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SQL (for debugging): Insert into SearchEntries Select 25907, Ids.ResourceKey, Versions.ResourceVersionKey, RIGHT ('0000000000000'+CAST(Versions.ResourceVersionKey AS VARCHAR(14)),14) as sort, null, null from Versions, Ids, Sessions where Ids.ResourceTypeKey = 17 and Versions.ResourceKey = Ids.ResourceKey and Versions.SessionKey = Sessions.SessionKey order by ResourceVersionKey DESC

Claim 960153 deleted

Deleted by ANONYMOUS (Unknown) at 1/4/2018 4:58:04 PM(UTC) (Audit)

Claim 960153 deleted

Deleted by ANONYMOUS (Unknown) at 1/4/2018 4:58:03 PM(UTC) (Audit)

Claim "960153" Version "2"

Updated by ANONYMOUS (Unknown) at 1/4/2018 4:57:38 PM(UTC) (Audit)

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This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

1TdkybTo++AJ4DB409/Ihw==

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</Claim>

Claim "960153" Version "1"

Created by ANONYMOUS (Unknown) at 1/4/2018 4:57:37 PM(UTC) (Audit)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

WY1NG+y0/YDcw1rnHsO5Dg==

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        <value value="2Uj+g//ZFx37jLsuszV6gg=="/>
      </identifier>
      <display value="Procedure zTCbO9dC5D6q/mGFdKBDXw=="/>
    </procedureReference>
  </procedure>
  <insurance>
    <sequence value="41"/>
    <focal value="false"/>
    <coverage>
      <identifier>
        <use value="secondary"/>
        <system value="http://projectcrucible.org/uDwS3p5z9zcSrPq/SIZMLA=="/>
        <value value="Teb2NQNBVKXrVhD2WmycFg=="/>
      </identifier>
      <display value="Coverage Y3hm7e3w0ZhWQEcooGsYdQ=="/>
    </coverage>
    <businessArrangement value="y+hHrG01aHTBwNSc+BPESQ=="/>
    <preAuthRef value="yY7cU34RwU3wmq93G8nldQ=="/>
    <claimResponse>
      <identifier>
        <use value="usual"/>
        <system value="http://projectcrucible.org/GRv1+bwyzcqSxU0ypi3OkQ=="/>
        <value value="74PIJJ44SjBXhiJMBWDKbA=="/>
      </identifier>
      <display value="ClaimResponse 8VVLBOO9C1XWVMqDYFRJLA=="/>
    </claimResponse>
  </insurance>
  <accident>
    <date value="2018-01-04"/>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/v3/ActCode"/>
        <code value="MVA"/>
        <display value="Motor vehicle accident"/>
        <userSelected value="false"/>
      </coding>
      <text value="l3CKWHbDsCEucxIDp6DSJQ=="/>
    </type>
    <locationReference>
      <identifier>
        <use value="official"/>
        <system value="http://projectcrucible.org/o4qWMAStNQSRp6C8dj2UcA=="/>
        <value value="qdwk++zV+DiuTxE+YLzLsQ=="/>
      </identifier>
      <display value="Location YthIuLd7rqQNQwHeeUT/3g=="/>
    </locationReference>
  </accident>
  <employmentImpacted>
    <start value="2018-01-04T11:57:36.758Z"/>
    <end value="2018-01-04T11:57:36.758Z"/>
  </employmentImpacted>
  <hospitalization>
    <start value="2018-01-04T11:57:36.758Z"/>
    <end value="2018-01-04T11:57:36.758Z"/>
  </hospitalization>
  <item>
    <sequence value="8"/>
    <careTeamLinkId value="35"/>
    <diagnosisLinkId value="75"/>
    <procedureLinkId value="94"/>
    <informationLinkId value="67"/>
    <revenue>
      <coding>
        <system value="http://hl7.org/fhir/ex-revenue-center"/>
        <code value="0452"/>
        <display value="Emergency Room - beyond EMTALA"/>
        <userSelected value="false"/>
      </coding>
      <text value="buwJI9l30eRAH/iMH9Wiag=="/>
    </revenue>
    <category>
      <coding>
        <system value="http://hl7.org/fhir/benefit-subcategory"/>
        <code value="35"/>
      </coding>
    </category>
    <service>
      <coding>
        <system value="http://hl7.org/fhir/ex-USCLS"/>
        <code value="21211"/>
        <display value="Amalgam, 1 surface"/>
        <userSelected value="true"/>
      </coding>
      <text value="ZlAZuLV9weFT5OVOymgfwg=="/>
    </service>
    <modifier>
      <coding>
        <system value="http://hl7.org/fhir/modifiers"/>
        <code value="rooh"/>
        <display value="Rush or Outside of office hours"/>
        <userSelected value="false"/>
      </coding>
      <text value="S3mPiU3cQdQzzOLWI2clXQ=="/>
    </modifier>
    <programCode>
      <coding>
        <system value="http://hl7.org/fhir/ex-programcode"/>
        <code value="hd"/>
        <display value="Heamodialisis"/>
        <userSelected value="true"/>
      </coding>
      <text value="x9lfsfROrpyBEUFXTv4NqQ=="/>
    </programCode>
    <servicedDate value="2018-01-04"/>
    <locationCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/ex-serviceplace"/>
        <code value="21"/>
        <display value="Inpatient Hospital"/>
        <userSelected value="true"/>
      </coding>
      <text value="gPpDFLTUS0LYido4rlEA/g=="/>
    </locationCodeableConcept>
    <quantity>
      <value value="0.7556106005109215"/>
      <comparator value="&gt;="/>
      <unit value="2sEnId2+Q6tz+L0hWmr2/g=="/>
      <system value="http://projectcrucible.org/eRwkhOqoBQ1JOfYl2Jpn/w=="/>
      <code value="9iwLAG29U0Ugqx8hrpfudg=="/>
    </quantity>
    <unitPrice>
      <value value="0.5159979566404613"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <factor value="0.698226783593601"/>
    <net>
      <value value="0.3713173777226776"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <udi>
      <identifier>
        <use value="temp"/>
        <system value="http://projectcrucible.org/MrLVZCaKVUL2z2WSTSKobg=="/>
        <value value="EF5dm1moRFoRBazoVXeO4A=="/>
      </identifier>
      <display value="Device 5qmml1EYg/d+aUgQt2x7pg=="/>
    </udi>
    <bodySite>
      <coding>
        <system value="http://hl7.org/fhir/ex-tooth"/>
        <code value="32"/>
        <display value="32"/>
        <userSelected value="false"/>
      </coding>
      <text value="avLzaqipYAapSJXjfKJNMA=="/>
    </bodySite>
    <subSite>
      <coding>
        <system value="http://hl7.org/fhir/FDI-surface"/>
        <code value="M"/>
        <display value="Mesial"/>
        <userSelected value="true"/>
      </coding>
      <text value="1VI4fImOJptC3L50l3JlVA=="/>
    </subSite>
    <encounter>
      <identifier>
        <use value="usual"/>
        <system value="http://projectcrucible.org/h4oi/nXATbiHzrbg4xe0/g=="/>
        <value value="kWvPspWqnyNSyaZK+1CdWw=="/>
      </identifier>
      <display value="Encounter jlXnNcc7QZlrtYy4EnAqVg=="/>
    </encounter>
    <detail>
      <sequence value="86"/>
      <revenue>
        <text value="HszTliKa0M6b91Q9fy1GTg=="/>
      </revenue>
      <category>
        <coding>
          <system value="http://hl7.org/fhir/benefit-subcategory"/>
          <code value="35"/>
        </coding>
      </category>
      <service>
        <text value="a23BdwE04pCHXzFmp4bTfQ=="/>
      </service>
      <modifier>
        <text value="mNKKM2tcQROJYj+PVQYqvg=="/>
      </modifier>
      <programCode>
        <text value="M2ehhv9HyIWEmOlXZ3oI1A=="/>
      </programCode>
      <quantity>
        <value value="0.4248283000892742"/>
        <comparator value="&lt;="/>
        <unit value="G3Rvp3vl1ElFnxpeBXD8WQ=="/>
        <system value="http://projectcrucible.org/o3ox4PJxO/MYgfSmIctrkw=="/>
        <code value="P3ZFt9quHr7NOslqEjNo0w=="/>
      </quantity>
      <unitPrice>
        <value value="0.88159967037136"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <factor value="0.40894160318474015"/>
      <net>
        <value value="0.2891489024810181"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
      <udi>
        <display value="Device mBBERA6BG0bNASsjEr0mHg=="/>
      </udi>
      <subDetail>
        <sequence value="17"/>
        <category>
          <coding>
            <system value="http://hl7.org/fhir/benefit-subcategory"/>
            <code value="35"/>
          </coding>
        </category>
        <service>
          <coding>
            <system value="http://hl7.org/fhir/ex-USCLS"/>
            <code value="1205"/>
          </coding>
        </service>
        <factor value="0.23763613975716624"/>
      </subDetail>
    </detail>
  </item>
  <total>
    <value value="0.7491521502888018"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="USD"/>
  </total>
</Claim>

