Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot
Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot
Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="4350490e-98f0-4c23-9e7d-4cd2c7011959"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|0.3.0"/>
</meta>
<type value="message"/>
<timestamp value="2023-07-15T14:56:49.034+03:00"/>
<entry>
<fullUrl value="urn:uuid:c19c71dc-cfad-4401-b5b0-c0f20e8f1959"/>
<resource>
<MessageHeader>
<id value="c19c71dc-cfad-4401-b5b0-c0f20e8f1959"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|0.3.0"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="MessageHeader_c19c71dc-cfad-4401-b5b0-c0f20e8f1959"> </a><p class="res-header-id"><b>Generated Narrative: MessageHeader c19c71dc-cfad-4401-b5b0-c0f20e8f1959</b></p><a name="c19c71dc-cfad-4401-b5b0-c0f20e8f1959"> </a><a name="hcc19c71dc-cfad-4401-b5b0-c0f20e8f1959"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-message-header.html">Nphies MessageHeaderversion: null0.3.0)</a></p></div><p><b>event</b>: <a href="CodeSystem-ksa-message-events.html#ksa-message-events-eligibility-request">KSA Message Events eligibility-request</a>: Eligibility Request</p><h3>Destinations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Endpoint</b></td><td><b>Receiver</b></td></tr><tr><td style="display: none">*</td><td><a href="http://nphies.sa/license/payer-license/INS-FHIR">http://nphies.sa/license/payer-license/INS-FHIR</a></td><td>Identifier: <code>http://nphies.sa/license/payer-license</code>/INS-FHIR</td></tr></table><p><b>sender</b>: Identifier: <code>http://nphies.sa/license/provider-license</code>/PR-FHIR</p><h3>Sources</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Endpoint</b></td></tr><tr><td style="display: none">*</td><td><a href="http://saudigeneralhospital.com.sa">http://saudigeneralhospital.com.sa</a></td></tr></table><p><b>focus</b>: <a href="Bundle-4350490e-98f0-4c23-9e7d-4cd2c7011959.html#http-//saudigeneralhospital.com.sa/CoverageEligibilityRequest/19596">Bundle: type = message; timestamp = 2023-07-15 14:56:49+0300</a></p></div>
</text>
<eventCoding>
<system
value="http://nphies.sa/terminology/CodeSystem/ksa-message-events"/>
<code value="eligibility-request"/>
</eventCoding>
<destination>
<endpoint value="http://nphies.sa/license/payer-license/INS-FHIR"/>
<receiver>
<type value="Organization"/>
<identifier>
<system value="http://nphies.sa/license/payer-license"/>
<value value="INS-FHIR"/>
</identifier>
</receiver>
</destination>
<sender>
<type value="Organization"/>
<identifier>
<system value="http://nphies.sa/license/provider-license"/>
<value value="PR-FHIR"/>
</identifier>
</sender>
<source>
<endpoint value="http://saudigeneralhospital.com.sa"/>
</source>
<focus>
<reference
value="http://saudigeneralhospital.com.sa/CoverageEligibilityRequest/19596"/>
</focus>
</MessageHeader>
</resource>
</entry>
<entry>
<fullUrl
value="http://saudigeneralhospital.com.sa/CoverageEligibilityRequest/19596"/>
<resource>
<CoverageEligibilityRequest>
<id value="19596"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/eligibility-request|0.3.0"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="CoverageEligibilityRequest_19596"> </a><p class="res-header-id"><b>Generated Narrative: CoverageEligibilityRequest 19596</b></p><a name="19596"> </a><a name="hc19596"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-eligibility-request.html">Nphies CoverageEligibilityRequestversion: null0.3.0)</a></p></div><p><b>identifier</b>: <code>http://saudigeneralhospital.com.sa/identifiers/coverageeligibilityrequest</code>/req_161959</p><p><b>status</b>: Active</p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><p><b>purpose</b>: Coverage Validation, Coverage benefits</p><p><b>patient</b>: <a href="Patient-123454186.html">Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)</a></p><p><b>serviced</b>: 2023-07-15 --> 2023-07-16</p><p><b>created</b>: 2023-07-15</p><p><b>provider</b>: <a href="Organization-b1b3432921324f97af3be9fd0b1a14ae.html">Organization Saudi General Hospital</a></p><p><b>insurer</b>: <a href="Organization-bff3aa1fbd3648619ac082357bf135db.html">Organization Saudi National Insurance</a></p><p><b>facility</b>: <a href="Location-2be1133308ed422a9923931c5a475f63.html">Location Saudi General Hospital</a></p><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td><a href="Coverage-1333.html">Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000001; status = active; type = extended healthcare; dependent = 01; relationship = Self; network = Golden C</a></td></tr></table></div>
