ex02 - TTL Representation - Belgian MyCareNet eTariff Profiles v1.0.0

Belgian MyCareNet eTariff 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/etariff/ and changes regularly. See the Directory of published versions
: ex02 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Bundle ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "ex02"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-etariff-response"^^xsd:anyURI ;
fhir:link <https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-etariff-response>     ] )
  ] ; # 
  fhir:type [ fhir:v "message"] ; # 
  fhir:timestamp [ fhir:v "2015-07-14T11:15:37+02:00"^^xsd:dateTime] ; # 
  fhir:entry ( [
fhir:fullUrl [ fhir:v "urn:uuid:667b18ce-3d37-4581-9baa-6fada338038c"^^xsd:anyURI ] ;
    ( fhir:resource <urn:uuid:667b18ce-3d37-4581-9baa-6fada338038c> )
  ] [
fhir:fullUrl [ fhir:v "urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3"^^xsd:anyURI ] ;
    ( fhir:resource <urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3> )
  ] [
fhir:fullUrl [ fhir:v "urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931"^^xsd:anyURI ] ;
    ( fhir:resource <urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931> )
  ] [
fhir:fullUrl [ fhir:v "urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358"^^xsd:anyURI ] ;
    ( fhir:resource <urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358> )
  ] [
fhir:fullUrl [ fhir:v "urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686"^^xsd:anyURI ] ;
    ( fhir:resource <urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686> )
  ] [
fhir:fullUrl [ fhir:v "urn:uuid:5330da7f-db68-4380-a265-d364aeed8653"^^xsd:anyURI ] ;
    ( fhir:resource <urn:uuid:5330da7f-db68-4380-a265-d364aeed8653> )
  ] [
fhir:fullUrl [ fhir:v "urn:uuid:0a0d60df-0340-45a6-a493-a5d67f74d693"^^xsd:anyURI ] ;
    ( fhir:resource <urn:uuid:0a0d60df-0340-45a6-a493-a5d67f74d693> )
  ] ) . # 

<urn:uuid:667b18ce-3d37-4581-9baa-6fada338038c> a fhir:MessageHeader ;
  fhir:id [ fhir:v "667b18ce-3d37-4581-9baa-6fada338038c"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-messageheader"^^xsd:anyURI ;
fhir:link <https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-messageheader>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_667b18ce-3d37-4581-9baa-6fada338038c\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader 667b18ce-3d37-4581-9baa-6fada338038c</b></p><a name=\"667b18ce-3d37-4581-9baa-6fada338038c\"> </a><a name=\"hc667b18ce-3d37-4581-9baa-6fada338038c\"> </a><a name=\"667b18ce-3d37-4581-9baa-6fada338038c-en-US\"> </a><p><b>event</b>: <a href=\"https://build.fhir.org/ig/hl7-be/mycarenet/CodeSystem-message-events.html#message-events-etariffresponse-consult\">CodeSystem message events</a> etariffresponse-consult: etariffresponse-consult</p><h3>Destinations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Endpoint</b></td><td><b>Receiver</b></td></tr><tr><td style=\"display: none\">*</td><td>urn:be:fgov:person:ssin:ehealth:1.0:doctor:nihii11:19234011004</td><td><a href=\"Bundle-ex02.html#urn-uuid-1dc5d974-5447-4afe-a4ab-57081ca518c3\">Bundle: type = message; timestamp = 2015-07-14 11:15:37+0200</a></td></tr></table><p><b>sender</b>: <a href=\"Bundle-ex02.html#urn-uuid-cfabb40d-a53f-4c56-bc19-725ea669b358\">Bundle: type = message; timestamp = 2015-07-14 11:15:37+0200</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>urn:be:fgov:kbo-bce:organization:cbe-number:0411724220</td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>267b18ce-3d37-4581-9baa-6fada338038b</td><td>OK</td></tr></table><p><b>focus</b>: <a href=\"Bundle-ex02.html#urn-uuid-0a0d60df-0340-45a6-a493-a5d67f74d693\">Bundle: type = message; timestamp = 2015-07-14 11:15:37+0200</a></p></div>"
  ] ; # 
  fhir:event [
a fhir:Coding ;
fhir:system [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events"^^xsd:anyURI ] ;
fhir:code [ fhir:v "etariffresponse-consult" ]
  ] ; # 
  fhir:destination ( [
fhir:endpoint [ fhir:v "urn:be:fgov:person:ssin:ehealth:1.0:doctor:nihii11:19234011004"^^xsd:anyURI ] ;
fhir:receiver [
fhir:reference [ fhir:v "urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3" ]     ]
  ] ) ; # 
  fhir:sender [
fhir:reference [ fhir:v "urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358" ]
  ] ; # 
  fhir:source [
fhir:endpoint [ fhir:v "urn:be:fgov:kbo-bce:organization:cbe-number:0411724220"^^xsd:anyURI ]
  ] ; # 
  fhir:response [
fhir:identifier [ fhir:v "267b18ce-3d37-4581-9baa-6fada338038b" ] ;
fhir:code [ fhir:v "ok" ]
  ] ; # 
  fhir:focus ( [
fhir:reference [ fhir:v "urn:uuid:0a0d60df-0340-45a6-a493-a5d67f74d693" ]
  ] ) . # 

<urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3> a fhir:PractitionerRole ;
  fhir:id [ fhir:v "1dc5d974-5447-4afe-a4ab-57081ca518c3"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"^^xsd:anyURI ;
fhir:link <https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"PractitionerRole_1dc5d974-5447-4afe-a4ab-57081ca518c3\"> </a><p class=\"res-header-id\"><b>Generated Narrative: PractitionerRole 1dc5d974-5447-4afe-a4ab-57081ca518c3</b></p><a name=\"1dc5d974-5447-4afe-a4ab-57081ca518c3\"> </a><a name=\"hc1dc5d974-5447-4afe-a4ab-57081ca518c3\"> </a><a name=\"1dc5d974-5447-4afe-a4ab-57081ca518c3-en-US\"> </a><p><b>practitioner</b>: <a href=\"Bundle-ex01.html#urn-uuid-03972cc4-d781-4285-8d79-0f05810e1931\">Bundle: type = message; timestamp = 2015-07-14 11:15:33+0200</a></p><p><b>code</b>: <span title=\"Codes:{https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty persphysician}\">physician</span></p></div>"
  ] ; # 
  fhir:practitioner [
fhir:reference [ fhir:v "urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931" ]
  ] ; # 
  fhir:code ( [
    ( fhir:coding [
fhir:system [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"^^xsd:anyURI ] ;
fhir:code [ fhir:v "persphysician" ]     ] )
  ] ) . # 

<urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931> a fhir:Practitioner ;
  fhir:id [ fhir:v "03972cc4-d781-4285-8d79-0f05810e1931"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"^^xsd:anyURI ;
fhir:link <https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_03972cc4-d781-4285-8d79-0f05810e1931\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner 03972cc4-d781-4285-8d79-0f05810e1931</b></p><a name=\"03972cc4-d781-4285-8d79-0f05810e1931\"> </a><a name=\"hc03972cc4-d781-4285-8d79-0f05810e1931\"> </a><a name=\"03972cc4-d781-4285-8d79-0f05810e1931-en-US\"> </a><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>: John Smith </p></div>"
  ] ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"^^xsd:anyURI ] ;
fhir:value [ fhir:v "19234011004" ]
  ] ) ; # 
  fhir:name ( [
fhir:family [ fhir:v "Smith" ] ;
    ( fhir:given [ fhir:v "John" ] )
  ] ) . # 

<urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358> a fhir:Organization ;
  fhir:id [ fhir:v "cfabb40d-a53f-4c56-bc19-725ea669b358"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization"^^xsd:anyURI ;
fhir:link <https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_cfabb40d-a53f-4c56-bc19-725ea669b358\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization cfabb40d-a53f-4c56-bc19-725ea669b358</b></p><a name=\"cfabb40d-a53f-4c56-bc19-725ea669b358\"> </a><a name=\"hccfabb40d-a53f-4c56-bc19-725ea669b358\"> </a><a name=\"cfabb40d-a53f-4c56-bc19-725ea669b358-en-US\"> </a><p><b>identifier</b>: <a href=\"https://build.fhir.org/ig/hl7-be/core/NamingSystem-be-insurancenumber.html\" title=\"the identification number of a mutual insurance association (mutualité) as “a not-for-profit association, which, with foresight, assistance and solidarity aims to promote the physical, mental and social well-being of its members” (The Belgian law of 6 August 1990)\">BeInsuranceNumberNamingSystem</a>/300</p><p><b>name</b>: Union Nationale des Mutualités Socialistes - Nationaal Verbond van de Socialistische Mutualiteiten</p></div>"
  ] ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancenumber"^^xsd:anyURI ] ;
fhir:value [ fhir:v "300" ]
  ] ) ; # 
  fhir:name [ fhir:v "Union Nationale des Mutualités Socialistes - Nationaal Verbond van de Socialistische Mutualiteiten"] . # 

<urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686> a fhir:Patient ;
  fhir:id [ fhir:v "a52efcb6-1f81-4333-a115-d45bd3183686"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient"^^xsd:anyURI ;
fhir:link <https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_a52efcb6-1f81-4333-a115-d45bd3183686\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient a52efcb6-1f81-4333-a115-d45bd3183686</b></p><a name=\"a52efcb6-1f81-4333-a115-d45bd3183686\"> </a><a name=\"hca52efcb6-1f81-4333-a115-d45bd3183686\"> </a><a name=\"a52efcb6-1f81-4333-a115-d45bd3183686-en-US\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Jean Dupont  Male, DoB Unknown ( https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin#BeSSINNamingSystem#73031805784)</p><hr/></div>"
  ] ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin"^^xsd:anyURI ] ;
fhir:value [ fhir:v "73031805784" ]
  ] ) ; # 
  fhir:name ( [
fhir:family [ fhir:v "Dupont" ] ;
    ( fhir:given [ fhir:v "Jean" ] )
  ] ) ; # 
  fhir:gender [ fhir:v "male"] . # 

<urn:uuid:5330da7f-db68-4380-a265-d364aeed8653> a fhir:Coverage ;
  fhir:id [ fhir:v "5330da7f-db68-4380-a265-d364aeed8653"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-mycarenet-coverage"^^xsd:anyURI ;
fhir:link <https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-mycarenet-coverage>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_5330da7f-db68-4380-a265-d364aeed8653\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage 5330da7f-db68-4380-a265-d364aeed8653</b></p><a name=\"5330da7f-db68-4380-a265-d364aeed8653\"> </a><a name=\"hc5330da7f-db68-4380-a265-d364aeed8653\"> </a><a name=\"5330da7f-db68-4380-a265-d364aeed8653-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode PUBLICPOL}\">public healthcare</span></p><p><b>beneficiary</b>: <a href=\"Bundle-ex01.html#urn-uuid-a52efcb6-1f81-4333-a115-d45bd3183686\">Bundle: type = message; timestamp = 2015-07-14 11:15:33+0200</a></p><p><b>payor</b>: <a href=\"Bundle-ex02.html#urn-uuid-cfabb40d-a53f-4c56-bc19-725ea669b358\">Bundle: type = message; timestamp = 2015-07-14 11:15:37+0200</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></p><p><b>value</b>: Mandatory Health Insurance</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class subplan}\">SubPlan</span></p><p><b>value</b>: 110</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class subplan}\">SubPlan</span></p><p><b>value</b>: 150</p></blockquote></div>"
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PUBLICPOL" ]     ] )
  ] ; # 
  fhir:beneficiary [
fhir:reference [ fhir:v "urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686" ]
  ] ; # 
  fhir:payor ( [
fhir:reference [ fhir:v "urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358" ]
  ] ) ; # 
  fhir:class ( [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
fhir:code [ fhir:v "plan" ]       ] )     ] ;
fhir:value [ fhir:v "Mandatory Health Insurance" ]
  ] [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
fhir:code [ fhir:v "subplan" ]       ] )     ] ;
fhir:value [
fhir:v "110" ;
      ( fhir:extension [
fhir:url [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system"^^xsd:anyURI ] ;
fhir:value [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1"^^xsd:anyURI ]       ] )     ]
  ] [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
fhir:code [ fhir:v "subplan" ]       ] )     ] ;
fhir:value [
fhir:v "150" ;
      ( fhir:extension [
fhir:url [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system"^^xsd:anyURI ] ;
fhir:value [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2"^^xsd:anyURI ]       ] )     ]
  ] ) . # 

