# ClaimsForm1-1 - NHDR Implementation Guide Release 1.0 v0.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **ClaimsForm1-1**

## Example Bundle: ClaimsForm1-1



## Resource Content

```json
{
  "resourceType" : "Bundle",
  "id" : "ClaimsForm1-1",
  "identifier" : {
    "system" : "http://nhdr.gov.ph/fhir/ValueSet-form-type",
    "value" : "CF1"
  },
  "type" : "transaction",
  "entry" : [{
    "fullUrl" : "urn:uuid:relatedperson",
    "resource" : {
      "resourceType" : "RelatedPerson",
      "id" : "CF1-RelatedPerson",
      "meta" : {
        "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-RelatedPerson"]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"RelatedPerson_CF1-RelatedPerson\"> </a><p class=\"res-header-id\"><b>Generated Narrative: RelatedPerson CF1-RelatedPerson</b></p><a name=\"CF1-RelatedPerson\"> </a><a name=\"hcCF1-RelatedPerson\"> </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-PH-RelatedPerson.html\">PH RelatedPerson</a></p></div><p><b>Sex at birth</b>: F</p><p><b>identifier</b>: PhilHealth Identification Number/PH54321</p><p><b>patient</b>: <a href=\"Bundle-ClaimsForm1-2.html#Patient_CF1-Patient-2\">Patient</a></p><p><b>name</b>: Lorna Mae Santos Bautista </p><p><b>telecom</b>: ph: 912-00-00, ph: 0927-000-0000, <a href=\"mailto:lmbautista@email.com\">lmbautista@email.com</a></p><p><b>birthDate</b>: 1971-02-11</p><p><b>address</b>: Fordham Road 1110 PH </p></div>"
      },
      "extension" : [{
        "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/Sex",
        "valueCode" : "F"
      }],
      "identifier" : [{
        "type" : {
          "coding" : [{
            "code" : "NIIP"
          }],
          "text" : "PhilHealth Identification Number"
        },
        "value" : "PH54321"
      }],
      "patient" : {
        "reference" : "Patient/CF1-Patient-2",
        "display" : "Patient"
      },
      "name" : [{
        "family" : "Bautista",
        "given" : ["Lorna Mae", "Santos"],
        "suffix" : ["Mrs."]
      }],
      "telecom" : [{
        "system" : "phone",
        "value" : "912-00-00"
      },
      {
        "system" : "phone",
        "value" : "0927-000-0000"
      },
      {
        "system" : "email",
        "value" : "lmbautista@email.com"
      }],
      "birthDate" : "1971-02-11",
      "address" : [{
        "extension" : [{
          "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/Barangay",
          "valueCoding" : {
            "code" : "0123456789",
            "display" : "Blue Ridge"
          }
        },
        {
          "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/CityMunicipality",
          "valueCoding" : {
            "code" : "0123456",
            "display" : "Quezon City"
          }
        },
        {
          "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/Province",
          "valueCoding" : {
            "code" : "01234",
            "display" : "Metro Manila"
          }
        }],
        "line" : ["Fordham Road"],
        "postalCode" : "1110",
        "country" : "PH"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "RelatedPerson"
    }
  },
  {
    "fullUrl" : "urn:uuid:organization",
    "resource" : {
      "resourceType" : "Organization",
      "id" : "CF1-Organization",
      "meta" : {
        "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-Organization"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_CF1-Organization\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization CF1-Organization</b></p><a name=\"CF1-Organization\"> </a><a name=\"hcCF1-Organization\"> </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-PH-Organization.html\">PH Organization</a></p></div><p><b>identifier</b>: PhilHealth Employer Number (PEN)/EN15243</p><p><b>name</b>: PhilHealth</p><p><b>telecom</b>: 080-00-00</p></div>"
      },
      "identifier" : [{
        "type" : {
          "coding" : [{
            "code" : "EN"
          }],
          "text" : "PhilHealth Employer Number (PEN)"
        },
        "value" : "EN15243"
      }],
      "name" : "PhilHealth",
      "telecom" : [{
        "value" : "080-00-00"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Organization"
    }
  },
  {
    "fullUrl" : "urn:uuid:questionnaire",
    "resource" : {
      "resourceType" : "Questionnaire",
      "id" : "CF1-Questionnaire",
      "meta" : {
