Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot Saudi Arabia flag

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

: Authorization Professional Request #1 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "173086"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/professional-priorauth|0.3.0"^^xsd:anyURI ;
fhir:link <http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/professional-priorauth|0.3.0>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim 173086</b></p><a name=\"173086\"> </a><a name=\"hc173086\"> </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-professional-priorauth.html\">Nphies Authorization Professionalversion: null0.3.0)</a></p></div><p><b>Encounter</b>: <a href=\"Encounter-10122.html\">Encounter: extension = Very Urgent,2023-12-04 07:15:05+0000,Initial client service event; identifier = http://saudiprofessional.com.sa/identifiers/encounter#AB0001; status = in-progress; class = emergency (ActCode#EMER); serviceType = Acute Care; priority = emergency; period = 2023-12-04 --&gt; (ongoing)</a></p><p><b>Eligibility Response</b>: Identifier: <code>http://sni.com.sa/identifiers/coverageeligibilityresponse</code>/Elig_199719982262</p><p><b>identifier</b>: <code>http://saudiprofessionalclinic.com.sa/identifiers/authorization</code>/req_17308886</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>subType</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-subtype emr}\">Emergency</span></p><p><b>use</b>: Preauthorization</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>created</b>: 2023-12-04 10:38:00+0300</p><p><b>insurer</b>: <a href=\"Organization-bff3aa1fbd3648619ac082357bf135db.html\">Organization Saudi National Insurance</a></p><p><b>provider</b>: <a href=\"Organization-5025.html\">Organization Saudi Professional Clinic</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td></tr></table><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td><td><b>Qualification</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-2.html\">Practitioner Dr. Amar Moustafa(official)</a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claimcareteamrole primary}\">Primary provider</span></td><td><span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/practice-codes 08.02}\">Cardiology</span></td></tr></table><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category vital-sign-systolic}\">Systolic</span></p><p><b>timing</b>: 2023-12-04 10:38:00+0300 --&gt; 2023-12-04 11:38:00+0300</p><p><b>value</b>: 160 mm[Hg]<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  codemm[Hg] = 'mm[Hg]')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category vital-sign-diastolic}\">Diastolic</span></p><p><b>timing</b>: 2023-12-04 10:38:00+0300 --&gt; 2023-12-04 11:38:00+0300</p><p><b>value</b>: 100 mm[Hg]<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  codemm[Hg] = 'mm[Hg]')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category vital-sign-height}\">Height</span></p><p><b>timing</b>: 2023-12-04 10:38:00+0300 --&gt; 2023-12-04 11:38:00+0300</p><p><b>value</b>: 133 cm<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  codecm = 'cm')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 4</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category vital-sign-weight}\">Weight</span></p><p><b>timing</b>: 2023-12-04 10:38:00+0300 --&gt; 2023-12-04 11:38:00+0300</p><p><b>value</b>: 120 kg<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  codekg = 'kg')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 5</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category pulse}\">Pulse</span></p><p><b>timing</b>: 2023-12-04 10:38:00+0300 --&gt; 2023-12-04 11:38:00+0300</p><p><b>value</b>: 140 /min<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code/min = '/min')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 6</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category temperature}\">Temperature</span></p><p><b>timing</b>: 2023-12-04 10:38:00+0300 --&gt; 2023-12-04 11:38:00+0300</p><p><b>value</b>: 37 Cel<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  codeCel = 'Cel')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 7</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category chief-complaint}\">chief complaint</span></p><p><b>code</b>: <span title=\"Codes:\">Chest tightness</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 8</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category oxygen-saturation}\">Oxygen Saturation</span></p><p><b>timing</b>: 2023-12-04 10:38:00+0300 --&gt; 2023-12-04 11:38:00+0300</p><p><b>value</b>: 100 %<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code% = '%')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 9</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category respiratory-rate}\">Respiratory Rate</span></p><p><b>timing</b>: 2023-12-04 10:38:00+0300 --&gt; 2023-12-04 11:38:00+0300</p><p><b>value</b>: 70 /min<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code/min = '/min')</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 10</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category patient-history}\">patient history</span></p><p><b>value</b>: No systemic