NHDR Implementation Guide Release 1.0
0.1.0 - ci-build

NHDR Implementation Guide Release 1.0, published by NHDR. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/PROJ-PHILHEALTH-EA-NHDR/nhdr-fhir-ig-review-project-2/ and changes regularly. See the Directory of published versions

## Resource Profile: PH Claim

Official URL: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Claim | Version: 0.1.0
Standards status: Draft | Computable Name: PH_Claim
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

Usages:

- This Profile is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:encounter |  | 0..* | Reference(PH Encounter) | Encounter (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | Σ | 1..1 | Reference(PH Patient) | The recipient of the products and services
created | Σ | 1..1 | dateTime | Resource creation date
provider | Σ | 1..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization) | Party responsible for the claim
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
prescription |  | 0..1 | Reference(DeviceRequest | PH MedicationRequest | VisionPrescription) | Prescription authorizing services and products
referral |  | 0..1 | Reference(PH ServiceRequest) | Treatment referral
insurance | Σ | 1..* | BackboneElement | Patient insurance information
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
coverage | Σ | 1..1 | Reference(PH Coverage) | Insurance information
Slices for item |  | 0..* | BackboneElement | Product or service provided Slice: Unordered, Open by pattern:productOrService.coding.code
item:All Slices |  |  |  | Content/Rules for all slices
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:repetitiveProcedure |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:zbenefitPackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:tbDots |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:animalbitePackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:newborncarePackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:firstCaseRate |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:secondCaseRate |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std.
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Claim

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
meta |  |  |  |
Slices for extension |  |  |  | Content/Rules for all slices
extension:hfRecordedDate |  | 0..1 | dateTime | The recorded date indicating when the record was uploaded by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
extension:hfLastUpdated |  | 0..* | dateTime | The date indicating when the record was last updated by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
lastUpdated |  | 0..1 | instant | When the resource was uploaded to the NHDR.
implicitRules |  | 0..0 |  | A set of rules under which this content was created
language |  | 0..0 |  | Language of the resource content
text |  | 0..0 |  | Text summary of the resource, for human interpretation
contained |  | 0..0 |  | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:encounter |  | 0..* | Reference(PH Encounter) | Encounter (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension
modifierExtension |  | 0..0 |  | Extension
subType |  | 0..0 |  | More granular claim type
patient |  | 1..1 | Reference(PH Patient) | The recipient of the products and services
billablePeriod |  | 0..0 |  | Relevant time frame for the claim
created |  | 1..1 | dateTime | Resource creation date
enterer |  | 0..0 |  | Author of the claim
insurer |  | 0..0 |  | Target
provider |  | 1..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization) | Party responsible for the claim
fundsReserve |  | 0..0 |  | For whom to reserve funds
related |  | 0..0 |  | Prior or corollary claims
prescription |  | 0..1 | Reference(DeviceRequest | PH MedicationRequest | VisionPrescription) | Prescription authorizing services and products
originalPrescription |  | 0..0 |  | Original prescription if superseded by fulfiller
payee |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
party |  | 0..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization | PH Patient | PH RelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(PH ServiceRequest) | Treatment referral
facility |  | 0..0 |  | Servicing facility
careTeam |  |  |  |
provider |  | 1..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization) | Practitioner or organization
responsible |  | 0..0 |  | Indicator of the lead practitioner
role |  | 0..0 |  | Function within the team
qualification |  | 0..0 |  | Practitioner credential or specialization
supportingInfo |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
code |  | 0..0 |  | Type of information
timing[x] |  | 0..0 |  | When it occurred
reason |  | 0..0 |  | Explanation for the information
diagnosis |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
Slices for diagnosis[x] |  | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Slice: Unordered, Open by type:$this
diagnosis[x]:diagnosisReference |  | 0..1 | Reference(PH Condition) | Nature of illness or problem
type |  | 0..0 |  | Timing or nature of the diagnosis
onAdmission |  | 0..0 |  | Present on admission
packageCode |  | 0..0 |  | Package billing code
procedure |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
type |  | 0..0 |  | Category of Procedure
Slices for procedure[x] |  | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Slice: Unordered, Open by type:$this
procedure[x]:procedureReference |  | 0..1 | Reference(PH Procedure) | Specific clinical procedure
udi |  | 0..0 |  | Unique device identifier
insurance |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
identifier |  | 0..0 |  | Pre-assigned Claim number
coverage |  | 1..1 | Reference(PH Coverage) | Insurance information
businessArrangement |  | 0..0 |  | Additional provider contract number
preAuthRef |  | 0..0 |  | Prior authorization reference number
claimResponse |  | 0..0 |  | Adjudication results
accident |  | 0..0 |  | Details of the event
Slices for item |  | 0..* | BackboneElement | Product or service provided Slice: Unordered, Open by pattern:productOrService.coding.code
item:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:repetitiveProcedure |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: repetitive-procedure
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:zbenefitPackage |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: zbenefit
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:tbDots |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: tb-dots
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:animalbitePackage |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: animal-bite
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:newborncarePackage |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: newborn-care
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:firstCaseRate |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: first-case-rate
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:secondCaseRate |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: second-case-rate
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:hfRecordedDate |  | 0..1 | dateTime | The recorded date indicating when the record was uploaded by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
extension:hfLastUpdated |  | 0..* | dateTime | The date indicating when the record was last updated by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource was uploaded to the NHDR.
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:encounter |  | 0..* | Reference(PH Encounter) | Encounter (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension
identifier |  | 0..* | Identifier | Business Identifier for claim
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | Σ | 1..1 | Reference(PH Patient) | The recipient of the products and services
created | Σ | 1..1 | dateTime | Resource creation date
provider | Σ | 1..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization) | Party responsible for the claim
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
prescription |  | 0..1 | Reference(DeviceRequest | PH MedicationRequest | VisionPrescription) | Prescription authorizing services and products
payee |  | 0..1 | BackboneElement | Recipient of benefits payable
type |  | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization | PH Patient | PH RelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(PH ServiceRequest) | Treatment referral
careTeam |  | 0..* | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization) | Practitioner or organization
supportingInfo |  | 0..* | BackboneElement | Supporting information
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
diagnosis |  | 0..* | BackboneElement | Pertinent diagnosis information
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
Slices for diagnosis[x] |  | 1..1 |  | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
diagnosis[x]:diagnosisReference |  | 0..1 | Reference(PH Condition) | Nature of illness or problem
procedure |  | 0..* | BackboneElement | Clinical procedures performed
sequence |  | 1..1 | positiveInt | Procedure instance identifier
date |  | 0..1 | dateTime | When the procedure was performed
Slices for procedure[x] |  | 1..1 |  | Specific clinical procedure Slice: Unordered, Open by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
procedure[x]:procedureReference |  | 0..1 | Reference(PH Procedure) | Specific clinical procedure
insurance | Σ | 1..* | BackboneElement | Patient insurance information
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
coverage | Σ | 1..1 | Reference(PH Coverage) | Insurance information
Slices for item |  | 0..* | BackboneElement | Product or service provided Slice: Unordered, Open by pattern:productOrService.coding.code
item:All Slices |  |  |  | Content/Rules for all slices
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:repetitiveProcedure |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: repetitive-procedure
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:zbenefitPackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: zbenefit
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:tbDots |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: tb-dots
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:animalbitePackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: animal-bite
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:newborncarePackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: newborn-care
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:firstCaseRate |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: first-case-rate
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:secondCaseRate |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: second-case-rate
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
total |  | 0..1 | Money | Total claim cost
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
Claim.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std.
Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.accident.type | Base | extensible | ActIncidentCode | 📦3.0.0 | THO v7.1
Claim.item.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Claim