<urn:uuid:0a0d60df-0340-45a6-a493-a5d67f74d693> a fhir:ClaimResponse ;
  fhir:id [ fhir:v "0a0d60df-0340-45a6-a493-a5d67f74d693"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-etariff-claimresponse"^^xsd:anyURI ;
fhir:link <https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-etariff-claimresponse>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_0a0d60df-0340-45a6-a493-a5d67f74d693\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse 0a0d60df-0340-45a6-a493-a5d67f74d693</b></p><a name=\"0a0d60df-0340-45a6-a493-a5d67f74d693\"> </a><a name=\"hc0a0d60df-0340-45a6-a493-a5d67f74d693\"> </a><a name=\"0a0d60df-0340-45a6-a493-a5d67f74d693-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>subType</b>: <span title=\"Codes:{https://www.ehealth.fgov.be/standards/fhir/etariff/CodeSystem/be-cs-etariff-types generalpractice}\">generalpractice</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Bundle-ex01.html#urn-uuid-a52efcb6-1f81-4333-a115-d45bd3183686\">Bundle: type = message; timestamp = 2015-07-14 11:15:33+0200</a></p><p><b>created</b>: 2015-07-14 11:15:30+0200</p><p><b>insurer</b>: <a href=\"Bundle-ex02.html#urn-uuid-cfabb40d-a53f-4c56-bc19-725ea669b358\">Bundle: type = message; timestamp = 2015-07-14 11:15:37+0200</a></p><p><b>requestor</b>: <a href=\"Bundle-ex02.html#urn-uuid-1dc5d974-5447-4afe-a4ab-57081ca518c3\">Bundle: type = message; timestamp = 2015-07-14 11:15:37+0200</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>addItem</b></p><p><b>BeExtItemReimbursement</b>: <span title=\"Euro\">€45.00</span> (EUR)</p><p><b>BeExtItemPatientFee</b>: <span title=\"Euro\">€5.00</span> (EUR)</p><p><b>BeExtEtariffItemCommitment</b>: etarif commitment number</p><p><b>itemSequence</b>: 1</p><p><b>provider</b>: <a href=\"Bundle-ex02.html#urn-uuid-1dc5d974-5447-4afe-a4ab-57081ca518c3\">Bundle: type = message; timestamp = 2015-07-14 11:15:37+0200</a></p><p><b>productOrService</b>: <span title=\"Codes:{https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature 101032}\">101032</span></p><p><b>serviced</b>: 2020-01-14</p><p><b>quantity</b>: 1</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>Euro</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>50</td><td>Euro</td></tr></table><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td><td><b>Reason</b></td></tr><tr><td style=\"display: none\">*</td><td>, </td><td><span title=\"Codes:{https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values refusal}\">refusal</span></td><td><span title=\"Codes:{https://www.ehealth.fgov.be/standards/fhir/etariff/CodeSystem/be-cs-refusal-values 001}\">Renewal period not yet expired</span></td></tr></table></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><a href=\"Bundle-ex02.html#urn-uuid-5330da7f-db68-4380-a265-d364aeed8653\">Bundle: type = message; timestamp = 2015-07-14 11:15:37+0200</a></td></tr></table></div>"
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "professional" ]     ] )
  ] ; # 
  fhir:subType [
    ( fhir:coding [
fhir:system [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/etariff/CodeSystem/be-cs-etariff-types"^^xsd:anyURI ] ;
fhir:code [ fhir:v "generalpractice" ]     ] ) #  attestationType 
  ] ; # 
  fhir:use [ fhir:v "predetermination"] ; # 
  fhir:patient [
fhir:reference [ fhir:v "urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686" ]
  ] ; # 
  fhir:created [ fhir:v "2015-07-14T11:15:30+02:00"^^xsd:dateTime] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358" ]
  ] ; # 
  fhir:requestor [
fhir:reference [ fhir:v "urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:addItem ( [
    ( fhir:extension [
fhir:url [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement"^^xsd:anyURI ] ;
fhir:value [
a fhir:Money ;
fhir:value [ fhir:v "45.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "EUR" ]       ] #  reimbursement for item      ] [
fhir:url [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee"^^xsd:anyURI ] ;
fhir:value [
a fhir:Money ;
fhir:value [ fhir:v "5.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "EUR" ]       ] #  patientfee for item      ] [
fhir:url [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-item-commitment"^^xsd:anyURI ] ;
fhir:value [ fhir:v "etarif commitment number" ] #  commitment for item      ] ) ;
    ( fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
    ( fhir:provider [
fhir:reference [ fhir:v "urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3" ] #  healthcare provider      ] ) ;
fhir:productOrService [
      ( fhir:coding [
fhir:system [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature"^^xsd:anyURI ] ;
fhir:code [ fhir:v "101032" ]       ] ) #  service identifier for item      ] ;
fhir:serviced [ fhir:v "2020-01-14"^^xsd:date ] ; #  date for item 
fhir:quantity [
fhir:value [ fhir:v "1"^^xsd:decimal ]     ] ; #  count for item 
fhir:unitPrice [
fhir:value [ fhir:v "50"^^xsd:decimal ] ;
fhir:currency [ fhir:v "EUR" ]     ] ;
fhir:net [
fhir:value [ fhir:v "50"^^xsd:decimal ] ; #  fee for item 
fhir:currency [ fhir:v "EUR" ]     ] ;
    ( fhir:adjudication [
      ( fhir:extension [
fhir:url [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
          ( fhir:coding [
fhir:system [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature"^^xsd:anyURI ] ;
fhir:code [ fhir:v "101045" ]           ] )         ] #  refusal service identifier for adjudication        ] [
fhir:url [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalservicedate"^^xsd:anyURI ] ;
fhir:value [ fhir:v "2020-01-01"^^xsd:date ] #  refusal service date for adjudication        ] ) ;
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values"^^xsd:anyURI ] ;
fhir:code [ fhir:v "refusal" ]         ] ) #  or tariff        ] ;
fhir:reason [
        ( fhir:coding [
fhir:system [ fhir:v "https://www.ehealth.fgov.be/standards/fhir/etariff/CodeSystem/be-cs-refusal-values"^^xsd:anyURI ] ;
fhir:code [ fhir:v "001" ]         ] )       ]     ] )
  ] ) ; # 
  fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
fhir:coverage [
fhir:reference [ fhir:v "urn:uuid:5330da7f-db68-4380-a265-d364aeed8653" ]     ]
  ] ) . #