Belgian MyCareNet eAttestation Profiles
1.0.0 - STU
Belgian MyCareNet eAttestation Profiles
1.0.0 - STU
Belgian MyCareNet eAttestation Profiles, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/eattestation/ and changes regularly. See the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="ex01"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-eattestation-request"/>
</meta>
<type value="message"/>
<timestamp value="2015-07-14T11:15:33+02:00"/>
<entry>
<fullUrl value="urn:uuid:267b18ce-3d37-4581-9baa-6fada338038b"/>
<resource>
<MessageHeader>
<id value="267b18ce-3d37-4581-9baa-6fada338038b"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-messageheader"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="MessageHeader_267b18ce-3d37-4581-9baa-6fada338038b"> </a><p><b>Generated Narrative: MessageHeader</b><a name="267b18ce-3d37-4581-9baa-6fada338038b"> </a><a name="hc267b18ce-3d37-4581-9baa-6fada338038b"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource MessageHeader "267b18ce-3d37-4581-9baa-6fada338038b" </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/mycarenet//StructureDefinition-be-messageheader.html">MyCareNet MessageHeader BE profile</a></p></div><p><b>event</b>: eattest-create (Details: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events code eattest-create = 'eattest-create', stated as 'null')</p><h3>Destinations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style="display: none">*</td><td>MyCareNet</td><td><code>urn:be:fgov:kbo-bce:organization:cbe-number:0820563481</code></td></tr></table><p><b>sender</b>: <a href="#PractitionerRole_62c7bfad-0cb3-4a39-9abb-3a62e06de834">See above (urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834)</a></p><h3>Sources</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Endpoint</b></td></tr><tr><td style="display: none">*</td><td><code>urn:be:fgov:person:ssin:ehealth:1.0:physiotherapist:nihii11:54263481527</code></td></tr></table><p><b>focus</b>: <a href="#Claim_e85173bc-6f0d-480b-a2cd-2b70d9ffff7a">See above (urn:uuid:e85173bc-6f0d-480b-a2cd-2b70d9ffff7a)</a></p></div>
</text>
<eventCoding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events"/>
<code value="eattest-create"/>
</eventCoding>
<destination>
<name value="MyCareNet"/>
<endpoint
value="urn:be:fgov:kbo-bce:organization:cbe-number:0820563481"/>
</destination>
<sender>
<!-- serviceProvider -->
<reference value="urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834"/>
</sender>
<source>
<endpoint
value="urn:be:fgov:person:ssin:ehealth:1.0:physiotherapist:nihii11:54263481527"/>
</source>
<focus>
<reference value="urn:uuid:e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"/>
</focus>
</MessageHeader>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834"/>
<resource>
<PractitionerRole>
<id value="62c7bfad-0cb3-4a39-9abb-3a62e06de834"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="PractitionerRole_62c7bfad-0cb3-4a39-9abb-3a62e06de834"> </a><p><b>Generated Narrative: PractitionerRole</b><a name="62c7bfad-0cb3-4a39-9abb-3a62e06de834"> </a><a name="hc62c7bfad-0cb3-4a39-9abb-3a62e06de834"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PractitionerRole "62c7bfad-0cb3-4a39-9abb-3a62e06de834" </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/core//StructureDefinition-be-practitionerrole.html">BePractitionerRole</a></p></div><p><b>practitioner</b>: <a href="#Practitioner_03972cc4-d781-4285-8d79-0f05810e1931">See above (urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931)</a></p><p><b>organization</b>: <span><a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-cbe.html" title="BCE/KBO">BeCBENamingSystem</a>/0425.222.333</span></p><p><b>code</b>: physiotherapist <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/core//CodeSystem-cd-hcparty.html">BeCdHcParty</a>#persphysiotherapist)</span></p></div>
</text>
<practitioner>
<reference value="urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931"/>
</practitioner>
<organization>
<!-- collector (paymentreceivingparty) for attest -->
<identifier>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/cbe"/>
<value value="0425.222.333"/>
</identifier>
</organization>
<code>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
<code value="persphysiotherapist"/>
</coding>
</code>
</PractitionerRole>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931"/>
<resource>
<Practitioner>
<id value="03972cc4-d781-4285-8d79-0f05810e1931"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_03972cc4-d781-4285-8d79-0f05810e1931"> </a><p><b>Generated Narrative: Practitioner</b><a name="03972cc4-d781-4285-8d79-0f05810e1931"> </a><a name="hc03972cc4-d781-4285-8d79-0f05810e1931"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Practitioner "03972cc4-d781-4285-8d79-0f05810e1931" </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/core//StructureDefinition-be-practitioner.html">BePractitioner</a></p></div><p><b>identifier</b>: <a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-nihdi.html" title="RIZIV/INAMI">BeNIHDINamingSystem</a>/54263481527</p><p><b>name</b>: John Smith </p></div>