</text>
<identifier>
<system
value="http://saudigeneralhospital.com.sa/identifiers/coverageeligibilityrequest"/>
<value value="req_161959"/>
</identifier>
<status value="active"/>
<priority>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/processpriority"/>
<code value="normal"/>
</coding>
</priority>
<purpose value="validation"/>
<purpose value="benefits"/>
<patient>🔗
<reference value="Patient/123454186"/>
</patient>
<servicedPeriod>
<start value="2023-07-15"/>
<end value="2023-07-16"/>
</servicedPeriod>
<created value="2023-07-15"/>
<provider>🔗
<reference value="Organization/b1b3432921324f97af3be9fd0b1a14ae"/>
</provider>
<insurer>🔗
<reference value="Organization/bff3aa1fbd3648619ac082357bf135db"/>
</insurer>
<facility>🔗
<reference value="Location/2be1133308ed422a9923931c5a475f63"/>
</facility>
<insurance>
<coverage>🔗
<reference value="Coverage/1333"/>
</coverage>
</insurance>
</CoverageEligibilityRequest>
</resource>
</entry>
<entry>
<fullUrl value="http://saudigeneralhospital.com.sa/Coverage/1333"/>
<resource>
<Coverage>
<id value="1333"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|0.3.0"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Coverage_1333"> </a><p class="res-header-id"><b>Generated Narrative: Coverage 1333</b></p><a name="1333"> </a><a name="hc1333"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-coverage.html">Nphies Coverageversion: null0.3.0)</a></p></div><p><b>identifier</b>: <code>http://sni.com.sa/identifiers/memberid</code>/0000000001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://nphies.sa/terminology/CodeSystem/coverage-type EHCPOL}">extended healthcare</span></p><p><b>policyHolder</b>: <a href="Organization-13.html">Organization Policy Holder Organization</a></p><p><b>subscriber</b>: <a href="Patient-123454186.html">Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)</a></p><p><b>beneficiary</b>: <a href="Patient-123454186.html">Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)</a></p><p><b>dependent</b>: 01</p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>payor</b>: <a href="Organization-bff3aa1fbd3648619ac082357bf135db.html">Organization Saudi National Insurance</a></p><h3>Classes</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}">Plan</span></td><td>CB135</td><td>Insurance Plan A</td></tr></table><p><b>network</b>: Golden C</p></div>
</text>
<identifier>
<system value="http://sni.com.sa/identifiers/memberid"/>
<value value="0000000001"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/coverage-type"/>
<code value="EHCPOL"/>
<display value="extended healthcare"/>
</coding>
</type>
<policyHolder>🔗
<reference value="Organization/13"/>
</policyHolder>
<subscriber>🔗
<reference value="Patient/123454186"/>
</subscriber>
<beneficiary>🔗
<reference value="Patient/123454186"/>
</beneficiary>
<dependent value="01"/>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
<code value="self"/>
<display value="Self"/>
</coding>
</relationship>
<payor>🔗
<reference value="Organization/bff3aa1fbd3648619ac082357bf135db"/>
</payor>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="plan"/>
</coding>
</type>
<value value="CB135"/>
<name value="Insurance Plan A"/>
</class>
<network value="Golden C"/>
</Coverage>
</resource>
</entry>
<entry>
<fullUrl value="http://saudigeneralhospital.com.sa/Organization/13"/>
<resource>
<Organization>
<id value="13"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|0.3.0"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_13"> </a><p class="res-header-id"><b>Generated Narrative: Organization 13</b></p><a name="13"> </a><a name="hc13"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-policyholder-organization.html">Nphies Policy Holder Organizationversion: null0.3.0)</a></p></div><p><b>identifier</b>: <code>http://nphies.sa/identifiers/organization</code>/5009</p><p><b>active</b>: true</p><p><b>name</b>: Policy Holder Organization</p></div>
</text>
<identifier>
