0.2.3 - ci-build

HealthDataReceipt - Local Development build (v0.2.3). See the Directory of published versions

: Receipt-Purchase - XML Representation

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<Claim xmlns="http://hl7.org/fhir">
  <id value="Receipt-Purchase"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2018-10-04T19:42:52.061-04:00"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Claim</b><a name="Receipt-Purchase"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Claim "Receipt-Purchase" Version "1" Updated "2018-10-04 07:42:52-0400" </p></div><p><b>status</b>: active</p><p><b>type</b>: Over The Counter <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-claim-type.html">Claim Type Codes</a>#over-the-counter)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href="Patient/john-smith">Patient/john-smith: John Smith</a></p><p><b>created</b>: 2018-10-04</p><p><b>provider</b>: <a href="Patient/acme-pharmacy">Patient/acme-pharmacy: ACME Pharmacy</a></p><p><b>priority</b>: Normal <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-processpriority.html">Process Priority Codes</a>#normal)</span></p><h3>SupportingInfos</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>1</td><td>Medical Care <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-ex-benefitcategory.html">Benefit Category Codes</a>#1)</span></td><td><a href="Medication/zyrtec">Medication/zyrtec: Zyrtec</a></td></tr></table><h3>Insurances</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>false</td><td><a href="Coverage/self-pay">Coverage/self-pay: Self-pay</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: Expense <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-ex-USCLS.html">USCLS Codes</a>#99555)</span></p><p><b>serviced</b>: 2018-10-04</p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class="grid"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>12.95</td><td>USD</td></tr></table><h3>Nets</h3><table class="grid"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>13.65</td><td>USD</td></tr></table></blockquote><h3>Totals</h3><table class="grid"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>13.65</td><td>USD</td></tr></table></div>
  </text>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="over-the-counter"/>
      <display value="Over The Counter"/>
    </coding>
  </type>
  <use value="claim"/>
  <patient>
    <reference value="Patient/john-smith"/>
    <display value="John Smith"/>
  </patient>
  <created value="2018-10-04"/>
  <provider>
    <reference value="Patient/acme-pharmacy"/>
    <display value="ACME Pharmacy"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="normal"/>
      <display value="Normal"/>
    </coding>
  </priority>
  <supportingInfo>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
        <code value="1"/>
        <display value="Medical Care"/>
      </coding>
    </category>
    <valueReference>
      <reference value="Medication/zyrtec"/>
      <display value="Zyrtec"/>
    </valueReference>
  </supportingInfo>
  <insurance>
    <sequence value="1"/>
    <focal value="false"/>
    <coverage>
      <reference value="Coverage/self-pay"/>
      <display value="Self-pay"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <productOrService>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/ex-USCLS"/>
        <code value="99555"/>
        <display value="Expense"/>
      </coding>
    </productOrService>
    <servicedDate value="2018-10-04"/>
    <quantity>
      <value value="1"/>
    </quantity>
    <unitPrice>
      <value value="12.95"/>
      <currency value="USD"/>
    </unitPrice>
    <net>
      <value value="13.65"/>
      <currency value="USD"/>
    </net>
  </item>
  <total>
    <value value="13.65"/>
    <currency value="USD"/>
  </total>
</Claim>