Summary

Mandatory: 0 element(7 nested mandatory elements)
Prohibited: 268 elements

Structures

This structure refers to these other structures:

- PH Patient (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Patient)
- PH Practitioner (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Practitioner)
- PH PractitionerRole (https://nhdr.gov.ph/fhir/StructureDefinition/PH-PractitionerRole)
- PH Organization (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Organization)
- PH MedicationRequest (https://nhdr.gov.ph/fhir/StructureDefinition/PH-MedicationRequest)
- PH RelatedPerson (https://nhdr.gov.ph/fhir/StructureDefinition/PH-RelatedPerson)
- PH ServiceRequest (https://nhdr.gov.ph/fhir/StructureDefinition/PH-ServiceRequest)
- PH Condition (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Condition)
- PH Procedure (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Procedure)
- PH Coverage (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Coverage)
- PH Encounter (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Encounter)

Extensions

This structure refers to these extensions:

- https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
- https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
- https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Claim.diagnosis.diagnosis[x]
- The element 1 is sliced based on the value of Claim.procedure.procedure[x]
- The element 1 is sliced based on the value of Claim.item

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:encounter |  | 0..* | Reference(PH Encounter) | Encounter (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | Σ | 1..1 | Reference(PH Patient) | The recipient of the products and services
created | Σ | 1..1 | dateTime | Resource creation date
provider | Σ | 1..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization) | Party responsible for the claim
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
prescription |  | 0..1 | Reference(DeviceRequest | PH MedicationRequest | VisionPrescription) | Prescription authorizing services and products
referral |  | 0..1 | Reference(PH ServiceRequest) | Treatment referral
insurance | Σ | 1..* | BackboneElement | Patient insurance information
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
coverage | Σ | 1..1 | Reference(PH Coverage) | Insurance information
Slices for item |  | 0..* | BackboneElement | Product or service provided Slice: Unordered, Open by pattern:productOrService.coding.code
item:All Slices |  |  |  | Content/Rules for all slices
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:repetitiveProcedure |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:zbenefitPackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:tbDots |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:animalbitePackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:newborncarePackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:firstCaseRate |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
item:secondCaseRate |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std.
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