</text>
<identifier>
<!-- serviceProvider for attest (and in this case also the provider for item) -->
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
<value value="54263481527"/>
</identifier>
<name>
<family value="Smith"/>
<given value="John"/>
</name>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686"/>
<resource>
<Patient>
<id value="a52efcb6-1f81-4333-a115-d45bd3183686"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_a52efcb6-1f81-4333-a115-d45bd3183686"> </a><p><b>Generated Narrative: Patient</b><a name="a52efcb6-1f81-4333-a115-d45bd3183686"> </a><a name="hca52efcb6-1f81-4333-a115-d45bd3183686"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Patient "a52efcb6-1f81-4333-a115-d45bd3183686" </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/core//StructureDefinition-be-patient.html">BePatient</a></p></div><p><b>identifier</b>: <a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-ssin.html" title="NISS/INSZ">BeSSINNamingSystem</a>/73031805784</p><p><b>name</b>: Jean Dupont </p><p><b>gender</b>: male</p></div>
</text>
<identifier>
<!-- patient -->
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin"/>
<value value="73031805784"/>
</identifier>
<name>
<family value="Dupont"/>
<given value="Jean"/>
</name>
<gender value="male"/>
</Patient>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:035e3de4-011f-48a4-92c9-15b2bbcec321"/>
<resource>
<PractitionerRole>
<id value="035e3de4-011f-48a4-92c9-15b2bbcec321"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="PractitionerRole_035e3de4-011f-48a4-92c9-15b2bbcec321"> </a><p><b>Generated Narrative: PractitionerRole</b><a name="035e3de4-011f-48a4-92c9-15b2bbcec321"> </a><a name="hc035e3de4-011f-48a4-92c9-15b2bbcec321"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PractitionerRole "035e3de4-011f-48a4-92c9-15b2bbcec321" </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/core//StructureDefinition-be-practitionerrole.html">BePractitionerRole</a></p></div><p><b>practitioner</b>: <a href="#Practitioner_8fc72085-d349-4bd7-ba84-91a935a4e3c6">See above (urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c6)</a></p><p><b>code</b>: physician <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/core//CodeSystem-cd-hcparty.html">BeCdHcParty</a>#persphysician)</span></p></div>
</text>
<practitioner>
<reference value="urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c6"/>
</practitioner>
<code>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
<code value="persphysician"/>
</coding>
</code>
</PractitionerRole>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c6"/>
<resource>
<Practitioner>
<id value="8fc72085-d349-4bd7-ba84-91a935a4e3c6"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_8fc72085-d349-4bd7-ba84-91a935a4e3c6"> </a><p><b>Generated Narrative: Practitioner</b><a name="8fc72085-d349-4bd7-ba84-91a935a4e3c6"> </a><a name="hc8fc72085-d349-4bd7-ba84-91a935a4e3c6"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Practitioner "8fc72085-d349-4bd7-ba84-91a935a4e3c6" </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/core//StructureDefinition-be-practitioner.html">BePractitioner</a></p></div><p><b>identifier</b>: <a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-nihdi.html" title="RIZIV/INAMI">BeNIHDINamingSystem</a>/19234011004</p><p><b>name</b>: Prénom du prescripteur Nom du prescripteur </p></div>
</text>
<identifier>
<!-- prescription - requestor - identifier -->
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
<value value="19234011004"/>
</identifier>
<name>
<family value="Nom du prescripteur"/>
<given value="Prénom du prescripteur"/>
</name>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:b3586cda-f1e5-4c58-a389-94249957d87a"/>
<resource>
<ServiceRequest>
<id value="b3586cda-f1e5-4c58-a389-94249957d87a"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-eattestationservicerequest"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="ServiceRequest_b3586cda-f1e5-4c58-a389-94249957d87a"> </a><p><b>Generated Narrative: ServiceRequest</b><a name="b3586cda-f1e5-4c58-a389-94249957d87a"> </a><a name="hcb3586cda-f1e5-4c58-a389-94249957d87a"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource ServiceRequest "b3586cda-f1e5-4c58-a389-94249957d87a" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-be-eattestationservicerequest.html">MyCareNet eAttestation ServiceRequest BE profile</a></p></div><p><b>BeExtPrescriptionRequesterStandard</b>: 1 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-requester-norm.html">Prescriber Standard</a>#1)</span></p><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>category</b>: Physical therapy procedure <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#91251008)</span></p><p><b>code</b>: Physical therapy procedure <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#91251008)</span></p><p><b>subject</b>: <a href="#Patient_a52efcb6-1f81-4333-a115-d45bd3183686">See above (urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686)</a></p><p><b>authoredOn</b>: 2015-07-14</p><p><b>requester</b>: <a href="#PractitionerRole_035e3de4-011f-48a4-92c9-15b2bbcec321">See above (urn:uuid:035e3de4-011f-48a4-92c9-15b2bbcec321)</a></p></div>