<system value="http://nphies.sa/identifiers/organization"/>
<value value="5009"/>
</identifier>
<active value="true"/>
<name value="Policy Holder Organization"/>
</Organization>
</resource>
</entry>
<entry>
<fullUrl
value="http://saudigeneralhospital.com.sa/Organization/b1b3432921324f97af3be9fd0b1a14ae"/>
<resource>
<Organization>
<id value="b1b3432921324f97af3be9fd0b1a14ae"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|0.3.0"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_b1b3432921324f97af3be9fd0b1a14ae"> </a><p class="res-header-id"><b>Generated Narrative: Organization b1b3432921324f97af3be9fd0b1a14ae</b></p><a name="b1b3432921324f97af3be9fd0b1a14ae"> </a><a name="hcb1b3432921324f97af3be9fd0b1a14ae"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-provider-organization.html">Nphies Provider Organizationversion: null0.3.0)</a></p></div><p><b>Provider Type</b>: <span title="Codes:{http://nphies.sa/terminology/CodeSystem/provider-type 1}">Hospital</span></p><p><b>identifier</b>: <code>http://nphies.sa/license/provider-license</code>/PR-FHIR</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://nphies.sa/terminology/CodeSystem/organization-type prov}">Healthcare Provider</span></p><p><b>name</b>: Saudi General Hospital</p><p><b>address</b>: Salamah Street, Building 25, Suite 2, Riyadh Saudi Arabia(work)</p></div>
</text>
<extension
url="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type">
<valueCodeableConcept>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/provider-type"/>
<code value="1"/>
<display value="Hospital"/>
</coding>
</valueCodeableConcept>
</extension>
<identifier>
<system value="http://nphies.sa/license/provider-license"/>
<value value="PR-FHIR"/>
</identifier>
<active value="true"/>
<type>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/organization-type"/>
<code value="prov"/>
</coding>
</type>
<name value="Saudi General Hospital"/>
<address>
<use value="work"/>
<text
value="Salamah Street, Building 25, Suite 2, Riyadh Saudi Arabia"/>
<line value="Salamah Street, Building 25, Suite 2"/>
<line value="Al Malga District"/>
<city value="Riyadh"/>
<country value="Saudi Arabia"/>
</address>
</Organization>
</resource>
</entry>
<entry>
<fullUrl value="http://saudigeneralhospital.com.sa/Patient/123454186"/>
<resource>
<Patient>
<id value="123454186"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|0.3.0"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_123454186"> </a><p class="res-header-id"><b>Generated Narrative: Patient 123454186</b></p><a name="123454186"> </a><a name="hc123454186"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-patient.html">Nphies Patientversion: null0.3.0)</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Record is active">Active:</td><td>true</td><td style="background-color: #f3f5da" title="Known status of Patient">Deceased:</td><td>false</td></tr><tr><td style="background-color: #f3f5da" title="Known Marital status of Patient">Marital Status:</td><td colspan="3"><span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-MaritalStatus M}">Married</span></td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3"><ul><li><a href="tel:+966512345691">+966512345691</a></li><li>Salamah Street, Building 25, Suite 2, Saudi Arabia(home)</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Patient occupation as per the nphies adopted list of occupations."><a href="StructureDefinition-extension-occupation.html">Patient Occupation</a></td><td colspan="3"><span title="Codes:{http://nphies.sa/terminology/CodeSystem/occupation business}">Business</span></td></tr></table></div>
</text>
<extension
url="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation">
<valueCodeableConcept>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/occupation"/>
<code value="business"/>
</coding>
</valueCodeableConcept>
</extension>
<identifier>
<extension
url="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-identifier-country">
<valueCodeableConcept>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="SAU"/>
<display value="Saudi Arabia"/>
</coding>
</valueCodeableConcept>
</extension>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="PPN"/>
<display value="Passport Number"/>
</coding>
</type>
<system value="http://nphies.sa/identifier/passportnumber"/>