This structure is derived from Claim

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
meta |  |  |  |
Slices for extension |  |  |  | Content/Rules for all slices
extension:hfRecordedDate |  | 0..1 | dateTime | The recorded date indicating when the record was uploaded by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
extension:hfLastUpdated |  | 0..* | dateTime | The date indicating when the record was last updated by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
lastUpdated |  | 0..1 | instant | When the resource was uploaded to the NHDR.
implicitRules |  | 0..0 |  | A set of rules under which this content was created
language |  | 0..0 |  | Language of the resource content
text |  | 0..0 |  | Text summary of the resource, for human interpretation
contained |  | 0..0 |  | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:encounter |  | 0..* | Reference(PH Encounter) | Encounter (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension
modifierExtension |  | 0..0 |  | Extension
subType |  | 0..0 |  | More granular claim type
patient |  | 1..1 | Reference(PH Patient) | The recipient of the products and services
billablePeriod |  | 0..0 |  | Relevant time frame for the claim
created |  | 1..1 | dateTime | Resource creation date
enterer |  | 0..0 |  | Author of the claim
insurer |  | 0..0 |  | Target
provider |  | 1..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization) | Party responsible for the claim
fundsReserve |  | 0..0 |  | For whom to reserve funds
related |  | 0..0 |  | Prior or corollary claims
prescription |  | 0..1 | Reference(DeviceRequest | PH MedicationRequest | VisionPrescription) | Prescription authorizing services and products
originalPrescription |  | 0..0 |  | Original prescription if superseded by fulfiller
payee |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
party |  | 0..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization | PH Patient | PH RelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(PH ServiceRequest) | Treatment referral
facility |  | 0..0 |  | Servicing facility
careTeam |  |  |  |
provider |  | 1..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization) | Practitioner or organization
responsible |  | 0..0 |  | Indicator of the lead practitioner
role |  | 0..0 |  | Function within the team
qualification |  | 0..0 |  | Practitioner credential or specialization
supportingInfo |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
code |  | 0..0 |  | Type of information
timing[x] |  | 0..0 |  | When it occurred
reason |  | 0..0 |  | Explanation for the information
diagnosis |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
Slices for diagnosis[x] |  | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Slice: Unordered, Open by type:$this
diagnosis[x]:diagnosisReference |  | 0..1 | Reference(PH Condition) | Nature of illness or problem
type |  | 0..0 |  | Timing or nature of the diagnosis
onAdmission |  | 0..0 |  | Present on admission
packageCode |  | 0..0 |  | Package billing code
procedure |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
type |  | 0..0 |  | Category of Procedure
Slices for procedure[x] |  | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Slice: Unordered, Open by type:$this
procedure[x]:procedureReference |  | 0..1 | Reference(PH Procedure) | Specific clinical procedure
udi |  | 0..0 |  | Unique device identifier
insurance |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
identifier |  | 0..0 |  | Pre-assigned Claim number
coverage |  | 1..1 | Reference(PH Coverage) | Insurance information
businessArrangement |  | 0..0 |  | Additional provider contract number
preAuthRef |  | 0..0 |  | Prior authorization reference number
claimResponse |  | 0..0 |  | Adjudication results
accident |  | 0..0 |  | Details of the event
Slices for item |  | 0..* | BackboneElement | Product or service provided Slice: Unordered, Open by pattern:productOrService.coding.code
item:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:repetitiveProcedure |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: repetitive-procedure
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:zbenefitPackage |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: zbenefit
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:tbDots |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: tb-dots
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:animalbitePackage |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: animal-bite
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:newborncarePackage |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: newborn-care
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:firstCaseRate |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: first-case-rate
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
item:secondCaseRate |  | 0..1 | BackboneElement | Product or service provided
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
careTeamSequence |  | 0..0 |  | Applicable careTeam members
diagnosisSequence |  | 0..0 |  | Applicable diagnoses
procedureSequence |  | 0..0 |  | Applicable procedures
informationSequence |  | 0..0 |  | Applicable exception and supporting information
revenue |  | 0..0 |  | Revenue or cost center code
productOrService |  |  |  |
coding |  |  |  |
code |  | 1..1 | code | Symbol in syntax defined by the system Required Pattern: second-case-rate
modifier |  | 0..0 |  | Product or service billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
location[x] |  | 0..0 |  | Place of service or where product was supplied
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
bodySite |  | 0..0 |  | Anatomical location
subSite |  | 0..0 |  | Anatomical sub-location
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
revenue |  | 0..0 |  | Revenue or cost center code
category |  | 0..0 |  | Benefit classification
modifier |  | 0..0 |  | Service/Product billing modifiers
programCode |  | 0..0 |  | Program the product or service is provided under
quantity |  | 0..0 |  | Count of products or services
unitPrice |  | 0..0 |  | Fee, charge or cost per item
factor |  | 0..0 |  | Price scaling factor
udi |  | 0..0 |  | Unique device identifier
subDetail |  | 0..0 |  | Product or service provided