Claim 100153 deleted

Deleted by ANONYMOUS (Unknown) at 1/4/2018 4:55:09 PM(UTC) (Audit)

Claim 100152 deleted

Deleted by ANONYMOUS (Unknown) at 1/4/2018 4:52:00 PM(UTC) (Audit)

Claim 100151 deleted

Deleted by ANONYMOUS (Unknown) at 1/4/2018 4:37:02 PM(UTC) (Audit)

Claim 100150 deleted

Deleted by ANONYMOUS (Unknown) at 1/4/2018 4:22:07 PM(UTC) (Audit)

Claim "960152" Version "4"

Updated by ANONYMOUS (Unknown) at 12/18/2017 3:31:33 PM(UTC) (Audit)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by


<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="960152"/>
  <meta>
    <versionId value="4"/>
    <lastUpdated value="2017-12-18T15:31:33Z"/>
  </meta>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="professional"/>
    </coding>
    <coding>
      <system value="http://fhir.agembi.com/CodeSystem/ega-claimtypes-de"/>
      <code value="zahn"/>
      <display value="Zahn&#228;rztliche Abrechnung"/>
    </coding>
    <text value="Zahn&#228;rztliche Abrechnung"/>
  </type>
  <billablePeriod>
    <start value="2014-01-01"/>
    <end value="2014-03-31"/>
  </billablePeriod>
  <provider>
    <reference value="p0001"/>
  </provider>
  <information>
    <sequence value="1"/>
    <category>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-category"/>
        <code value="behandlungsplan"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-code"/>
        <code value="behandlungsplan-dauer"/>
      </coding>
    </code>
    <timingPeriod>
      <start value="2017-01-01"/>
      <end value="2017-02-12"/>
    </timingPeriod>
  </information>
  <information>
    <sequence value="2"/>
    <category>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-category"/>
        <code value="behandlungsplan"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-code"/>
        <code value="behandlungsplan-ausstellungsdatum"/>
      </coding>
    </code>
    <timingDate value="2017-01-01"/>
  </information>
  <item>
    <sequence value="1"/>
    <service>
      <text value="Eigenlaborkosten"/>
    </service>
    <net>
      <value value="200.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="2"/>
    <service>
      <text value="Fremdlaborkosten"/>
    </service>
    <net>
      <value value="150.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="3"/>
    <service>
      <text value="Kundenanteil"/>
    </service>
    <net>
      <value value="100.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="4"/>
    <service>
      <text value="Kassenzuschuss"/>
    </service>
    <net>
      <value value="300.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="5"/>
    <service>
      <text value="Sonstige Kosten"/>
    </service>
    <net>
      <value value="10.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="6"/>
    <service>
      <text value="Honorarkosten"/>
    </service>
    <net>
      <value value="200.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="7"/>
    <service>
      <coding>
        <system value="http://fhir.agembi.com/DummyUri/claim-servicecodes-xx"/>
        <code value="01"/>
        <display value="Beratung"/>
      </coding>
      <text value="Beratung"/>
    </service>
    <servicedDate value="2010-11-03"/>
    <quantity>
      <value value="1"/>
    </quantity>
    <encounter>
      <reference value="e0001"/>
    </encounter>
  </item>
  <total>
    <value value="160.00"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="EUR"/>
  </total>
</Claim>

Claim "960152" Version "3"

Updated by ANONYMOUS (Unknown) at 12/18/2017 3:30:55 PM(UTC) (Audit)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by