<value value="G12345678"/>
</identifier>
<active value="true"/>
<name>
<use value="official"/>
<text value="Ahmad Khaled Abbas"/>
<family value="Ahmad"/>
<given value="Khaled"/>
<given value="Abbas"/>
</name>
<telecom>
<system value="phone"/>
<value value="+966512345691"/>
</telecom>
<gender value="male">
<extension
url="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender">
<valueCodeableConcept>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender"/>
<code value="male"/>
</coding>
</valueCodeableConcept>
</extension>
</gender>
<birthDate value="1984-12-25"/>
<deceasedBoolean value="false"/>
<address>
<use value="home"/>
<text value="Salamah Street, Building 25, Suite 2, Saudi Arabia"/>
<line value="Salamah Street, Building 25, Suite 2"/>
<line value="Al Malga District"/>
<city value="Riyadh"/>
<country value="Saudi Arabia"/>
</address>
<maritalStatus>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-MaritalStatus"/>
<code value="M"/>
</coding>
</maritalStatus>
</Patient>
</resource>
</entry>
<entry>
<fullUrl
value="http://saudigeneralhospital.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db"/>
<resource>
<Organization>
<id value="bff3aa1fbd3648619ac082357bf135db"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|0.3.0"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_bff3aa1fbd3648619ac082357bf135db"> </a><p class="res-header-id"><b>Generated Narrative: Organization bff3aa1fbd3648619ac082357bf135db</b></p><a name="bff3aa1fbd3648619ac082357bf135db"> </a><a name="hcbff3aa1fbd3648619ac082357bf135db"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-insurer-organization.html">Nphies Insurer Organizationversion: null0.3.0)</a></p></div><p><b>identifier</b>: National Insurance Organization Identifier/INS-FHIR (use: official, )</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://nphies.sa/terminology/CodeSystem/organization-type ins}">Insurance Company</span></p><p><b>name</b>: Saudi National Insurance</p><p><b>address</b>: Olaya Street, Building 70, Riyadh Saudi Arabia(work)</p></div>
</text>
<identifier>
<use value="official"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="NII"/>
</coding>
</type>
<system value="http://nphies.sa/license/payer-license"/>
<value value="INS-FHIR"/>
</identifier>
<active value="true"/>
<type>
<coding>
<system
value="http://nphies.sa/terminology/CodeSystem/organization-type"/>
<code value="ins"/>
</coding>
</type>
<name value="Saudi National Insurance"/>
<address>
<use value="work"/>
<text value="Olaya Street, Building 70, Riyadh Saudi Arabia"/>
<line value="Olaya Street, Building 70"/>
<line value="Al Olaya District"/>
<city value="Riyadh"/>
<country value="Saudi Arabia"/>
</address>
</Organization>
</resource>
</entry>
<entry>
<fullUrl
value="http://saudigeneralhospital.com.sa/Location/2be1133308ed422a9923931c5a475f63"/>
<resource>
<Location>
<id value="2be1133308ed422a9923931c5a475f63"/>
<meta>
<profile
value="http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/location|0.3.0"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Location_2be1133308ed422a9923931c5a475f63"> </a><p class="res-header-id"><b>Generated Narrative: Location 2be1133308ed422a9923931c5a475f63</b></p><a name="2be1133308ed422a9923931c5a475f63"> </a><a name="hc2be1133308ed422a9923931c5a475f63"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-location.html">Nphies Locationversion: null0.3.0)</a></p></div><p><b>identifier</b>: <code>http://nphies.sa/license/location-license</code>/GACH</p><p><b>status</b>: Active</p><p><b>name</b>: Saudi General Hospital</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode GACH}">Hospitals; General Acute Care Hospital</span></p><p><b>managingOrganization</b>: <a href="Organization-b1b3432921324f97af3be9fd0b1a14ae.html">Organization Saudi General Hospital</a></p></div>
</text>
<identifier>
<system value="http://nphies.sa/license/location-license"/>
<value value="GACH"/>
</identifier>
<status value="active"/>
<name value="Saudi General Hospital"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="GACH"/>
</coding>
</type>
<managingOrganization>🔗
<reference value="Organization/b1b3432921324f97af3be9fd0b1a14ae"/>
</managingOrganization>
</Location>
</resource>
</entry>
</Bundle>