@prefix fhir: . @prefix owl: . @prefix rdf: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:Claim ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "ECLM-IMG-001"] ; # fhir:meta [ fhir:profile ( [ fhir:v "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-imagingpreauth"^^xsd:anyURI ; fhir:l ] ) ; fhir:tag ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/common-tags"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "actionable" ] ; fhir:display [ fhir:v "Actionable" ] ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div [ fhir:v "

Generated Narrative: Claim ECLM-IMG-001

Clinical Indications: Suspected fracture of right femur shaft following road traffic accident

Investigations: MRI right femur — plain and contrast

identifier: https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number/CLAIM-IMG-001

status: Active

type: Institutional

use: Preauthorization

patient: John Mwangi Kamau (official) Male, DoB: 1985-06-15 ( National ID: 12345678 (use: official, ))

billablePeriod: 2025-11-05 --> 2025-11-05

created: 2025-11-05 10:00:00+0300

insurer: Organization Social Health Authority

provider: Organization Nairobi General Hospital

priority: Normal

Payees

-Type
*Provider

CareTeams

-SequenceProviderRoleQualification
*1Practitioner Dr. James Ochieng (official)Ordering providerDoctor of Medicine

Diagnoses

-SequenceDiagnosis[x]
*1Fracture of shaft of femur

Insurances

-SequenceFocalCoverage
*1trueCoverage: extension = Mobile Money,Active,General Practice; identifier = https://nshr-uat.sha.go.ke/fhir/Identifier/coverage-number#COV-SHA-2024-001234; status = active; type = Medical; relationship = Self; period = 2024-01-01 --> 2024-12-31

item

sequence: 1

careTeamSequence: 1

category: Medical Care

productOrService: Medical Imaging

quantity: 1

UnitPrices

-ValueCurrency
*18500Kenyan shilling

Nets

-ValueCurrency
*18500Kenyan shilling
"^^rdf:XMLLiteral ] ] ; # fhir:extension ( [ fhir:url [ fhir:v "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-clinical-indications"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:String ; fhir:v "Suspected fracture of right femur shaft following road traffic accident" ] ] [ fhir:url [ fhir:v "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-investigations"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:String ; fhir:v "MRI right femur — plain and contrast" ] ] ) ; # fhir:identifier ( [ fhir:system [ fhir:v "https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number"^^xsd:anyURI ; fhir:l ] ; fhir:value [ fhir:v "CLAIM-IMG-001" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-type-cs"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "institutional" ] ; fhir:display [ fhir:v "Institutional" ] ] ) ] ; # fhir:use [ fhir:v "preauthorization"] ; # fhir:patient [ fhir:l ; fhir:reference [ fhir:v "Patient/ECLM-PT-001" ] ] ; # fhir:billablePeriod [ fhir:start [ fhir:v "2025-11-05"^^xsd:date ] ; fhir:end [ fhir:v "2025-11-05"^^xsd:date ] ] ; # fhir:created [ fhir:v "2025-11-05T10:00:00+03:00"^^xsd:dateTime] ; # fhir:insurer [ fhir:l ; fhir:reference [ fhir:v "Organization/ECLM-INS-001" ] ] ; # fhir:provider [ fhir:l ; fhir:reference [ fhir:v "Organization/ECLM-ORG-001" ] ] ; # fhir:priority [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "normal" ] ; fhir:display [ fhir:v "Normal" ] ] ) ] ; # fhir:payee [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "provider" ] ; fhir:display [ fhir:v "Provider" ] ] ) ] ] ; # fhir:careTeam ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:provider [ fhir:l ; fhir:reference [ fhir:v "Practitioner/ECLM-PRA-001" ] ] ; fhir:role [ fhir:coding ( [ fhir:system [ fhir:v "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-care-team-role-cs"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "ORDERING" ] ; fhir:display [ fhir:v "Ordering provider" ] ] ) ] ; fhir:qualification [ fhir:coding ( [ fhir:system [ fhir:v "https://nshr-uat.sha.go.ke/fhir/CodeSystem/eclaims-provider-qualification-cs"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "MD" ] ; fhir:display [ fhir:v "Doctor of Medicine" ] ] ) ] ] ) ; # fhir:diagnosis ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:diagnosis [ a fhir:CodeableConcept ; fhir:coding ( [ fhir:system [ fhir:v "https://nshr-uat.sha.go.ke/fhir/CodeSystem/icd11-codes-cs"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "NC72.5" ] ; fhir:display [ fhir:v "Fracture of shaft of femur" ] ] ) ] ] ) ; # fhir:insurance ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:focal [ fhir:v true ] ; fhir:coverage [ fhir:l ; fhir:reference [ fhir:v "Coverage/ECLM-COV-001" ] ] ] ) ; # fhir:item ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1" ] ; fhir:display [ fhir:v "Medical Care" ] ] ) ] ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "https://nshr-uat.sha.go.ke/fhir/CodeSystem/KenyaSocialHealthAuthorityInterventionCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "SHA-09" ] ; fhir:display [ fhir:v "Medical Imaging" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "1"^^xsd:decimal ] ] ; fhir:unitPrice [ fhir:value [ fhir:v "18500"^^xsd:decimal ] ; fhir:currency [ fhir:v "KES" ] ] ; fhir:net [ fhir:value [ fhir:v "18500"^^xsd:decimal ] ; fhir:currency [ fhir:v "KES" ] ] ] ) . # # -------------------------------------------------------------------------------------