<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="960152"/>
  <meta>
    <versionId value="3"/>
    <lastUpdated value="2017-12-18T15:30:55Z"/>
  </meta>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="professional"/>
    </coding>
    <coding>
      <system value="http://fhir.agembi.com/CodeSystem/ega-claimtypes-de"/>
      <code value="zahn"/>
      <display value="Zahn&#228;rztliche Abrechnung"/>
    </coding>
    <text value="Zahn&#228;rztliche Abrechnung"/>
  </type>
  <billablePeriod>
    <start value="2014-01-01"/>
    <end value="2014-03-31"/>
  </billablePeriod>
  <provider>
    <reference value="p0001"/>
  </provider>
  <information>
    <sequence value="1"/>
    <category>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-category"/>
        <code value="behandlungsplan"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-code"/>
        <code value="behandlungsplan-dauer"/>
      </coding>
    </code>
    <timingPeriod>
      <start value="2017-01-01"/>
      <end value="2017-02-12"/>
    </timingPeriod>
  </information>
  <information>
    <sequence value="2"/>
    <category>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-category"/>
        <code value="behandlungsplan"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-code"/>
        <code value="behandlungsplan-ausstellungsdatum"/>
      </coding>
    </code>
    <timingDate value="2017-01-01"/>
  </information>
  <item>
    <sequence value="1"/>
    <service>
      <text value="Eigenlaborkosten"/>
    </service>
    <net>
      <value value="200.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="2"/>
    <service>
      <text value="Fremdlaborkosten"/>
    </service>
    <net>
      <value value="150.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="3"/>
    <service>
      <text value="Kundenanteil"/>
    </service>
    <net>
      <value value="100.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="4"/>
    <service>
      <text value="Kassenzuschuss"/>
    </service>
    <net>
      <value value="300.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="5"/>
    <service>
      <text value="Sonstige Kosten"/>
    </service>
    <net>
      <value value="10.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="6"/>
    <service>
      <text value="Honorarkosten"/>
    </service>
    <net>
      <value value="200.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="7"/>
    <service>
      <coding>
        <system value="http://fhir.agembi.com/DummyUri/claim-servicecodes-xx"/>
        <code value="01"/>
        <display value="Beratung"/>
      </coding>
      <text value="Beratung"/>
    </service>
    <servicedDate value="2010-11-03"/>
    <quantity>
      <value value="1"/>
    </quantity>
    <encounter>
      <reference value="e0001"/>
    </encounter>
  </item>
  <total>
    <value value="160.00"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="EUR"/>
  </total>
</Claim>

Claim "960152" Version "2"

Updated by ANONYMOUS (Unknown) at 12/18/2017 3:25:38 PM(UTC) (Audit)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by


<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="960152"/>
  <meta>
    <versionId value="2"/>
    <lastUpdated value="2017-12-18T15:25:38Z"/>
  </meta>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="professional"/>
    </coding>
    <coding>
      <system value="http://fhir.agembi.com/CodeSystem/ega-claimtypes-de"/>
      <code value="zahn"/>
      <display value="Zahn&#228;rztliche Abrechnung"/>
    </coding>
    <text value="Zahn&#228;rztliche Abrechnung"/>
  </type>
  <billablePeriod>
    <start value="2014-01-01"/>
    <end value="2014-03-31"/>
  </billablePeriod>
  <provider>
    <reference value="p0001"/>
  </provider>
  <information>
    <sequence value="1"/>
    <category>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-category"/>
        <code value="behandlungsplan"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-code"/>
        <code value="behandlungsplan-dauer"/>
      </coding>
    </code>
    <timingPeriod>
      <start value="2017-01-01"/>
      <end value="2017-02-12"/>
    </timingPeriod>
  </information>
  <information>
    <sequence value="1"/>
    <category>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-category"/>
        <code value="behandlungsplan"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://fhir.agembi.com/CodeSystem/claim-information-code"/>
        <code value="behandlungsplan-ausstellungsdatum"/>
      </coding>
    </code>
    <timingDate value="2017-01-01"/>
  </information>
  <item>
    <sequence value="1"/>
    <service>
      <text value="Eigenlaborkosten"/>
    </service>
    <net>
      <value value="200.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="2"/>
    <service>
      <text value="Fremdlaborkosten"/>
    </service>
    <net>
      <value value="150.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="3"/>
    <service>
      <text value="Kundenanteil"/>
    </service>
    <net>
      <value value="100.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="4"/>
    <service>
      <text value="Kassenzuschuss"/>
    </service>
    <net>
      <value value="300.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="5"/>
    <service>
      <text value="Sonstige Kosten"/>
    </service>
    <net>
      <value value="10.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="6"/>
    <service>
      <text value="Honorarkosten"/>
    </service>
    <net>
      <value value="200.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="7"/>
    <service>
      <coding>
        <system value="http://fhir.agembi.com/DummyUri/claim-servicecodes-xx"/>
        <code value="01"/>
        <display value="Beratung"/>
      </coding>
      <text value="Beratung"/>
    </service>
    <servicedDate value="2010-11-03"/>
    <quantity>
      <value value="1"/>
    </quantity>
    <encounter>
      <reference value="e0001"/>
    </encounter>
  </item>
  <total>
    <value value="160.00"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="EUR"/>
  </total>
</Claim>

Claim "960152" Version "1"

Created by ANONYMOUS (Unknown) at 12/18/2017 3:17:08 PM(UTC) (Audit)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by


<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="960152"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-12-18T15:17:08Z"/>
  </meta>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="professional"/>
    </coding>
    <text value="Zahn&#228;rztliche Abrechnung"/>
  </type>
  <billablePeriod>
    <start value="2014-01-01"/>
    <end value="2014-03-31"/>
  </billablePeriod>
  <provider>
    <reference value="p0001"/>
  </provider>
  <item>
    <sequence value="1"/>
    <service>
      <text value="Eigenlaborkosten"/>
    </service>
    <net>
      <value value="200.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="2"/>
    <service>
      <text value="Fremdlaborkosten"/>
    </service>
    <net>
      <value value="150.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="3"/>
    <service>
      <text value="Kundenanteil"/>
    </service>
    <net>
      <value value="100.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="4"/>
    <service>
      <text value="Kassenzuschuss"/>
    </service>
    <net>
      <value value="300.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="5"/>
    <service>
      <text value="Sonstige Kosten"/>
    </service>
    <net>
      <value value="10.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="6"/>
    <service>
      <text value="Honorarkosten"/>
    </service>
    <net>
      <value value="200.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="EUR"/>
    </net>
  </item>
  <item>
    <sequence value="7"/>
    <service>
      <coding>
        <system value="http://fhir.agembi.com/DummyUri/claim-servicecodes-xx"/>
        <code value="01"/>
        <display value="Beratung"/>
      </coding>
      <text value="Beratung"/>
    </service>
    <servicedDate value="2010-11-03"/>
    <quantity>
      <value value="1"/>
    </quantity>
    <encounter>
      <reference value="e0001"/>
    </encounter>
  </item>
  <total>
    <value value="160.00"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="EUR"/>
  </total>
</Claim>

Claim "100150" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

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This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Oral Health Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="100150"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Oral Health Claim</div>
  </text>
  <identifier>
    <system value="http://happyvalley.com/claim"/>
    <value value="12345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="oral"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="123456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <code value="1200"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
</Claim>

Claim "660150" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

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This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Vision Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="660150"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Vision Claim</div>
  </text>
  <identifier>
    <system value="http://happysight.com/claim"/>
    <value value="6612345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="vision"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="654321"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://hl7.org/fhir/ex-visionservice"/>
        <code value="exam"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="80.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="80.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
</Claim>