</text>
<extension
url="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-ext-prescription-requester-standard">
<!-- prescription requester standard for item -->
<valueCodeableConcept>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-requester-norm"/>
<code value="1"/>
</coding>
</valueCodeableConcept>
</extension>
<status value="active"/>
<intent value="order"/>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="91251008"/>
<display value="Physical therapy procedure"/>
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="91251008"/>
<display value="Physical therapy procedure"/>
</coding>
</code>
<subject>
<reference value="urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686"/>
</subject>
<!-- prescription - authoredOn -->
<authoredOn value="2015-07-14"/>
<requester>
<reference value="urn:uuid:035e3de4-011f-48a4-92c9-15b2bbcec321"/>
</requester>
</ServiceRequest>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c7"/>
<resource>
<Location>
<id value="8fc72085-d349-4bd7-ba84-91a935a4e3c7"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Location_8fc72085-d349-4bd7-ba84-91a935a4e3c7"> </a><p><b>Generated Narrative: Location</b><a name="8fc72085-d349-4bd7-ba84-91a935a4e3c7"> </a><a name="hc8fc72085-d349-4bd7-ba84-91a935a4e3c7"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Location "8fc72085-d349-4bd7-ba84-91a935a4e3c7" </p></div><p><b>managingOrganization</b>: <span><a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-nihdi.html" title="RIZIV/INAMI">BeNIHDINamingSystem</a>/19234011004</span></p></div>
</text>
<managingOrganization>
<identifier>
<!-- location - identifier -->
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
<value value="19234011004"/>
</identifier>
</managingOrganization>
</Location>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c8"/>
<resource>
<Location>
<id value="8fc72085-d349-4bd7-ba84-91a935a4e3c8"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Location_8fc72085-d349-4bd7-ba84-91a935a4e3c8"> </a><p><b>Generated Narrative: Location</b><a name="8fc72085-d349-4bd7-ba84-91a935a4e3c8"> </a><a name="hc8fc72085-d349-4bd7-ba84-91a935a4e3c8"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Location "8fc72085-d349-4bd7-ba84-91a935a4e3c8" </p></div><p><b>type</b>: 130 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-hospital-service-cd.html">Hospital Service Code</a>#130)</span></p><p><b>partOf</b>: <a href="#Location_8fc72085-d349-4bd7-ba84-91a935a4e3c7">See above (urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c7)</a></p></div>
</text>
<type>
<coding>
<!-- location department -->
<system
value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-hospital-service-cd"/>
<code value="130"/>
</coding>
</type>
<partOf>
<reference value="urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c7"/>
</partOf>
</Location>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"/>
<resource>
<Claim>
<id value="e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"/>
<meta>
<!-- new profile to create for the request -->
<profile
value="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-eattestation-claim"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Claim_e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"> </a><p><b>Generated Narrative: Claim</b><a name="e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"> </a><a name="hce85173bc-6f0d-480b-a2cd-2b70d9ffff7a"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Claim "e85173bc-6f0d-480b-a2cd-2b70d9ffff7a" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-be-eattestation-claim.html">MyCareNet eAttestation Claim BE profile</a></p></div><p><b>BeExtEAttestationSupplement</b>: <span title="Euro">€60.00</span> (EUR)</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claim-type.html">Claim Type Codes</a>#professional)</span></p><p><b>subType</b>: physiotherapy <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-be-cs-eattestation-types.html">Attestation types</a>#physiotherapy)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href="#Patient_a52efcb6-1f81-4333-a115-d45bd3183686">See above (urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686)</a></p><p><b>created</b>: 2015-07-14 11:15:30+0200</p><p><b>enterer</b>: <a href="#PractitionerRole_62c7bfad-0cb3-4a39-9abb-3a62e06de834">See above (urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834)</a></p><p><b>provider</b>: <a href="#PractitionerRole_62c7bfad-0cb3-4a39-9abb-3a62e06de834">See above (urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834)</a></p><p><b>priority</b>: Immediate <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-processpriority.html">Process Priority Codes</a>#stat)</span></p><h3>Payees</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style="display: none">*</td><td>Subscriber <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-payeetype.html">Payee Type Codes</a>#subscriber)</span></td><td><a href="#Patient_a52efcb6-1f81-4333-a115-d45bd3183686">See above (urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686)</a></td></tr></table><blockquote><p><b>careTeam</b></p><p><b>sequence</b>: 1</p><p><b>provider</b>: <span><a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-nihdi.html" title="RIZIV/INAMI">BeNIHDINamingSystem</a>/numéro inami du prestataire</span></p><p><b>role</b>: Other <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claimcareteamrole.html">Claim Care Team Role Codes</a>#other)</span></p><p><b>qualification</b>: physician <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/core//CodeSystem-cd-hcparty.html">BeCdHcParty</a>#persphysician)</span></p></blockquote><blockquote><p><b>careTeam</b></p><p><b>sequence</b>: 2</p><p><b>provider</b>: <span><a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-nihdi.html" title="RIZIV/INAMI">BeNIHDINamingSystem</a>/numéro inami du prestataire</span></p><p><b>role</b>: Assisting Provider <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claimcareteamrole.html">Claim Care Team Role Codes</a>#assist)</span></p><p><b>qualification</b>: physician <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/core//CodeSystem-cd-hcparty.html">BeCdHcParty</a>#persphysician)</span></p></blockquote><blockquote><p><b>careTeam</b></p><p><b>sequence</b>: 3</p><p><b>provider</b>: <span><a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-nihdi.html" title="RIZIV/INAMI">BeNIHDINamingSystem</a>/numéro inami du prestataire</span></p><p><b>role</b>: Assisting Provider <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claimcareteamrole.html">Claim Care Team Role Codes</a>#assist)</span></p><p><b>qualification</b>: oral dental hygienist <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/core//CodeSystem-cd-hcparty.html">BeCdHcParty</a>#persoraldentalhygienist)</span></p></blockquote><blockquote><p><b>careTeam</b></p><p><b>sequence</b>: 4</p><p><b>provider</b>: <span><a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-nihdi.html" title="RIZIV/INAMI">BeNIHDINamingSystem</a>/numéro inami du prestataire</span></p><p><b>role</b>: Primary provider <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claimcareteamrole.html">Claim Care Team Role Codes</a>#primary)</span></p><p><b>qualification</b>: physiotherapist <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/core//CodeSystem-cd-hcparty.html">BeCdHcParty</a>#persphysiotherapist)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: Information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: 0050 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-treatment-reason.html">Treatment Reason</a>#0050)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: Information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: 1 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-claim-norm-code.html">Claim Norm Code</a>#1)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: Information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: 000000 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (be-ns-claim-related-claim#000000)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 4</p><p><b>category</b>: Information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: 1 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-claim-transplantation-code.html">Claim Transplantation Code</a>#1)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 5</p><p><b>category</b>: Information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: 01 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-claim-exemption-code.html">Claim Exemption Code</a>#01)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 6</p><p><b>category</b>: Information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#info)</span></p><p><b>value</b>: <a href="#ServiceRequest_b3586cda-f1e5-4c58-a389-94249957d87a">See above (urn:uuid:b3586cda-f1e5-4c58-a389-94249957d87a)</a></p></blockquote><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td><span>: use of mandatory insurance coverage, no further details provided here.</span></td></tr></table><blockquote><p><b>item</b></p><p><b>BeExtEAttestationItemSupplement</b>: <span title="Euro">€60.00</span> (EUR)</p><p><b>BeExtEAttestationItemPreAuthRef</b>: preauthref number</p><blockquote><p><b>BeExtPatientIdentityDocument</b></p><blockquote><p><b>url</b></p><code>readingDate</code></blockquote><p><b>value</b>: 2015-07-14</p><blockquote><p><b>url</b></p><code>readingTime</code></blockquote><p><b>value</b>: 11:14:30</p><blockquote><p><b>url</b></p><code>entryType</code></blockquote><p><b>value</b>: 4 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-id-doc-input-type.html">Id Doc Input Type</a>#4)</span></p><blockquote><p><b>url</b></p><code>reasonManual</code></blockquote><p><b>value</b>: 2 