        "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-Questionnaire"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Questionnaire_CF1-Questionnaire\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire CF1-Questionnaire</b></p><a name=\"CF1-Questionnaire\"> </a><a name=\"hcCF1-Questionnaire\"> </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-PH-Questionnaire.html\">PH Questionnaire</a></p></div><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Cardinality</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Type</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Additional information about the item\">Description &amp; Constraints</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64, \" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> </td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)\" id=\"item.CF1-Q1\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> CF1-Q1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Patient is the member?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64, \" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
      },
      "status" : "active",
      "item" : [{
        "linkId" : "CF1-Q1",
        "text" : "Patient is the member?",
        "type" : "boolean"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Questionnaire"
    }
  },
  {
    "fullUrl" : "urn:uuid:questionnaireresponse",
    "resource" : {
      "resourceType" : "QuestionnaireResponse",
      "id" : "CF1-QuestionnaireResponse",
      "meta" : {
        "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-QuestionnaireResponse"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"QuestionnaireResponse_CF1-QuestionnaireResponse\"> </a><p class=\"res-header-id\"><b>Generated Narrative: QuestionnaireResponse CF1-QuestionnaireResponse</b></p><a name=\"CF1-QuestionnaireResponse\"> </a><a name=\"hcCF1-QuestionnaireResponse\"> </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-PH-QuestionnaireResponse.html\">PH QuestionnaireResponse</a></p></div><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Definition</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Answer</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64, \" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireResponseRoot\" class=\"hierarchy\"/> CF1-QuestionnaireResponse</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire:None specified</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> CF1-Q1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">true</td></tr>\r\n<tr><td colspan=\"4\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64, \" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
      },
      "status" : "completed",
      "item" : [{
        "linkId" : "CF1-Q1",
        "answer" : [{
          "valueBoolean" : true
        }]
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "QuestionnaireResponse"
    }
  },
  {
    "fullUrl" : "urn:uuid:provenance",
    "resource" : {
      "resourceType" : "Provenance",
      "id" : "CF1-Provenance",
      "meta" : {
        "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-Provenance"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Provenance_CF1-Provenance\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Provenance CF1-Provenance</b></p><a name=\"CF1-Provenance\"> </a><a name=\"hcCF1-Provenance\"> </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-PH-Provenance.html\">PH Provenance</a></p></div><p>Provenance for <a href=\"Bundle-ClaimsForm1-1.html#Claim_CF1-Claim\">Claim</a></p><p>Summary</p><table class=\"grid\"><tr><td>Recorded</td><td>2026-02-03 09:00:00+0800</td></tr></table><p><b>Agents</b></p><table class=\"grid\"><tr><td><b>who</b></td></tr><tr><td><a href=\"Bundle-ClaimsForm1-1.html#Organization_CF1-Organization\">Organization</a></td></tr></table></div>"
      },
      "target" : [{
        "reference" : "Claim/CF1-Claim",
        "display" : "Claim"
      }],
      "recorded" : "2026-02-03T09:00:00+08:00",
      "agent" : [{
        "who" : {
          "reference" : "Organization/CF1-Organization",
          "display" : "Organization"
        }
      }],
      "signature" : [{
        "extension" : [{
          "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/SignatureReason",
          "valueString" : "Claim Approval"
        }],
        "type" : [{
          "system" : "urn:iso-astm:E1762-95:2013",
          "code" : "1.2.840.10065.1.12.1.20",
          "display" : "Electronic Signature"
        }],
        "when" : "2026-02-03T10:30:00+08:00",
        "who" : {
          "reference" : "RelatedPerson/CF1-RelatedPerson",