Claim "660151" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

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This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Vision Claim for Glasses

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="660151"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Vision Claim for Glasses</div>
  </text>
  <identifier>
    <system value="http://happysight.com/claim"/>
    <value value="6612346"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="vision"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <prescription>
    <reference value="http://www.optdocs.com/prescription/12345"/>
  </prescription>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="654321"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://hl7.org/fhir/ex-visionservice"/>
        <code value="glasses"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="214.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="214.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <detail>
      <sequence value="1"/>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-visionservice"/>
          <code value="frame"/>
        </coding>
      </service>
      <unitPrice>
        <value value="100.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="100.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="2"/>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-visionservice"/>
          <code value="lens"/>
        </coding>
      </service>
      <quantity>
        <value value="2"/>
      </quantity>
      <unitPrice>
        <value value="50.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="100.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="3"/>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-visionservice"/>
          <code value="fst"/>
        </coding>
      </service>
      <unitPrice>
        <value value="200.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <factor value="0.07"/>
      <net>
        <value value="14.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
  </item>
</Claim>

Claim "660152" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Vision Claim for Glasses

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="660152"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Vision Claim for Glasses</div>
  </text>
  <contained>
    <ClaimResponse>
      <id value="claimresponse-1"/>
      <identifier>
        <system value="http://thebenefircompany.com/claimresponse"/>
        <value value="CR6532875367"/>
      </identifier>
    </ClaimResponse>
  </contained>
  <contained>
    <Device>
      <id value="device-frame"/>
    </Device>
  </contained>
  <contained>
    <Device>
      <id value="device-lens"/>
    </Device>
  </contained>
  <identifier>
    <system value="http://happysight.com/claim"/>
    <value value="6612347"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="vision"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <prescription>
    <reference value="http://www.optdocs.com/prescription/12345"/>
  </prescription>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="654321"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="false"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
    <preAuthRef value="PR7652387237"/>
    <claimResponse>
      <reference value="#claimresponse-1"/>
    </claimResponse>
  </insurance>
  <insurance>
    <sequence value="2"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
    <preAuthRef value="AB543GTD7567"/>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <revenue>
      <coding>
        <system value="http://hl7.org/fhir/ex-revenue-center"/>
        <code value="0010"/>
        <display value="Vision Clinic"/>
      </coding>
    </revenue>
    <category>
      <coding>
        <system value="http://hl7.org/fhir/benefit-subcategory"/>
        <code value="F6"/>
        <display value="Vision Coverage"/>
      </coding>
    </category>
    <service>
      <coding>
        <system value="http://hl7.org/fhir/ex-visionservice"/>
        <code value="glasses"/>
      </coding>
    </service>
    <modifier>
      <coding>
        <system value="http://hl7.org/fhir/modifiers"/>
        <code value="rooh"/>
      </coding>
    </modifier>
    <programCode>
      <coding>
        <system value="http://hl7.org/fhir/ex-programcode"/>
        <code value="none"/>
      </coding>
    </programCode>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="235.40"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="235.40"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <detail>
      <sequence value="1"/>
      <revenue>
        <coding>
          <system value="http://hl7.org/fhir/ex-revenue-center"/>
          <code value="0010"/>
          <display value="Vision Clinic"/>
        </coding>
      </revenue>
      <category>
        <coding>
          <system value="http://hl7.org/fhir/benefit-subcategory"/>
          <code value="F6"/>
          <display value="Vision Coverage"/>
        </coding>
      </category>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-visionservice"/>
          <code value="frame"/>
        </coding>
      </service>
      <modifier>
        <coding>
          <system value="http://hl7.org/fhir/modifiers"/>
          <code value="rooh"/>
        </coding>
      </modifier>
      <unitPrice>
        <value value="100.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <factor value="1.1"/>
      <net>
        <value value="110.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
      <udi>
        <reference value="#device-frame"/>
      </udi>
    </detail>
    <detail>
      <sequence value="2"/>
      <revenue>
        <coding>
          <system value="http://hl7.org/fhir/ex-revenue-center"/>
          <code value="0010"/>
          <display value="Vision Clinic"/>
        </coding>
      </revenue>
      <category>
        <coding>
          <system value="http://hl7.org/fhir/benefit-subcategory"/>
          <code value="F6"/>
          <display value="Vision Coverage"/>
        </coding>
      </category>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-visionservice"/>
          <code value="lens"/>
        </coding>
      </service>
      <programCode>
        <coding>
          <system value="http://hl7.org/fhir/ex-programcode"/>
          <code value="none"/>
        </coding>
      </programCode>
      <quantity>
        <value value="2"/>
      </quantity>
      <unitPrice>
        <value value="55.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="110.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
      <subDetail>
        <sequence value="1"/>
        <revenue>
          <coding>
            <system value="http://hl7.org/fhir/ex-revenue-center"/>
            <code value="0010"/>
            <display value="Vision Clinic"/>
          </coding>
        </revenue>
        <category>
          <coding>
            <system value="http://hl7.org/fhir/benefit-subcategory"/>
            <code value="F6"/>
            <display value="Vision Coverage"/>
          </coding>
        </category>
        <service>
          <coding>
            <system value="http://hl7.org/fhir/ex-visionservice"/>
            <code value="lens"/>
          </coding>
        </service>
        <modifier>
          <coding>
            <system value="http://hl7.org/fhir/modifiers"/>
            <code value="rooh"/>
          </coding>
        </modifier>
        <programCode>
          <coding>
            <system value="http://hl7.org/fhir/ex-programcode"/>
            <code value="none"/>
          </coding>
        </programCode>
        <quantity>
          <value value="2"/>
        </quantity>
        <unitPrice>
          <value value="30.00"/>
          <system value="urn:iso:std:iso:4217"/>
          <code value="USD"/>
        </unitPrice>
        <factor value="1.1"/>
        <net>
          <value value="66.00"/>
          <system value="urn:iso:std:iso:4217"/>
          <code value="USD"/>
        </net>
        <udi>
          <reference value="#device-lens"/>
        </udi>
      </subDetail>
      <subDetail>
        <sequence value="2"/>
        <revenue>
          <coding>
            <system value="http://hl7.org/fhir/ex-revenue-center"/>
            <code value="0010"/>
            <display value="Vision Clinic"/>
          </coding>
        </revenue>
        <category>
          <coding>
            <system value="http://hl7.org/fhir/benefit-subcategory"/>
            <code value="F6"/>
            <display value="Vision Coverage"/>
          </coding>
        </category>
        <service>
          <coding>
            <system value="http://hl7.org/fhir/ex-visionservice"/>
            <code value="hardening"/>
          </coding>
        </service>
        <modifier>
          <coding>
            <system value="http://hl7.org/fhir/modifiers"/>
            <code value="rooh"/>
          </coding>
        </modifier>
        <quantity>
          <value value="2"/>
        </quantity>
        <unitPrice>
          <value value="15.00"/>
          <system value="urn:iso:std:iso:4217"/>
          <code value="USD"/>
        </unitPrice>
        <factor value="1.1"/>
        <net>
          <value value="33.00"/>
          <system value="urn:iso:std:iso:4217"/>
          <code value="USD"/>
        </net>
      </subDetail>
      <subDetail>
        <sequence value="3"/>
        <revenue>
          <coding>
            <system value="http://hl7.org/fhir/ex-revenue-center"/>
            <code value="0010"/>
            <display value="Vision Clinic"/>
          </coding>
        </revenue>
        <category>
          <coding>
            <system value="http://hl7.org/fhir/benefit-subcategory"/>
            <code value="F6"/>
            <display value="Vision Coverage"/>
          </coding>
        </category>
        <service>
          <coding>
            <system value="http://hl7.org/fhir/ex-visionservice"/>
            <code value="UV coating"/>
          </coding>
        </service>
        <modifier>
          <coding>
            <system value="http://hl7.org/fhir/modifiers"/>
            <code value="rooh"/>
          </coding>
        </modifier>
        <quantity>
          <value value="2"/>
        </quantity>
        <unitPrice>
          <value value="5.00"/>
          <system value="urn:iso:std:iso:4217"/>
          <code value="USD"/>
        </unitPrice>
        <factor value="1.1"/>
        <net>
          <value value="11.00"/>
          <system value="urn:iso:std:iso:4217"/>
          <code value="USD"/>
        </net>
      </subDetail>
    </detail>
    <detail>
      <sequence value="3"/>
      <revenue>
        <coding>
          <system value="http://hl7.org/fhir/ex-revenue-center"/>
          <code value="0010"/>
          <display value="Vision Clinic"/>
        </coding>
      </revenue>
      <category>
        <coding>
          <system value="http://hl7.org/fhir/benefit-subcategory"/>
          <code value="F6"/>
          <display value="Vision Coverage"/>
        </coding>
      </category>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-visionservice"/>
          <code value="fst"/>
        </coding>
      </service>
      <unitPrice>
        <value value="220.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <factor value="0.07"/>
      <net>
        <value value="15.40"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
  </item>
</Claim>