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-id-doc-manual-input-justification.html">Id Doc Manual Input Justification</a>#2)</span></p><blockquote><p><b>url</b></p><code>medium</code></blockquote><p><b>value</b>: 1 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-id-doc-media-type.html">Id Doc Media Type</a>#1)</span></p><blockquote><p><b>url</b></p><code>stickerReason</code></blockquote><p><b>value</b>: 1 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-id-doc-vignette-use-justification.html">Id Doc Vignette Use Justification</a>#1)</span></p><blockquote><p><b>url</b></p><code>serialNumber</code></blockquote><p><b>value</b>: actual cardnumber as string</p></blockquote><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1, 2, 3, 4</p><p><b>informationSequence</b>: 2, 3, 4, 5, 6</p><p><b>productOrService</b>: 101032 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (be-ns-nihdi-nomenclature#101032)</span></p><p><b>serviced</b>: 2020-01-14</p><p><b>location</b>: <a href="#Location_8fc72085-d349-4bd7-ba84-91a935a4e3c7">See above (urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c7)</a></p><p><b>quantity</b>: 10</p><h3>UnitPrices</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>50</td><td>EUR</td></tr></table><h3>Nets</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>500</td><td>EUR</td></tr></table><p><b>bodySite</b>: Mandibular left first premolar tooth <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#2400006)</span></p></blockquote><h3>Totals</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>500</td><td>EUR</td></tr></table></div>
</text>
<extension
url="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-ext-eattestation-supplement">
<!-- supplement for eattest -->
<valueMoney>
<value value="60"/>
<currency value="EUR"/>
</valueMoney>
</extension>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="professional"/>
</coding>
</type>
<subType>
<!-- attestationType -->
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/eattestation/CodeSystem/be-cs-eattestation-types"/>
<code value="physiotherapy"/>
</coding>
</subType>
<use value="claim"/>
<patient>
<reference value="urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686"/>
</patient>
<created value="2015-07-14T11:15:30+02:00"/>
<enterer>
<reference value="urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834"/>
</enterer>
<provider>
<!-- provider for item -->
<reference value="urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834"/>
</provider>
<priority>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/processpriority"/>
<code value="stat"/>
</coding>
</priority>
<payee>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/payeetype"/>
<code value="subscriber"/>
</coding>
</type>
<party>
<reference value="urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686"/>
</party>
</payee>
<careTeam>
<!-- auxiliaryProvider: gmf manager -->
<sequence value="1"/>
<provider>
<identifier>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
<value value="numéro inami du prestataire"/>
</identifier>
</provider>
<role>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claimcareteamrole"/>
<code value="other"/>
</coding>
</role>
<qualification>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
<code value="persphysician"/>
</coding>
</qualification>
</careTeam>
<careTeam>
<!-- AuxiliaryProvider: trainee -->
<sequence value="2"/>
<provider>
<identifier>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
<value value="numéro inami du prestataire"/>
</identifier>
</provider>
<role>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claimcareteamrole"/>
<code value="assist"/>
</coding>
</role>
<qualification>
<!-- hcparty ? -->
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
<code value="persphysician"/>
</coding>
</qualification>
</careTeam>
<careTeam>
<!-- AuxiliaryProvider: oralHygienist -->
<sequence value="3"/>
<provider>
<identifier>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
<value value="numéro inami du prestataire"/>
</identifier>
</provider>
<role>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claimcareteamrole"/>
<code value="assist"/>
</coding>
</role>
<qualification>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
<code value="persoraldentalhygienist"/>
</coding>
</qualification>
</careTeam>
<careTeam>
<!-- service - Provider -->
<sequence value="4"/>
<provider>
<identifier>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
<value value="numéro inami du prestataire"/>
</identifier>
</provider>
<role>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claimcareteamrole"/>
<code value="primary"/>
</coding>
</role>
<qualification>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
<code value="persphysiotherapist"/>
</coding>
</qualification>
</careTeam>
<supportingInfo>
<!-- treatmentCauses for attest -->
<sequence value="1"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
<code value="info"/>
</coding>
</category>
<code>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-treatment-reason"/>