          "display" : "Related Person"
        },
        "data" : "QkFTRTY0X1NJR05BVFVSRV9QQVRJRU5U"
      },
      {
        "type" : [{
          "system" : "urn:iso-astm:E1762-95:2013",
          "code" : "1.2.840.10065.1.12.1.20",
          "display" : "Electronic Signature"
        }],
        "when" : "2026-02-03T10:30:00+08:00",
        "who" : {
          "reference" : "Organization/CF1-Organization",
          "display" : "PhilHealth Regional Office"
        },
        "data" : "QkFTRTY0X1NJR05BVFVSRV9PUkdBTklaVElPTg=="
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Provenance"
    }
  },
  {
    "fullUrl" : "urn:uuid:coverage",
    "resource" : {
      "resourceType" : "Coverage",
      "id" : "CF1-Coverage",
      "meta" : {
        "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-Coverage"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_CF1-Coverage\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage CF1-Coverage</b></p><a name=\"CF1-Coverage\"> </a><a name=\"hcCF1-Coverage\"> </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-PH-Coverage.html\">PH Coverage</a></p></div><p><b>status</b>: Active</p><p><b>policyHolder</b>: <a href=\"Bundle-ClaimsForm1-1.html#Organization_CF1-Organization\">Organization</a></p><p><b>beneficiary</b>: <a href=\"Bundle-ClaimsForm1-2.html#Patient_CF1-Patient-2\">Patient</a></p><p><b>payor</b>: <a href=\"Bundle-ClaimsForm1-1.html#Organization_CF1-Organization\">Organization</a></p></div>"
      },
      "status" : "active",
      "policyHolder" : {
        "reference" : "Organization/CF1-Organization",
        "display" : "Organization"
      },
      "beneficiary" : {
        "reference" : "Patient/CF1-Patient-2",
        "display" : "Patient"
      },
      "payor" : [{
        "reference" : "Organization/CF1-Organization",
        "display" : "Organization"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Coverage"
    }
  },
  {
    "fullUrl" : "urn:uuid:claim",
    "resource" : {
      "resourceType" : "Claim",
      "id" : "CF1-Claim",
      "meta" : {
        "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-Claim"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_CF1-Claim\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim CF1-Claim</b></p><a name=\"CF1-Claim\"> </a><a name=\"hcCF1-Claim\"> </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-PH-Claim.html\">PH Claim</a></p></div><p><b>identifier</b>: <code>https://philhealth.gov.ph/claim</code>/CF1-CLM-00001</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>: Claim</p><p><b>patient</b>: <a href=\"Bundle-ClaimsForm1-2.html#Patient_CF1-Patient-2\">Patient</a></p><p><b>created</b>: 2026-02-03 08:00:00+0800</p><p><b>provider</b>: <a href=\"Bundle-ClaimsForm1-1.html#Organization_CF1-Organization\">Organization</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><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype subscriber}\">Subscriber</span></td><td><a href=\"Bundle-ClaimsForm1-1.html#RelatedPerson_CF1-RelatedPerson\">RelatedPerson</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=\"Bundle-ClaimsForm1-1.html#Coverage_CF1-Coverage\">Coverage</a></td></tr></table></div>"
      },
      "identifier" : [{
        "system" : "https://philhealth.gov.ph/claim",
        "value" : "CF1-CLM-00001"
      }],
      "status" : "active",
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
          "code" : "institutional",
          "display" : "Institutional"
        }]
      },
      "use" : "claim",
      "patient" : {
        "reference" : "Patient/CF1-Patient-2",
        "display" : "Patient"
      },
      "created" : "2026-02-03T08:00:00+08:00",
      "provider" : {
        "reference" : "Organization/CF1-Organization",
        "display" : "Organization"
      },
      "priority" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
          "code" : "normal",
          "display" : "Normal"
        }]
      },
      "payee" : {
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/payeetype",
            "code" : "subscriber",
            "display" : "Subscriber"
          }]
        },
        "party" : {
          "reference" : "RelatedPerson/CF1-RelatedPerson",
          "display" : "RelatedPerson"
        }
      },
      "insurance" : [{
        "sequence" : 1,
        "focal" : true,
        "coverage" : {
          "reference" : "Coverage/CF1-Coverage",
          "display" : "Coverage"
        }
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Claim"
    }
  }]
}

```