Claim "860150" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="860150"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Claim</div>
  </text>
  <identifier>
    <system value="http://happypdocs.com/claim"/>
    <value value="8612345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="professional"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="654456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://hl7.org/fhir/ex-serviceproduct"/>
        <code value="exam"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="75.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="75.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
</Claim>

Claim "760150" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Pharmacy Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="760150"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Pharmacy Claim</div>
  </text>
  <identifier>
    <system value="http://happypharma.com/claim"/>
    <value value="7612345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="pharmacy"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="stat"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="654456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://hl7.org/fhir/ex-pharmaservice"/>
        <code value="smokecess"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="60.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="60.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
</Claim>

Claim "760151" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Pharmacy Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="760151"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Pharmacy Claim</div>
  </text>
  <identifier>
    <system value="http://happypharma.com/claim"/>
    <value value="7612345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="pharmacy"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="stat"/>
    </coding>
  </priority>
  <prescription>
    <reference value="http://pharmacy.org/MedicationRequest/AB1234G"/>
  </prescription>
  <originalPrescription>
    <reference value="http://pharmacy.org/MedicationRequest/AB1202B"/>
  </originalPrescription>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <information>
    <sequence value="1"/>
    <category>
      <coding>
        <code value="pharmacyrefill"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/pharmacy-refill"/>
        <code value="new"/>
      </coding>
    </code>
  </information>
  <information>
    <sequence value="2"/>
    <category>
      <coding>
        <code value="pharmacyinformation"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/pharmacy-information"/>
        <code value="refillsremaining"/>
      </coding>
    </code>
    <valueQuantity>
      <value value="2"/>
    </valueQuantity>
  </information>
  <information>
    <sequence value="3"/>
    <category>
      <coding>
        <code value="pharmacyinformation"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/pharmacy-information"/>
        <code value="dayssupply"/>
      </coding>
    </code>
    <valueQuantity>
      <value value="90"/>
    </valueQuantity>
  </information>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="654456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <informationLinkId value="1"/>
    <informationLinkId value="2"/>
    <informationLinkId value="3"/>
    <service>
      <coding>
        <system value="http://hl7.org/fhir/RxNorm"/>
        <code value="562721"/>
        <display value="Alprazolam 0.25mg (Xanax)"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <quantity>
      <value value="90"/>
      <unit value="TAB"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="TAB"/>
    </quantity>
    <net>
      <value value="90.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <detail>
      <sequence value="1"/>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-pharmaservice"/>
          <code value="drugcost"/>
        </coding>
      </service>
      <net>
        <value value="45.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="2"/>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-pharmaservice"/>
          <code value="markup"/>
        </coding>
      </service>
      <net>
        <value value="9.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="3"/>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-pharmaservice"/>
          <code value="dispensefee"/>
        </coding>
      </service>
      <net>
        <value value="36.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
  </item>
  <total>
    <value value="90.00"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="USD"/>
  </total>
</Claim>