<code value="0050"/>
</coding>
</code>
</supportingInfo>
<supportingInfo>
<!-- standard (claim norm) for item -->
<sequence value="2"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
<code value="info"/>
</coding>
</category>
<code>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-claim-norm-code"/>
<code value="1"/>
</coding>
</code>
</supportingInfo>
<supportingInfo>
<!-- related (claim) for item -->
<sequence value="3"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
<code value="info"/>
</coding>
</category>
<code>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/NamingSystem/be-ns-claim-related-claim"/>
<code value="000000"/>
</coding>
</code>
</supportingInfo>
<supportingInfo>
<!-- transplantation for item -->
<sequence value="4"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
<code value="info"/>
</coding>
</category>
<code>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-claim-transplantation-code"/>
<code value="1"/>
</coding>
</code>
</supportingInfo>
<supportingInfo>
<!-- identical (exemption) for item -->
<sequence value="5"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
<code value="info"/>
</coding>
</category>
<code>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-claim-exemption-code"/>
<code value="01"/>
</coding>
</code>
</supportingInfo>
<supportingInfo>
<!-- prescription for item -->
<sequence value="6"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
<code value="info"/>
</coding>
</category>
<valueReference>
<reference value="urn:uuid:b3586cda-f1e5-4c58-a389-94249957d87a"/>
</valueReference>
</supportingInfo>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>
<display
value="use of mandatory insurance coverage, no further details provided here."/>
</coverage>
</insurance>
<!-- laterality for item
<bodySite>
<extension url="https://www.ehealth.fgov.be/standards/fhir/core-clinical/StructureDefinition/be-ext-laterality">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="419161000"/>
</valueCoding>
</extension>
</bodySite>
-->
<item>
<extension
url="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-ext-eattestation-item-supplement">
<!-- supplement for item -->
<valueMoney>
<value value="60"/>
<currency value="EUR"/>
</valueMoney>
</extension>
<extension
url="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-ext-eattestation-item-preauthref">
<!-- medicalAdvisorDecisionNr for item -->
<valueString value="preauthref number"/>
</extension>
<extension
url="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/StructureDefinition/be-ext-patientidentitydocument">
<!-- patientIdentityDocument for item -->
<extension url="readingDate">
<valueDate value="2015-07-14"/>
</extension>
<extension url="readingTime">
<valueTime value="11:14:30"/>
</extension>
<extension url="entryType">
<valueCodeableConcept>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-id-doc-input-type"/>
<code value="4"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="reasonManual">
<valueCodeableConcept>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-id-doc-manual-input-justification"/>
<code value="2"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="medium">
<valueCodeableConcept>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-id-doc-media-type"/>
<code value="1"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="stickerReason">
<valueCodeableConcept>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-id-doc-vignette-use-justification"/>
<code value="1"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="serialNumber">
<valueString value="actual cardnumber as string"/>
</extension>
</extension>
<sequence value="1"/>
<careTeamSequence value="1"/>
<careTeamSequence value="2"/>
<careTeamSequence value="3"/>
<careTeamSequence value="4"/>
<informationSequence value="2"/>
<informationSequence value="3"/>
<informationSequence value="4"/>
<informationSequence value="5"/>
<informationSequence value="6"/>
<productOrService>
<!-- identifier for item -->
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature"/>
<code value="101032"/>
</coding>
</productOrService>
<!-- date for item -->
<servicedDate value="2020-01-14"/>
<locationReference>
<!-- location for item -->
<reference value="urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c7"/>
</locationReference>
<!-- count for item -->
<quantity>
<value value="10"/>
</quantity>
<unitPrice>
<value value="50"/>
<currency value="EUR"/>
</unitPrice>
<net>
<!-- fee for item -->
<value value="500"/>
<currency value="EUR"/>
</net>
<bodySite>
<!-- toothNumber for item -->
<!-- Mandibular left first premolar tooth -->
<coding>
<system value="http://snomed.info/sct"/>
<code value="2400006"/>
</coding>
</bodySite>
</item>
<total>
<!-- totalFee for the whole attest -->
<value value="500"/>
<currency value="EUR"/>
</total>
</Claim>
</resource>
</entry>
</Bundle>
IG © 2023+ eHealth Platform. Package hl7.fhir.be.eattestation#1.0.0 based on FHIR 4.0.1. Generated 2024-03-14
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