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
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PERMANENT TEETH # 5</span></p><p><b>subSite</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/fdi-tooth-surface V}\">Ventral</span></p><p><b>noteNumber</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td><td>Saudi riyal</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}\">CoPay</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>0</td><td>Saudi riyal</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/ksa-adjudication approved-quantity}\">Approved Quantity</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Saudi riyal</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication tax}\">Tax</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>15</td><td>Saudi riyal</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td><td>Saudi riyal</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td><td>Saudi riyal</td></tr></table></blockquote><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Number</b></td><td><b>Type</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Display</td><td>Process Note Text to give more general information or direction</td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>false</td><td><a href=\"Bundle-43c68545-8e37-4744-b8ea-9a1e3c1ada84.html#http-//sni.com.sa/Coverage/1333\">Bundle: type = message; 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"div" : "<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>"
},
"identifier" : [
{
"system" : "http://sni.com.sa/identifiers/memberid",
"value" : "0000000001"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code" : "EHCPOL",
"display" : "extended healthcare"
}
]
},
"policyHolder" : {
🔗 "reference" : "Organization/13"
},
"subscriber" : {
🔗 "reference" : "Patient/123454186"
},
"beneficiary" : {
🔗 "reference" : "Patient/123454186"
},
"dependent" : "01",
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self",
"display" : "Self"
}
]
},
"payor" : [
{
🔗 "reference" : "Organization/bff3aa1fbd3648619ac082357bf135db"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
}
]
},
"value" : "CB135",
"name" : "Insurance Plan A"
}
],
"network" : "Golden C"
}
},
{
"fullUrl" : "http://sni.com.sa/Organization/13",
"resource" : {
"resourceType" : "Organization",
"id" : "13",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|0.3.0"
]
},
"text" : {
"status" : "generated",
"div" : "<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>"
},
"identifier" : [
{
"system" : "http://nphies.sa/identifiers/organization",
"value" : "5009"
}
],
"active" : true,
"name" : "Policy Holder Organization"
}
},
{
"fullUrl" : "http://sni.com.sa/Organization/b1b3432921324f97af3be9fd0b1a14ae",
"resource" : {
"resourceType" : "Organization",
"id" : "b1b3432921324f97af3be9fd0b1a14ae",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|0.3.0"
]
},
"text" : {
"status" : "extensions",
"div" : "<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>"
},
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/provider-type",
"code" : "1",
"display" : "Hospital"
}
]
}
}
],
"identifier" : [
{
"system" : "http://nphies.sa/license/provider-license",
"value" : "PR-FHIR"
}
],
"active" : true,
"type" : [
{
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/organization-type",
"code" : "prov"
}
]
}
],
"name" : "Saudi General Hospital",
"address" : [
{
"use" : "work",
"text" : "Salamah Street, Building 25, Suite 2, Riyadh Saudi Arabia",
"line" : [
"Salamah Street, Building 25, Suite 2",
"Al Malga District"
],
"city" : "Riyadh",
"country" : "Saudi Arabia"
}
]
}
},
{
"fullUrl" : "http://sni.com.sa/Patient/123454186",
"resource" : {
"resourceType" : "Patient",
"id" : "123454186",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|0.3.0"
]
},
"text" : {
"status" : "generated",
"div" : "<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>"
},
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/occupation",
"code" : "business"
}
]
}
}
],
"identifier" : [
{
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-identifier-country",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "SAU",
"display" : "Saudi Arabia"
}
]
}
}
],
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PPN",
"display" : "Passport Number"
}
]
},
"system" : "http://nphies.sa/identifier/passportnumber",
"value" : "G12345678"
}
],
"active" : true,
"name" : [
{
"use" : "official",
"text" : "Ahmad Khaled Abbas",
"family" : "Ahmad",
"given" : [
"Khaled",
"Abbas"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "+966512345691"
}
],
"gender" : "male",
"_gender" : {
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code" : "male"
}
]
}
}
]
},
"birthDate" : "1984-12-25",
"deceasedBoolean" : false,
"address" : [
{
"use" : "home",
"text" : "Salamah Street, Building 25, Suite 2, Saudi Arabia",
"line" : [
"Salamah Street, Building 25, Suite 2",
"Al Malga District"
],
"city" : "Riyadh",
"country" : "Saudi Arabia"
}
],
"maritalStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code" : "M"
}
]
}
}
},
{
"fullUrl" : "http://sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db",
"resource" : {
"resourceType" : "Organization",
"id" : "bff3aa1fbd3648619ac082357bf135db",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|0.3.0"
]
},
"text" : {
"status" : "generated",
"div" : "<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\u00a0(use:\u00a0official,\u00a0)</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>"
},
"identifier" : [
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "NII"
}
]
},
"system" : "http://nphies.sa/license/payer-license",
"value" : "INS-FHIR"
}
],
"active" : true,
"type" : [
{
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/organization-type",
"code" : "ins"
}
]
}
],
"name" : "Saudi National Insurance",
"address" : [
{
"use" : "work",
"text" : "Olaya Street, Building 70, Riyadh Saudi Arabia",
"line" : [
"Olaya Street, Building 70",
"Al Olaya District"
],
"city" : "Riyadh",
"country" : "Saudi Arabia"
}
]
}
}
]
}