Claim "760152" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Pharmacy Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="760152"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Pharmacy Claim</div>
  </text>
  <identifier>
    <system value="http://happypharma.com/claim"/>
    <value value="7612345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="pharmacy"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="stat"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <information>
    <sequence value="1"/>
    <category>
      <coding>
        <code value="pharmacyrefill"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/pharmacy-refill"/>
        <code value="new"/>
      </coding>
    </code>
  </information>
  <information>
    <sequence value="2"/>
    <category>
      <coding>
        <code value="pharmacyinformation"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/pharmacy-information"/>
        <code value="refillsremaining"/>
      </coding>
    </code>
    <valueQuantity>
      <value value="0"/>
    </valueQuantity>
  </information>
  <information>
    <sequence value="3"/>
    <category>
      <coding>
        <code value="pharmacyinformation"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/pharmacy-information"/>
        <code value="dayssupply"/>
      </coding>
    </code>
    <valueQuantity>
      <value value="10"/>
    </valueQuantity>
  </information>
  <information>
    <sequence value="4"/>
    <category>
      <coding>
        <code value="pharmacy"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/pharmacy-form"/>
        <code value="capsule"/>
      </coding>
    </code>
  </information>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="654456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <informationLinkId value="1"/>
    <informationLinkId value="2"/>
    <informationLinkId value="3"/>
    <informationLinkId value="4"/>
    <service>
      <coding>
        <system value="http://localdruglist.org"/>
        <code value="compound"/>
        <display value="Custom compound"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <quantity>
      <value value="30"/>
      <unit value="TAB"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="TAB"/>
    </quantity>
    <net>
      <value value="155.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <detail>
      <sequence value="1"/>
      <service>
        <coding>
          <system value="http://localdruglist.org"/>
          <code value="44001"/>
          <display value="Acetaminophen 250mg"/>
        </coding>
      </service>
      <quantity>
        <value value="250"/>
        <unit value="mg"/>
      </quantity>
      <net>
        <value value="20.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
      <subDetail>
        <sequence value="1"/>
        <service>
          <coding>
            <system value="http://hl7.org/fhir/ex-pharmaservice"/>
            <code value="drugcost"/>
          </coding>
        </service>
        <net>
          <value value="20.00"/>
          <system value="urn:iso:std:iso:4217"/>
          <code value="USD"/>
        </net>
      </subDetail>
    </detail>
    <detail>
      <sequence value="2"/>
      <service>
        <coding>
          <system value="http://localdruglist.org"/>
          <code value="44035"/>
          <display value="Phenacetin 50mg"/>
        </coding>
      </service>
      <quantity>
        <value value="50"/>
        <unit value="mg"/>
      </quantity>
      <net>
        <value value="25.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
      <subDetail>
        <sequence value="1"/>
        <service>
          <coding>
            <system value="http://hl7.org/fhir/ex-pharmaservice"/>
            <code value="drugcost"/>
          </coding>
        </service>
        <net>
          <value value="25.00"/>
          <system value="urn:iso:std:iso:4217"/>
          <code value="USD"/>
        </net>
      </subDetail>
    </detail>
    <detail>
      <sequence value="3"/>
      <service>
        <coding>
          <system value="http://localdruglist.org"/>
          <code value="44057"/>
          <display value="Codeine 25mg"/>
        </coding>
      </service>
      <quantity>
        <value value="25"/>
        <unit value="mg"/>
      </quantity>
      <net>
        <value value="28.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
      <subDetail>
        <sequence value="1"/>
        <service>
          <coding>
            <system value="http://hl7.org/fhir/ex-pharmaservice"/>
            <code value="drugcost"/>
          </coding>
        </service>
        <net>
          <value value="28.00"/>
          <system value="urn:iso:std:iso:4217"/>
          <code value="USD"/>
        </net>
      </subDetail>
    </detail>
    <detail>
      <sequence value="2"/>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-pharmaservice"/>
          <code value="markup"/>
        </coding>
      </service>
      <net>
        <value value="22.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="3"/>
      <service>
        <coding>
          <system value="http://hl7.org/fhir/ex-pharmaservice"/>
          <code value="compoundfee"/>
        </coding>
      </service>
      <net>
        <value value="60.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
  </item>
  <total>
    <value value="155.00"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="USD"/>
  </total>
</Claim>

Claim "100153" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Oral Health Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="100153"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Oral Health Claim</div>
  </text>
  <identifier>
    <system value="http://happyvalley.com/claim"/>
    <value value="12355"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="oral"/>
    </coding>
  </type>
  <use value="proposed"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2015-03-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <fundsReserve>
    <coding>
      <code value="provider"/>
    </coding>
  </fundsReserve>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/sid/icd-10"/>
        <code value="123457"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <diagnosisLinkId value="1"/>
    <service>
      <coding>
        <system value="http://example.org/fhir/oralservicecodes"/>
        <code value="ORTHPLAN"/>
      </coding>
    </service>
    <servicedDate value="2015-05-16"/>
    <unitPrice>
      <value value="9000.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="9000.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <detail>
      <sequence value="1"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="ORTHOEXAM"/>
        </coding>
      </service>
      <unitPrice>
        <value value="1000.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="1000.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="2"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="ORTHODIAG"/>
        </coding>
      </service>
      <unitPrice>
        <value value="1500.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="1500.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="3"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="ORTHOINITIAL"/>
        </coding>
      </service>
      <unitPrice>
        <value value="500.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="500.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="4"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="ORTHOMONTHS"/>
        </coding>
      </service>
      <quantity>
        <value value="24"/>
      </quantity>
    </detail>
    <detail>
      <sequence value="5"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="ORTHOPERIODIC"/>
        </coding>
      </service>
      <quantity>
        <value value="24"/>
      </quantity>
      <unitPrice>
        <value value="250.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="250.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
  </item>
  <item>
    <sequence value="2"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://example.org/fhir/oralservicecodes"/>
        <code value="21211"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="105.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="105.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <bodySite>
      <coding>
        <system value="http://fdi.org/fhir/oraltoothcodes"/>
        <code value="21"/>
      </coding>
    </bodySite>
    <subSite>
      <coding>
        <system value="http://fdi.org/fhir/oralsurfacecodes"/>
        <code value="L"/>
      </coding>
    </subSite>
  </item>
  <item>
    <sequence value="3"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://example.org/fhir/oralservicecodes"/>
        <code value="27211"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="1100.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="1100.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <bodySite>
      <coding>
        <system value="http://fdi.org/fhir/oraltoothcodes"/>
        <code value="36"/>
      </coding>
    </bodySite>
    <detail>
      <sequence value="1"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="27211"/>
        </coding>
      </service>
      <unitPrice>
        <value value="750.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="750.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="2"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="lab"/>
        </coding>
      </service>
      <unitPrice>
        <value value="350.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="350.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
  </item>
</Claim>

Claim "100154" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="100154"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>
  </text>
  <identifier>
    <system value="http://happyvalley.com/claim"/>
    <value value="12347"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="oral"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <identifier>
      <system value="http://www.jurisdiction.com/nationalId"/>
      <value value="123AB345"/>
    </identifier>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <identifier>
      <system value="http://www.jurisdiction.com/insurers"/>
      <value value="123456"/>
    </identifier>
  </insurer>
  <organization>
    <identifier>
      <system value="http://www.jurisdiction.com/careorganizations"/>
      <value value="HOSP12345"/>
    </identifier>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <identifier>
        <system value="http://www.jurisdiction.com/providerId"/>
        <value value="MD98765"/>
      </identifier>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="123456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <identifier>
        <system value="http://www.jurisdiction.com/nationalplan"/>
        <value value="123AB345"/>
      </identifier>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <code value="1200"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
</Claim>