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:hfRecordedDate |  | 0..1 | dateTime | The recorded date indicating when the record was uploaded by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
extension:hfLastUpdated |  | 0..* | dateTime | The date indicating when the record was last updated by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource was uploaded to the NHDR.
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:encounter |  | 0..* | Reference(PH Encounter) | Encounter (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension
identifier |  | 0..* | Identifier | Business Identifier for claim
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | Σ | 1..1 | Reference(PH Patient) | The recipient of the products and services
created | Σ | 1..1 | dateTime | Resource creation date
provider | Σ | 1..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization) | Party responsible for the claim
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
prescription |  | 0..1 | Reference(DeviceRequest | PH MedicationRequest | VisionPrescription) | Prescription authorizing services and products
payee |  | 0..1 | BackboneElement | Recipient of benefits payable
type |  | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization | PH Patient | PH RelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(PH ServiceRequest) | Treatment referral
careTeam |  | 0..* | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PH Practitioner | PH PractitionerRole | PH Organization) | Practitioner or organization
supportingInfo |  | 0..* | BackboneElement | Supporting information
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
diagnosis |  | 0..* | BackboneElement | Pertinent diagnosis information
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
Slices for diagnosis[x] |  | 1..1 |  | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
diagnosis[x]:diagnosisReference |  | 0..1 | Reference(PH Condition) | Nature of illness or problem
procedure |  | 0..* | BackboneElement | Clinical procedures performed
sequence |  | 1..1 | positiveInt | Procedure instance identifier
date |  | 0..1 | dateTime | When the procedure was performed
Slices for procedure[x] |  | 1..1 |  | Specific clinical procedure Slice: Unordered, Open by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
procedure[x]:procedureReference |  | 0..1 | Reference(PH Procedure) | Specific clinical procedure
insurance | Σ | 1..* | BackboneElement | Patient insurance information
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
coverage | Σ | 1..1 | Reference(PH Coverage) | Insurance information
Slices for item |  | 0..* | BackboneElement | Product or service provided Slice: Unordered, Open by pattern:productOrService.coding.code
item:All Slices |  |  |  | Content/Rules for all slices
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:repetitiveProcedure |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: repetitive-procedure
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:zbenefitPackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: zbenefit
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:tbDots |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: tb-dots
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:animalbitePackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: animal-bite
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:newborncarePackage |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: newborn-care
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:firstCaseRate |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: first-case-rate
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
item:secondCaseRate |  | 0..1 | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: second-case-rate
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 0..1 | Money | Total item cost
encounter |  | 0..* | Reference(PH Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
net |  | 0..1 | Money | Total item cost
total |  | 0..1 | Money | Total claim cost
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
Claim.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std.
Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.accident.type | Base | extensible | ActIncidentCode | 📦3.0.0 | THO v7.1
Claim.item.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:repetitiveProcedure.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:zbenefitPackage.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:tbDots.detail.​subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:animalbitePackage.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:newborncarePackage.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:firstCaseRate.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item:secondCaseRate.​detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Claim

Summary

Mandatory: 0 element(7 nested mandatory elements)
Prohibited: 268 elements

Structures

This structure refers to these other structures:

- PH Patient (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Patient)
- PH Practitioner (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Practitioner)
- PH PractitionerRole (https://nhdr.gov.ph/fhir/StructureDefinition/PH-PractitionerRole)
- PH Organization (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Organization)
- PH MedicationRequest (https://nhdr.gov.ph/fhir/StructureDefinition/PH-MedicationRequest)
- PH RelatedPerson (https://nhdr.gov.ph/fhir/StructureDefinition/PH-RelatedPerson)
- PH ServiceRequest (https://nhdr.gov.ph/fhir/StructureDefinition/PH-ServiceRequest)
- PH Condition (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Condition)
- PH Procedure (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Procedure)
- PH Coverage (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Coverage)
- PH Encounter (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Encounter)

Extensions

This structure refers to these extensions:

- https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
- https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
- https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Claim.diagnosis.diagnosis[x]
- The element 1 is sliced based on the value of Claim.procedure.procedure[x]
- The element 1 is sliced based on the value of Claim.item

Other representations of profile: CSV, Excel, Schematron