannedPeriodOfService
       ] ;
       fhir:value [
         a fhir:Date ;
         fhir:v "2021-10-31"^^xsd:date
       ]
     ] ) ;
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo>
     ]
  ] ) ; # 
  fhir:identifier ( [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203>
         ] ;
         fhir:code [ fhir:v "PLAC" ] ;
         fhir:display [ fhir:v "Placer Identifier" ]
       ] )
     ] ;
     fhir:system [
       fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
       fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203>
     ] ;
     fhir:value [ fhir:v "GFEProviderAssignedID0001" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>
       ] ;
       fhir:code [ fhir:v "institutional" ] ;
       fhir:display [ fhir:v "Institutional" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "predetermination"] ; # 
  fhir:patient [
     fhir:l <http://hl7.org/fhir/us/davinci-pct/Patient/patient1001> ;
     fhir:reference [ fhir:v "Patient/patient1001" ]
  ] ; # 
  fhir:created [ fhir:v "2021-10-05"^^xsd:date] ; # 
  fhir:insurer [
     fhir:l <http://hl7.org/fhir/us/davinci-pct/Organization/org1001> ;
     fhir:reference [ fhir:v "Organization/org1001" ]
  ] ; # 
  fhir:provider [
     fhir:l <http://hl7.org/fhir/us/davinci-pct/Organization/Submitter-Org-1> ;
     fhir:extension ( [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "http://nucc.org/provider-taxonomy"^^xsd:anyURI ;
             fhir:l <http://nucc.org/provider-taxonomy>
           ] ;
           fhir:code [ fhir:v "2085D0003X" ] ;
           fhir:display [ fhir:v "Diagnostic Neuroimaging (Radiology) Physician" ]
         ] )
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling>
       ] ;
       fhir:value [
         a fhir:Boolean ;
         fhir:v true
       ]
     ] ) ;
     fhir:reference [ fhir:v "Organization/Submitter-Org-1" ]
  ] ; # 
  fhir:priority [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/processpriority>
       ] ;
       fhir:code [ fhir:v "normal" ]
     ] )
  ] ; # 
  fhir:payee [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/payeetype>
         ] ;
         fhir:code [ fhir:v "provider" ]
       ] )
     ]
  ] ; # 
  fhir:referral [
     fhir:extension ( [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber>
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "REF12022002-121"
       ]
     ] ) ;
     fhir:display [ fhir:v "Referral Number" ]
  ] ; # 
  fhir:supportingInfo ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType>
         ] ;
         fhir:code [ fhir:v "typeofbill" ]
       ] )
     ] ;
     fhir:code [
       fhir:coding ( [
         fhir:system [
           fhir:v "https://www.nubc.org/CodeSystem/TypeOfBill"^^xsd:anyURI ;
           fhir:l <https://www.nubc.org/CodeSystem/TypeOfBill>
         ] ;
         fhir:code [ fhir:v "011X" ] ;
         fhir:display [ fhir:v "Hospital Inpatient (Part A)" ]
       ] )
     ]
  ] ) ; # 
  fhir:diagnosis ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/sid/icd-10-cm>
         ] ;
         fhir:code [ fhir:v "S06.30" ] ;
         fhir:display [ fhir:v "Unspecified focal traumatic brain injury" ]
       ] )
     ] ;
     fhir:type ( [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/diagnosistype"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/diagnosistype>
         ] ;
         fhir:code [ fhir:v "principal" ]
       ] )
     ] ) ;
     fhir:packageCode [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup>
         ] ;
         fhir:code [ fhir:v "400" ] ;
         fhir:display [ fhir:v "Head trauma - concussion" ]
       ] )
     ]
  ] ) ; # 
  fhir:insurance ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:focal [ fhir:v true ] ;
     fhir:coverage [
       fhir:l <http://hl7.org/fhir/us/davinci-pct/Coverage/coverage1001> ;
       fhir:reference [ fhir:v "Coverage/coverage1001" ]
     ]
  ] ) ; # 
  fhir:item ( [
     fhir:extension ( [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription>
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "Imaging"
       ]
     ] ) ;
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:revenue [
       fhir:coding ( [
         fhir:system [
           fhir:v "https://www.nubc.org/CodeSystem/RevenueCodes"^^xsd:anyURI ;
           fhir:l <https://www.nubc.org/CodeSystem/RevenueCodes>
         ] ;
         fhir:code [ fhir:v "0611" ] ;
         fhir:display [ fhir:v "Magnetic Resonance Technology (MRT) - Brain/brain stem" ]
       ] )
     ] ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ;
           fhir:l <http://www.ama-assn.org/go/cpt>
         ] ;
         fhir:code [ fhir:v "70551" ] ;
         fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ]
       ] )
     ] ;
     fhir:modifier ( [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ;
           fhir:l <http://www.ama-assn.org/go/cpt>
         ] ;
         fhir:code [ fhir:v "70551" ] ;
         fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ]
       ] )
     ] ) ;
     fhir:serviced [
       a fhir:Date ;
       fhir:v "2021-10-31"^^xsd:date
     ] ;
     fhir:quantity [
       fhir:value [ fhir:v "1"^^xsd:decimal ]
     ] ;
     fhir:net [
       fhir:value [ fhir:v "200"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] ) ; # 
  fhir:total [
     fhir:value [ fhir:v "200"^^xsd:decimal ] ;
     fhir:currency [ fhir:v "USD" ]
  ] . # 

<http://hl7.org/fhir/us/davinci-pct/Patient/patient1001> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pct/Organization/org1001> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pct/Organization/Submitter-Org-1> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pct/Coverage/coverage1001> a fhir:Us .

# -------------------------------------------------------------------------------------