fhir-react
Version:
React component library for displaying FHIR Resources
267 lines • 5.35 kB
JSON
{
"resourceType": "Claim",
"id": "100151",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>"
},
"identifier": [
{
"system": "http://happyvalley.com/claim",
"value": "12346"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "oral"
}
]
},
"use": "claim",
"patient": {
"reference": "Patient/1"
},
"created": "2014-08-16",
"insurer": {
"reference": "Organization/2"
},
"provider": {
"reference": "Organization/1"
},
"priority": {
"coding": [
{
"code": "normal"
}
]
},
"payee": {
"type": {
"coding": [
{
"code": "provider"
}
]
}
},
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "Practitioner/example"
}
}
],
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "missingtooth"
}
]
},
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-tooth",
"code": "15"
}
]
},
"timingDate": "2012-04-07",
"reason": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/missingtoothreason",
"code": "e"
}
]
}
},
{
"sequence": 2,
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "exception"
}
]
},
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-exception",
"code": "student"
}
]
},
"valueString": "Happy Valley Community College"
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "123456"
}
]
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/9876B1"
}
}
],
"item": [
{
"sequence": 1,
"careTeamSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://example.org/fhir/oralservicecodes",
"code": "1200"
}
]
},
"servicedDate": "2014-08-16",
"unitPrice": {
"value": 135.57,
"currency": "USD"
},
"net": {
"value": 135.57,
"currency": "USD"
}
},
{
"sequence": 2,
"careTeamSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://example.org/fhir/oralservicecodes",
"code": "21211"
}
]
},
"servicedDate": "2014-08-16",
"unitPrice": {
"value": 105.00,
"currency": "USD"
},
"net": {
"value": 105.00,
"currency": "USD"
},
"bodySite": {
"coding": [
{
"system": "http://fdi.org/fhir/oraltoothcodes",
"code": "21"
}
]
},
"subSite": [
{
"coding": [
{
"system": "http://fdi.org/fhir/oralsurfacecodes",
"code": "L"
}
]
}
]
},
{
"sequence": 3,
"careTeamSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://example.org/fhir/oralservicecodes",
"code": "27211"
}
]
},
"servicedDate": "2014-08-16",
"unitPrice": {
"value": 1100.00,
"currency": "USD"
},
"net": {
"value": 1100.00,
"currency": "USD"
},
"bodySite": {
"coding": [
{
"system": "http://fdi.org/fhir/oraltoothcodes",
"code": "36"
}
]
},
"detail": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://example.org/fhir/oralservicecodes",
"code": "27211"
}
]
},
"unitPrice": {
"value": 1000.00,
"currency": "USD"
},
"factor": 0.75,
"net": {
"value": 750.00,
"currency": "USD"
}
},
{
"sequence": 2,
"productOrService": {
"coding": [
{
"system": "http://example.org/fhir/oralservicecodes",
"code": "lab"
}
]
},
"unitPrice": {
"value": 350.00,
"currency": "USD"
},
"net": {
"value": 350.00,
"currency": "USD"
}
}
]
}
]
}