Claim "100152" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Oral Health Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="100152"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Oral Health Claim</div>
  </text>
  <contained>
    <Organization>
      <id value="org-insurer"/>
      <identifier>
        <system value="http://www.bindb.com/bin"/>
        <value value="123456"/>
      </identifier>
    </Organization>
  </contained>
  <contained>
    <Organization>
      <id value="org-org"/>
      <identifier>
        <system value="http://www.jurisdiction.com/oralhealthoffices"/>
        <value value="3456"/>
      </identifier>
    </Organization>
  </contained>
  <contained>
    <Practitioner>
      <id value="provider-1"/>
      <identifier>
        <system value="http://www.jurisdiction.com/oralhealthproviders"/>
        <value value="123456789"/>
      </identifier>
    </Practitioner>
  </contained>
  <contained>
    <Patient>
      <id value="patient-1"/>
      <name>
        <use value="official"/>
        <family value="Donald"/>
        <given value="Duck"/>
      </name>
      <gender value="male"/>
      <birthDate value="1986-05-17"/>
      <address>
        <use value="home"/>
        <line value="1234 Main Street"/>
        <city value="Vancouver"/>
        <postalCode value="V2H1Y3"/>
        <country value="CAD"/>
      </address>
    </Patient>
  </contained>
  <contained>
    <Coverage>
      <id value="coverage-1"/>
      <identifier>
        <system value="http://benefitsinc.com/certificate"/>
        <value value="12345"/>
      </identifier>
      <status value="active"/>
      <type>
        <coding>
          <system value="http://hl7.org/fhir/v3/ActCode"/>
          <code value="EHCPOL"/>
        </coding>
      </type>
      <subscriber>
        <reference value="#patient-1"/>
      </subscriber>
      <beneficiary>
        <reference value="#patient-1"/>
      </beneficiary>
      <relationship>
        <coding>
          <code value="self"/>
        </coding>
      </relationship>
      <payor>
        <identifier>
          <system value="http://www.bindb.com/bin"/>
          <value value="123456"/>
        </identifier>
      </payor>
      <grouping>
        <plan value="CBI35"/>
        <planDisplay value="Corporate Baker&apos;s Inc. Plan#35"/>
        <subPlan value="123"/>
        <subPlanDisplay value="Trainee Part-time Benefits"/>
      </grouping>
      <dependent value="1"/>
      <sequence value="1"/>
    </Coverage>
  </contained>
  <identifier>
    <system value="http://happyvalley.com/claim"/>
    <value value="12347"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="oral"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="#patient-1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="#org-insurer"/>
  </insurer>
  <organization>
    <reference value="#org-org"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="#provider-1"/>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="123456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="#coverage-1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <code value="1200"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
</Claim>

Claim "100155" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="100155"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>
  </text>
  <contained>
    <Patient>
      <id value="patient-1"/>
      <name>
        <use value="official"/>
        <family value="Donald"/>
        <given value="Duck"/>
      </name>
      <gender value="male"/>
      <birthDate value="1986-05-17"/>
      <address>
        <use value="home"/>
        <line value="1234 Main Street"/>
        <city value="Vancouver"/>
        <postalCode value="V2H1Y3"/>
        <country value="CAD"/>
      </address>
    </Patient>
  </contained>
  <identifier>
    <system value="http://happyvalley.com/claim"/>
    <value value="12347"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="oral"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="#patient-1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <identifier>
      <system value="http://www.jurisdiction.com/insurers"/>
      <value value="123456"/>
    </identifier>
  </insurer>
  <organization>
    <identifier>
      <system value="http://www.jurisdiction.com/careorganizations"/>
      <value value="HOSP12345"/>
    </identifier>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <identifier>
        <system value="http://www.jurisdiction.com/providerId"/>
        <value value="MD98765"/>
      </identifier>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="123456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="http://www.jurisdiction.com/nationalplan/123AB345"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <code value="1200"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
</Claim>

Claim "100156" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Oral Health Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="100156"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Oral Health Claim</div>
  </text>
  <contained>
    <Device>
      <id value="device-bridge"/>
    </Device>
  </contained>
  <contained>
    <ReferralRequest>
      <id value="referral"/>
      <status value="active"/>
      <intent value="order"/>
      <subject>
        <reference value="Patient/1"/>
      </subject>
    </ReferralRequest>
  </contained>
  <identifier>
    <system value="http://happyvalley.com/claim"/>
    <value value="123466"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="oral"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <related>
    <claim>
      <reference value="Claim/100151"/>
    </claim>
    <relationship>
      <coding>
        <system value="http://hl7.org/fhir/ex-relatedclaimrelationship"/>
        <code value="associated"/>
      </coding>
    </relationship>
    <reference>
      <value value="CASE156746B"/>
    </reference>
  </related>
  <payee>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/payeetype"/>
        <code value="other"/>
      </coding>
    </type>
    <resourceType>
      <system value="http://hl7.org/fhir/ex-payee-resource-type"/>
      <code value="relatedperson"/>
    </resourceType>
    <party>
      <reference value="RelatedPerson/peter"/>
    </party>
  </payee>
  <referral>
    <reference value="#referral"/>
  </referral>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <information>
    <sequence value="1"/>
    <category>
      <coding>
        <system value="http://hl7.org/fhir/claiminformationcategory"/>
        <code value="prosthesis"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/ex-oralprostho"/>
        <code value="2"/>
        <display value="Maryland Bridge"/>
      </coding>
    </code>
    <timingDate value="2001-04-07"/>
  </information>
  <procedure>
    <sequence value="1"/>
    <date value="2014-07-04"/>
    <procedureCodeableConcept>
      <text value="Resection of gum to increase exposed tooth."/>
    </procedureCodeableConcept>
  </procedure>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <informationLinkId value="1"/>
    <service>
      <coding>
        <system value="http://example.org/fhir/oralservicecodes"/>
        <code value="67221"/>
        <display value="Maryland Bridge"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <locationCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/ex-serviceplace"/>
        <code value="11"/>
      </coding>
    </locationCodeableConcept>
    <unitPrice>
      <value value="1400.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <factor value="0.75"/>
    <net>
      <value value="1050.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <udi>
      <reference value="#device-bridge"/>
    </udi>
    <bodySite>
      <coding>
        <system value="http://fdi.org/fhir/oraltoothcodes"/>
        <code value="01"/>
      </coding>
    </bodySite>
  </item>
  <item>
    <sequence value="2"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://example.org/fhir/oralservicecodes"/>
        <code value="21211"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <locationCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/ex-serviceplace"/>
        <code value="11"/>
      </coding>
    </locationCodeableConcept>
    <unitPrice>
      <value value="105.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="105.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <bodySite>
      <coding>
        <system value="http://fdi.org/fhir/oraltoothcodes"/>
        <code value="21"/>
      </coding>
    </bodySite>
    <subSite>
      <coding>
        <system value="http://fdi.org/fhir/oralsurfacecodes"/>
        <code value="L"/>
      </coding>
    </subSite>
  </item>
  <item>
    <sequence value="3"/>
    <careTeamLinkId value="1"/>
    <procedureLinkId value="1"/>
    <service>
      <coding>
        <system value="http://example.org/fhir/oralservicecodes"/>
        <code value="27211"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <locationCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/ex-serviceplace"/>
        <code value="11"/>
      </coding>
    </locationCodeableConcept>
    <unitPrice>
      <value value="1100.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="1100.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <bodySite>
      <coding>
        <system value="http://fdi.org/fhir/oraltoothcodes"/>
        <code value="24"/>
      </coding>
    </bodySite>
    <detail>
      <sequence value="1"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="27211"/>
        </coding>
      </service>
      <unitPrice>
        <value value="1000.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <factor value="0.75"/>
      <net>
        <value value="750.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="2"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="lab"/>
        </coding>
      </service>
      <unitPrice>
        <value value="350.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="350.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
  </item>
  <total>
    <value value="2255.00"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="USD"/>
  </total>
</Claim>

