# Claims Form 1 - NHDR Implementation Guide Release 1.0 v0.1.0

* [**Table of Contents**](toc.md)
* **Claims Form 1**

## Claims Form 1

This is a sample representation of the **Use Case** implementation guide for **Claims Form 1**

This can be viewed as instances ["Member is not the Patient"](Bundle-ClaimsForm1-1.md) & ["Member is the Patient"](Bundle-ClaimsForm1-2.md) to also see downloadable XML, JSON, and TTL formats.

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### Implementation Rules

* name.given is an array that captures the first name and middle name. 
1. name.`given[0]`is used to capture a person's**first name**.
1. name.`given[1]`is used to capture a person's**middle name**.
 
* For the field under **Part I - Member Information**, if `Patient is the member?` is true, you **must** add a `Patient` resource to the bundle and use `Patient.link` to reference this `RelatedPerson` resource. For example:

### Questionnaire Fields in CF1:

```
    {
        "resourceType": "Questionnaire",
        "id": "CF1-Questionnaire",
        "meta": {
            "profile": [
                "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Questionnaire"
            ]
        },
        "item": [
            {
                "linkId": "1",
                "text": "Patient is the member? [Yes, Proceed to Part III | No, Proceed to Part II]",
                "type": "boolean"
            }
        ],
        "status": "active"
    }


```

**QuestionnaireResponse:**

```
"resource": {
    "resourceType": "QuestionnaireResponse",
    "id": "QuestionnaireResponse-2",
    "meta": {
        "profile": [
            "https://nhdr.gov.ph/fhir/StructureDefinition/PH-QuestionnaireResponse"
        ]
    },
    "questionnaire": "Questionnaire/Questionnaire-2",
    "item": [
        {
            "linkId": "1",
            "text": "Patient is the member?",
            "answer": [
                {
                    "valueBoolean": true
                }
            ]
        }
    ],
    "status": "in-progress"
}

```

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**Patient:**

```
"resource": {
    "resourceType": "Patient",
    "id": "Patient-2",
    "meta": {
        "profile": [
            "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Patient"
        ]
    },
    "link": [
        {
            "other": {
                "reference": "RelatedPerson/RelatedPerson-2"
            },
            "type": "refer"
        }
    ]
}

```

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**RelatedPerson:**

```
"resource": {
    "resourceType": "RelatedPerson",
    "id": "RelatedPerson-2",
    "meta": {
        "profile": [
            "https://nhdr.gov.ph/fhir/StructureDefinition/PH-RelatedPerson"
        ]
    },
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "code": "NIIP"
                    }
                ],
                "text": "PhilHealth Identification Number"
            },
            "value": "PH54321"
        }
    ],
    "patient": {
        "reference": "Patient/Patient-2"
    }
    
    <!-- Rest of the resource -->

}

```

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