Message: Claim Institutional Request #1 - Healthcare Financial Services IG Edition 1 v0.3.0

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

Example Bundle: Message: Claim Institutional Request #1

Generated Narrative: Bundle a84aabfa-1163-407d-aa38-f8119a0b8888

Profile: Nphies Bundle

Bundle a84aabfa-1163-407d-aa38-f8119a0b8888 of type message

Entry 1 - fullUrl = urn:uuid:a7e4caf2-0441-40e5-97d2-5ae1802730af

Resource MessageHeader:

Generated Narrative: MessageHeader a7e4caf2-0441-40e5-97d2-5ae1802730af

Profile: Nphies MessageHeader
event: KSA Message Events claim-request: Claim Request
Destinations
- Receiver
* Identifier: http://nphies.sa/license/payer-license/INS-FHIR
sender: Identifier: http://nphies.sa/license/provider-license/PR-FHIR
source
focus: Bundle: type = message; timestamp = 2023-12-05 09:20:15+0300

Entry 2 - fullUrl = http://saudigeneralhospital.com.sa/Claim/483070

Resource Claim:

Generated Narrative: Claim 483070

Profile: Nphies Claim Institutional
Encounter: Bundle: type = message; timestamp = 2023-12-05 09:20:15+0300
Eligibility Offline Reference: EligResp-31212432
Eligibility Offline Date: 2023-12-05
Episode: http://saudigeneralhospital.com.sa/identifiers/episode/provider_EpisodeID_48903211
identifier: http://saudigeneralhospital.com.sa/identifiers/claim/req_3085
status: Active
type: Institutional
subType: InPatient
use: Claim
patient: Muhammad Khaled Abbas(official) Male, DoB: 2010-08-21 ( Permanent Resident Card Number: 2000000002)
created: 2023-12-05 12:30:15+0300
insurer: Organization Saudi National Insurance
provider: Organization Saudi General Hospital
priority: Normal
Payees
- Type
* Provider
CareTeams
- Sequence Provider Role
* 1 Practitioner Dr. Ameera Hassan(official) Primary provider
supportingInfo
sequence: 1
category: Systolic
timing: 2023-12-05 12:30:15+0300 --> 2023-12-05 12:30:15+0300
value: 120 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')
supportingInfo
sequence: 2
category: Diastolic
timing: 2023-12-05 12:30:15+0300 --> 2023-12-05 12:30:15+0300
value: 80 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')
supportingInfo
sequence: 3
category: Height
timing: 2023-12-05 12:30:15+0300 --> 2023-12-05 12:30:15+0300
value: 175 cm (Details: UCUM codecm = 'cm')
supportingInfo
sequence: 4
category: Weight
timing: 2023-12-05 12:30:15+0300 --> 2023-12-05 12:30:15+0300
value: 129 kg (Details: UCUM codekg = 'kg')
supportingInfo
sequence: 5
category: Pulse
timing: 2023-12-05 12:30:15+0300 --> 2023-12-05 12:30:15+0300
value: 100 /min (Details: UCUM code/min = '/min')
supportingInfo
sequence: 6
category: Temperature
timing: 2023-12-05 12:30:15+0300 --> 2023-12-05 12:30:15+0300
value: 37 Cel (Details: UCUM codeCel = 'Cel')
supportingInfo
sequence: 7
category: chief complaint
code: Chronic atrial fibrillation (disorder)
supportingInfo
sequence: 8
category: Oxygen Saturation
timing: 2023-12-05 12:30:15+0300 --> 2023-12-05 12:30:15+0300
value: 100 % (Details: UCUM code% = '%')
supportingInfo
sequence: 9
category: Respiratory Rate
timing: 2023-12-05 12:30:15+0300 --> 2023-12-05 12:30:15+0300
value: 18 /min (Details: UCUM code/min = '/min')
supportingInfo
sequence: 10
category: Admission Weight
value: 129 kg (Details: UCUM codekg = 'kg')
supportingInfo
sequence: 11
category: patient history
value: No systemic disease
supportingInfo
sequence: 12
category: Investigation Result
code: Investigation(s) not performed
supportingInfo
sequence: 13
category: Treatment Plan
value: Surgery
supportingInfo
sequence: 14
category: Physical Examination
value: Stable
supportingInfo
sequence: 15
category: history Of Present Illness
value: No history
supportingInfo
sequence: 16
category: Onset
code: Chest pain on breathing
timing: 2023-12-05
supportingInfo
sequence: 17
category: Ventilation Hours
timing: 2023-12-05 12:30:15+0300 --> 2023-12-05 12:30:15+0300
value: 1.5 h (Details: UCUM codeh = 'h')
diagnosis
Condition Onset: Not reported
sequence: 1
diagnosis: Chronic atrial fibrillation
type: Principal Diagnosis
onAdmission: Yes
diagnosis
Condition Onset: Not reported
sequence: 2
diagnosis: Headache
type: Secondary Diagnosis
onAdmission: Yes
Insurances
- Sequence Focal Coverage
* 1 true Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000002; status = active; type = extended healthcare; relationship = Child; network = Golden C
item
Package Code: false
Tax: SAR750.00 (SAR)
Patient Share: SAR0.00 (SAR)
Patient Invoice: http://saudigeneralhospital.com.sa/identifiers/patientInvoice/Invc-20220120/IP-1110987
Maternity: false
sequence: 1
careTeamSequence: 1
diagnosisSequence: 1
informationSequence: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17
productOrService: Catheter ablation of arrhythmia circuit or focus involving left atrial chamber
serviced: 2023-12-05
quantity: 1
UnitPrices
- Value Currency
* 5000 SAR
Nets
- Value Currency
* 5750 SAR
item
Package Code: false
Tax: SAR45.00 (SAR)
Patient Share: SAR0.00 (SAR)
Patient Invoice: http://saudigeneralhospital.com.sa/identifiers/patientInvoice/Invc-20220120/IP-1110987
Maternity: false
sequence: 2
careTeamSequence: 1
diagnosisSequence: 1
informationSequence: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17
productOrService: Management of continuous ventilatory support, <= 24 hours
serviced: 2023-12-04
quantity: 1
UnitPrices
- Value Currency
* 300 SAR
Nets
- Value Currency
* 345 SAR
Totals
- Value Currency
* 6095 SAR