disease</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 11</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category investigation-result}\">Investigation Result</span></p><p><b>code</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/investigation-result INP}\">Investigation(s) not performed</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 12</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category treatment-plan}\">Treatment Plan</span></p><p><b>value</b>: administration of thrombolytic agent</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 13</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category physical-examination}\">Physical Examination</span></p><p><b>value</b>: Stable</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 14</p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category history-of-present-illness}\">history Of Present Illness</span></p><p><b>value</b>: No history</p></blockquote><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-am I21.9}\">Acute myocardial infarction, unspecified</span></td><td><span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/diagnosis-type principal}\">Principal Diagnosis</span></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>true</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><blockquote><p><b>item</b></p><p><b>Package Code</b>: false</p><p><b>Patient Share</b>: <span title=\"Saudi Riyal\">SAR0.00</span> (SAR)</p><p><b>Maternity</b>: false</p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>diagnosisSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/procedures 96196-01-00}\">Intra-arterial administration of pharmacological agent, thrombolytic agent</span></p><p><b>serviced</b>: 2023-12-04</p><p><b>quantity</b>: 1</p><h3>UnitPrices</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>120</td><td>Saudi riyal</td></tr></table><h3>Nets</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>120</td><td>Saudi riyal</td></tr></table></blockquote><h3>Totals</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>120</td><td>Saudi riyal</td></tr></table></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:extension ( [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:reference [ fhir:v "Encounter/10122" ]     ]
  ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-response"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:identifier [
fhir:system [ fhir:v "http://sni.com.sa/identifiers/coverageeligibilityresponse"^^xsd:anyURI ] ;
fhir:value [ fhir:v "Elig_199719982262" ]       ]     ]
  ] ) ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "http://saudiprofessionalclinic.com.sa/identifiers/authorization"^^xsd:anyURI ] ;
fhir:value [ fhir:v "req_17308886" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "professional" ]     ] )
  ] ; # 
  fhir:subType [
    ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-subtype"^^xsd:anyURI ] ;
fhir:code [ fhir:v "emr" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "preauthorization"] ; # 
  fhir:patient [
fhir:reference [ fhir:v "Patient/123454186" ]
  ] ; # 
  fhir:created [ fhir:v "2023-12-04T10:38:00+03:00"^^xsd:dateTime] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/bff3aa1fbd3648619ac082357bf135db" ]
  ] ; # 
  fhir:provider [
fhir:reference [ fhir:v "Organization/5025" ]
  ] ; # 
  fhir:priority [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
fhir:code [ fhir:v "normal" ]     ] )
  ] ; # 
  fhir:payee [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ;
fhir:code [ fhir:v "provider" ]       ] )     ]
  ] ; # 
  fhir:careTeam ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:provider [
fhir:reference [ fhir:v "Practitioner/2" ]     ] ;
fhir:role [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ] ;
fhir:code [ fhir:v "primary" ]       ] )     ] ;
fhir:qualification [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/practice-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "08.02" ]       ] )     ]
  ] ) ; # 
  fhir:supportingInfo ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "vital-sign-systolic" ]       ] )     ] ;
fhir:timing [
a fhir:Period ;
fhir:start [ fhir:v "2023-12-04T10:38:00+03:00"^^xsd:dateTime ] ;
fhir:end [ fhir:v "2023-12-04T11:38:00+03:00"^^xsd:dateTime ]     ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "160"^^xsd:decimal ] ;
fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mm[Hg]" ]     ]
  ] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "vital-sign-diastolic" ]       ] )     ] ;
fhir:timing [
a fhir:Period ;
fhir:start [ fhir:v "2023-12-04T10:38:00+03:00"^^xsd:dateTime ] ;
fhir:end [ fhir:v "2023-12-04T11:38:00+03:00"^^xsd:dateTime ]     ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "100"^^xsd:decimal ] ;
fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mm[Hg]" ]     ]
  ] [
fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "vital-sign-height" ]       ] )     ] ;
fhir:timing [
a fhir:Period ;
fhir:start [ fhir:v "2023-12-04T10:38:00+03:00"^^xsd:dateTime ] ;
fhir:end [ fhir:v "2023-12-04T11:38:00+03:00"^^xsd:dateTime ]     ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "133"^^xsd:decimal ] ;
fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "cm" ]     ]