Claim "100151" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Oral Health Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="100151"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Oral Health Claim</div>
  </text>
  <identifier>
    <system value="http://happyvalley.com/claim"/>
    <value value="12346"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="oral"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <information>
    <sequence value="1"/>
    <category>
      <coding>
        <system value="http://hl7.org/fhir/claiminformationcategory"/>
        <code value="missingtooth"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/ex-tooth"/>
        <code value="15"/>
      </coding>
    </code>
    <timingDate value="2012-04-07"/>
    <reason>
      <coding>
        <system value="http://hl7.org/fhir/missingtoothreason"/>
        <code value="e"/>
      </coding>
    </reason>
  </information>
  <information>
    <sequence value="2"/>
    <category>
      <coding>
        <system value="http://hl7.org/fhir/claiminformationcategory"/>
        <code value="exception"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/claim-exception"/>
        <code value="student"/>
      </coding>
    </code>
    <valueString value="Happy Valley Community College"/>
  </information>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="123456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://example.org/fhir/oralservicecodes"/>
        <code value="1200"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
  <item>
    <sequence value="2"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://example.org/fhir/oralservicecodes"/>
        <code value="21211"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="105.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="105.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <bodySite>
      <coding>
        <system value="http://fdi.org/fhir/oraltoothcodes"/>
        <code value="21"/>
      </coding>
    </bodySite>
    <subSite>
      <coding>
        <system value="http://fdi.org/fhir/oralsurfacecodes"/>
        <code value="L"/>
      </coding>
    </subSite>
  </item>
  <item>
    <sequence value="3"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://example.org/fhir/oralservicecodes"/>
        <code value="27211"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="1100.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="1100.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <bodySite>
      <coding>
        <system value="http://fdi.org/fhir/oraltoothcodes"/>
        <code value="36"/>
      </coding>
    </bodySite>
    <detail>
      <sequence value="1"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="27211"/>
        </coding>
      </service>
      <unitPrice>
        <value value="1000.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <factor value="0.75"/>
      <net>
        <value value="750.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="2"/>
      <service>
        <coding>
          <system value="http://example.org/fhir/oralservicecodes"/>
          <code value="lab"/>
        </coding>
      </service>
      <unitPrice>
        <value value="350.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </unitPrice>
      <net>
        <value value="350.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>
      </net>
    </detail>
  </item>
</Claim>

Claim "960150" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="960150"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Claim</div>
  </text>
  <identifier>
    <system value="http://happyhospital.com/claim"/>
    <value value="9612345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="institutional"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimsubtype"/>
      <code value="emergency"/>
    </coding>
  </subType>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <created value="2014-08-16"/>
  <enterer>
    <identifier>
      <system value="http://jurisdiction.org/facilities/HOSP1234/users"/>
      <value value="UC1234"/>
    </identifier>
  </enterer>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <facility>
    <identifier>
      <system value="http://jurisdiction.org/facilities"/>
      <value value="HOSP1234"/>
    </identifier>
  </facility>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="654456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://hl7.org/fhir/ex-serviceproduct"/>
        <code value="exam"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="125.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="125.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
    <encounter>
      <reference value="Encounter/example"/>
    </encounter>
  </item>
  <total>
    <value value="125.00"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="USD"/>
  </total>
</Claim>

Claim "960151" Version "1"

Created by SYSTEM () at 11/28/2017 8:28:09 AM(UTC)

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the Claim

<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">
  <id value="960151"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2017-11-28T08:28:09Z"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Claim</div>
  </text>
  <identifier>
    <system value="http://happyhospital.com/claim"/>
    <value value="96123451"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="institutional"/>
    </coding>
  </type>
  <use value="complete"/>
  <patient>
    <reference value="Patient/1"/>
  </patient>
  <billablePeriod>
    <start value="2014-08-15"/>
    <end value="2014-08-16"/>
  </billablePeriod>
  <created value="2014-08-16"/>
  <enterer>
    <identifier>
      <system value="http://jurisdiction.org/facilities/HOSP1234/users"/>
      <value value="UC1234"/>
    </identifier>
  </enterer>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <provider>
    <identifier>
      <system value="http://npid.org/providerid"/>
      <value value="NJ12345"/>
    </identifier>
  </provider>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <facility>
    <identifier>
      <system value="http://jurisdiction.org/facilities"/>
      <value value="HOSP1234"/>
    </identifier>
  </facility>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
    <responsible value="true"/>
    <role>
      <coding>
        <system value="http://hl7.org/fhir/claim-careteamrole"/>
        <code value="primary"/>
      </coding>
    </role>
    <qualification>
      <coding>
        <system value="http://hl7.org/fhir/provider-qualification"/>
        <code value="physician"/>
      </coding>
    </qualification>
  </careTeam>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="654456"/>
      </coding>
    </diagnosisCodeableConcept>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/ex-diagnosistype"/>
        <code value="admitting"/>
      </coding>
    </type>
    <packageCode>
      <coding>
        <system value="http://hl7.org/fhir/ex-diagnosisrelatedgroup"/>
        <code value="400"/>
        <display value="Head trauma - concussion"/>
      </coding>
    </packageCode>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
    <businessArrangement value="BA987123"/>
    <preAuthRef value="PA2014G56473"/>
  </insurance>
  <accident>
    <date value="2014-07-09"/>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/v3/ActIncidentCode"/>
        <code value="SPT"/>
        <display value="Sporting Accident"/>
      </coding>
    </type>
    <locationAddress>
      <text value="Grouse Mountain Ski Hill"/>
    </locationAddress>
  </accident>
  <employmentImpacted>
    <start value="2014-08-16"/>
    <end value="2014-08-16"/>
  </employmentImpacted>
  <hospitalization>
    <start value="2014-08-15"/>
    <end value="2014-08-16"/>
  </hospitalization>
  <item>
    <sequence value="1"/>
    <careTeamLinkId value="1"/>
    <service>
      <coding>
        <system value="http://hl7.org/fhir/ex-serviceproduct"/>
        <code value="exam"/>
      </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="125.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="125.00"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
  <total>
    <value value="125.00"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="USD"/>
  </total>
</Claim>