Healthcare Financial Services IG Edition 1
0.3.0 - ci-build
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 Claim: Authorization Vision Request #1
Generated Narrative: Claim 123073
Profile: Nphies Authorization Vision
identifier: http://saudivisioncare.com.sa/identifiers/authorization/req_9123073
status: Active
type: Vision
subType: OutPatient
use: Preauthorization
patient: Sara Abbas Female, DoB: 1989-03-13 ( Permanent Resident Card Number: 2000000003)
created: 2023-12-03 09:23:15+0300
insurer: Organization Saudi National Insurance
provider: Organization Saudi Vision Care
priority: Normal
Payees
| Type |
| Provider |
CareTeams
| Sequence | Provider | Role | Qualification |
| 1 | Practitioner Dr. Ashraf Naeem | Primary provider | Optometric |
Diagnoses
| Sequence | Diagnosis[x] | Type |
| 1 | Examination of eyes and vision | Principal Diagnosis |
Insurances
| Sequence | Focal | Coverage |
| 1 | true | Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000003; status = active; type = extended healthcare; relationship = Spouse; network = Golden C |
item
Package Code: false
Patient Share: SAR0.00 (SAR)
sequence: 1
careTeamSequence: 1
diagnosisSequence: 1
productOrService: Fitting of spectacles
serviced: 2023-12-04
quantity: 1
UnitPrices
Value Currency 800 Saudi riyal factor: 0.5
Nets
Value Currency 400 Saudi riyal
Totals
| Value | Currency |
| 400 | Saudi riyal |