  ] [
fhir:sequence [ fhir:v "4"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "vital-sign-weight" ]       ] )     ] ;
fhir:timing [
a fhir:Period ;
fhir:start [ fhir:v "2023-12-04T10:38:00+03:00"^^xsd:dateTime ] ;
fhir:end [ fhir:v "2023-12-04T11:38:00+03:00"^^xsd:dateTime ]     ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "120"^^xsd:decimal ] ;
fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "kg" ]     ]
  ] [
fhir:sequence [ fhir:v "5"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "pulse" ]       ] )     ] ;
fhir:timing [
a fhir:Period ;
fhir:start [ fhir:v "2023-12-04T10:38:00+03:00"^^xsd:dateTime ] ;
fhir:end [ fhir:v "2023-12-04T11:38:00+03:00"^^xsd:dateTime ]     ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "140"^^xsd:decimal ] ;
fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "/min" ]     ]
  ] [
fhir:sequence [ fhir:v "6"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "temperature" ]       ] )     ] ;
fhir:timing [
a fhir:Period ;
fhir:start [ fhir:v "2023-12-04T10:38:00+03:00"^^xsd:dateTime ] ;
fhir:end [ fhir:v "2023-12-04T11:38:00+03:00"^^xsd:dateTime ]     ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "37"^^xsd:decimal ] ;
fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Cel" ]     ]
  ] [
fhir:sequence [ fhir:v "7"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "chief-complaint" ]       ] )     ] ;
fhir:code [
fhir:text [ fhir:v "Chest tightness" ]     ]
  ] [
fhir:sequence [ fhir:v "8"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "oxygen-saturation" ]       ] )     ] ;
fhir:timing [
a fhir:Period ;
fhir:start [ fhir:v "2023-12-04T10:38:00+03:00"^^xsd:dateTime ] ;
fhir:end [ fhir:v "2023-12-04T11:38:00+03:00"^^xsd:dateTime ]     ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "100"^^xsd:decimal ] ;
fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "%" ]     ]
  ] [
fhir:sequence [ fhir:v "9"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "respiratory-rate" ]       ] )     ] ;
fhir:timing [
a fhir:Period ;
fhir:start [ fhir:v "2023-12-04T10:38:00+03:00"^^xsd:dateTime ] ;
fhir:end [ fhir:v "2023-12-04T11:38:00+03:00"^^xsd:dateTime ]     ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "70"^^xsd:decimal ] ;
fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "/min" ]     ]
  ] [
fhir:sequence [ fhir:v "10"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "patient-history" ]       ] )     ] ;
fhir:value [
a fhir:string ;
fhir:v "No systemic disease"     ]
  ] [
fhir:sequence [ fhir:v "11"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "investigation-result" ]       ] )     ] ;
fhir:code [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/investigation-result"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INP" ]       ] )     ]
  ] [
fhir:sequence [ fhir:v "12"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "treatment-plan" ]       ] )     ] ;
fhir:value [
a fhir:string ;
fhir:v "administration of thrombolytic agent"     ]
  ] [
fhir:sequence [ fhir:v "13"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "physical-examination" ]       ] )     ] ;
fhir:value [
a fhir:string ;
fhir:v "Stable"     ]
  ] [
fhir:sequence [ fhir:v "14"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "history-of-present-illness" ]       ] )     ] ;
fhir:value [
a fhir:string ;
fhir:v "No history"     ]
  ] ) ; # 
  fhir:diagnosis ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:diagnosis [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10-am"^^xsd:anyURI ] ;
fhir:code [ fhir:v "I21.9" ] ;
fhir:display [ fhir:v "Acute myocardial infarction, unspecified" ]       ] )     ] ;
    ( fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/diagnosis-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "principal" ]       ] )     ] )
  ] ) ; # 
  fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v true ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/1333" ]     ]
  ] ) ; # 
  fhir:item ( [
    ( fhir:extension [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package"^^xsd:anyURI ] ;
fhir:value [
a fhir:boolean ;
fhir:v false       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-share"^^xsd:anyURI ] ;
fhir:value [
a fhir:Money ;
fhir:value [ fhir:v "0"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-maternity"^^xsd:anyURI ] ;
fhir:value [
a fhir:boolean ;
fhir:v false       ]     ] ) ;
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    ( fhir:careTeamSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
    ( fhir:diagnosisSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/procedures"^^xsd:anyURI ] ;
fhir:code [ fhir:v "96196-01-00" ] ;
fhir:display [ fhir:v "Intra-arterial administration of pharmacological agent, thrombolytic agent" ]       ] )     ] ;
fhir:serviced [
a fhir:date ;
fhir:v "2023-12-04"^^xsd:date     ] ;
fhir:quantity [
fhir:value [ fhir:v "1"^^xsd:decimal ]     ] ;
fhir:unitPrice [
fhir:value [ fhir:v "120"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]     ] ;
fhir:net [
fhir:value [ fhir:v "120"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]     ]
  ] ) ; # 
  fhir:total [
fhir:value [ fhir:v "120"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]
  ] . #