Entry 3 - fullUrl = http://saudigeneralhospital.com.sa/Coverage/1334

Resource Coverage:

Generated Narrative: Coverage 1334

Profile: Nphies Coverage
identifier: http://sni.com.sa/identifiers/memberid/0000000002
status: Active
type: extended healthcare
policyHolder: Organization Policy Holder Organization
subscriber: Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)
beneficiary: Muhammad Khaled Abbas(official) Male, DoB: 2010-08-21 ( Permanent Resident Card Number: 2000000002)
relationship: Child
Classes
- Type Value Name
* Plan CB135 Insurance Plan A
network: Golden C

Entry 4 - fullUrl = http://saudigeneralhospital.com.sa/Organization/13

Resource Organization:

Generated Narrative: Organization 13

Profile: Nphies Policy Holder Organization
identifier: http://nphies.sa/identifiers/organization/5009
active: true
name: Policy Holder Organization

Entry 5 - fullUrl = http://saudigeneralhospital.com.sa/Organization/b1b3432921324f97af3be9fd0b1a14ae

Resource Organization:

Generated Narrative: Organization b1b3432921324f97af3be9fd0b1a14ae

Profile: Nphies Provider Organization
Provider Type: Hospital
identifier: http://nphies.sa/license/provider-license/PR-FHIR
active: true
type: Healthcare Provider
name: Saudi General Hospital
Contacts
- Address
* Salamah Street, Building 25, Suite 2, Riyadh Saudi Arabia(work)

Entry 6 - fullUrl = http://saudigeneralhospital.com.sa/Patient/173826788

Resource Patient:

Generated Narrative: Patient 173826788

Profile: Nphies Patient
Muhammad Khaled Abbas(official) Male, DoB: 2010-08-21 ( Permanent Resident Card Number: 2000000002)
Active: true Marital Status: unmarried
Contact Detail +966517382691
Patient Occupation Student

Entry 7 - fullUrl = http://saudigeneralhospital.com.sa/Patient/123454186

Resource Patient:

Generated Narrative: Patient 123454186

Profile: Nphies Patient
Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)
Active: true Deceased: false
Marital Status: Married
Contact Detail
+966512345691
Salamah Street, Building 25, Suite 2, Saudi Arabia(home)
Patient Occupation Business

Entry 8 - fullUrl = http://saudigeneralhospital.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db

Resource Organization:

Generated Narrative: Organization bff3aa1fbd3648619ac082357bf135db

Profile: Nphies Insurer Organization
identifier: National Insurance Organization Identifier/INS-FHIR (use: official, )
active: true
type: Insurance Company
name: Saudi National Insurance
Contacts
- Address
* Olaya Street, Building 70, Riyadh Saudi Arabia(work)

Entry 9 - fullUrl = http://saudigeneralhospital.com.sa/Practitioner/1

Resource Practitioner:

Generated Narrative: Practitioner 1

Profile: Nphies Practitioner
identifier: Provider number/N-P-00001
active: true
name: Dr. Ameera Hassan(Official)

Entry 10 - fullUrl = http://saudigeneralhospital.com.sa/Encounter/10130

Resource Encounter:

Generated Narrative: Encounter 10130

Profile: Nphies Encounter IMP (Claim)
Cause Of Death: Mycoplasma infection, unspecified
identifier: http://saudigeneralhospital.com.sa/identifiers/encounter/AB00030
status: completed
class: inpatient encounter
serviceType: No display for Encounter.serviceType (concept: Acute Care)
subject: Muhammad Khaled Abbas(official) Male, DoB: 2010-08-21 ( Permanent Resident Card Number: 2000000002)
serviceProvider: Organization Saudi General Hospital