Healthcare Financial Services IG Edition 1
0.3.0 - ci-build 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

Example Claim: Claim Oral Request #2

Generated Narrative: Claim 173094

Encounter: Encounter: extension = Initial client service event; identifier = http://saudidentalclinic.com.sa/identifiers/encounter#AB0032; status = finished; class = ambulatory (ActCode#AMB); serviceType = Dental Care; priority = elective; period = 2023-12-04 --> (ongoing)

Episode: http://saudidentalclinic.com.sa/identifiers/episode/SDC_EpisodeID_48903211

identifier: http://saudidentalclinic.com.sa/identifiers/claim/req_29309905401

status: Active

type: Oral

subType: OutPatient

use: Claim

patient: Sara Abbas Female, DoB: 1989-03-13 ( Permanent Resident Card Number: 2000000003)

created: 2023-12-04 08:38:00+0300

insurer: Organization Saudi National Insurance

provider: Organization Saudi Dental Clinic

priority: Normal

Payees

-Type
*Provider

CareTeams

-SequenceProviderRoleQualification
*1Practitioner Dr. Ashraf NaeemPrimary providerDental

Diagnoses

-SequenceDiagnosis[x]Type
*1Caries limited to enamelPrincipal Diagnosis

Insurances

-SequenceFocalCoverage
*1trueCoverage: identifier = http://sni.com.sa/identifiers/memberid#0000000003; status = active; type = extended healthcare; relationship = Spouse; network = Golden C

item

Package Code: false

Tax: SAR30.00 (SAR)

Patient Share: SAR40.00 (SAR)

Patient Invoice: http://saudigeneralhospital.com.sa/identifiers/patientInvoice/Invc-20220120/IP-1110987

sequence: 1

careTeamSequence: 1

diagnosisSequence: 1

productOrService: Adhesive restor tooth 1 surf direct

serviced: 2023-12-05

quantity: 1

UnitPrices

-ValueCurrency
*200Saudi riyal

Nets

-ValueCurrency
*230Saudi riyal

Totals

-ValueCurrency
*230Saudi riyal