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
: Claim Professional Request #1 - JSON Representation
{
"resourceType" : "Claim",
"id" : "173386",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/professional-claim"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim 173386</b></p><a name=\"173386\"> </a><a name=\"hc173386\"> </a><a name=\"173386-en-US\"> </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-claim.html\">Nphies Claim Professional</a></p></div><p><b>Encounter</b>: <a href=\"Encounter-10131.html\">Encounter: extension = Urgent,2023-12-05 11:38:32+0300,Initial client service event,Ground EMS Ambulance,2023-12-05 11:38:32+0300,Died in ED,Mycoplasma infection, unspecified; identifier = http://saudiprofessional.com.sa/identifiers/encounter#AB0011; status = finished; class = emergency (ActCode#EMER); serviceType = Sub-Acute Care; priority = emergency; period = 2023-12-05 08:38:00+0300 --> 2023-12-06 11:38:00+0300</a></p><p><b>Authorization Offline Date</b>: 2023-12-05 11:05:48+0300</p><p><b>Episode</b>: <code>http://saudiprofessionalclinic.com.sa/identifiers/episode</code>/provider_EpisodeID_2314596</p><p><b>identifier</b>: <code>http://saudiprofessionalclinic.com.sa/identifiers/claim</code>/req_17307786</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>: Claim</p><p><b>patient</b>: <a href=\"Patient-3662364643.html\">Maria Khaled Rizwan(official) Female, DoB: 1990-12-25 ( Permanent Resident Card Number: 2000000010)</a></p><p><b>created</b>: 2023-12-05 12:21:15+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>: 2023-12-05 12:21:15+0300 --> 2023-12-05 12:21:15+0300</p><p><b>value</b>: 120 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>: 2023-12-05 12:21:15+0300 --> 2023-12-05 12:21:15+0300</p><p><b>value</b>: 80 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>: 2023-12-05 12:21:15+0300 --> 2023-12-05 12:21:15+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>: 2023-12-05 12:21:15+0300 --> 2023-12-05 12:21:15+0300</p><p><b>value</b>: 50 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>: 2023-12-05 12:21:15+0300 --> 2023-12-05 12:21:15+0300</p><p><b>value</b>: 100 /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>: 2023-12-05 12:21:15+0300 --> 2023-12-05 12:21:15+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:{http://snomed.info/sct 426749004}\">Chronic atrial fibrillation (disorder)</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>: 2023-12-05 12:21:15+0300 --> 2023-12-05 12:21:15+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>: 2023-12-05 12:21:15+0300 --> 2023-12-05 12:21:15+0300</p><p><b>value</b>: 18 /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>: Analgesic Drugs</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 I48.2}\">Chronic atrial fibrillation</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><td><b>PreAuthRef</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-1445.html\">Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000002; status = active; type = extended healthcare; relationship = Self; network = Golden C</a></td><td>DEF987</td></tr></table><blockquote><p><b>item</b></p><p><b>Patient Share</b>: <span title=\"Saudi Riyal\">SAR20.00</span> (SAR)</p><p><b>Package Code</b>: false</p><p><b>Tax</b>: <span title=\"Saudi Riyal\">SAR75.00</span> (SAR)</p><p><b>Patient Invoice</b>: <code>http://saudiprofessionalclinic.com.sa/identifiers/patientInvoice</code>/Invc-20220120/OP-883923</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/services 83600-00-10}\">Office Assessment for diagnosis treatment and counselling of a new or established patient by Specialist</span></p><p><b>serviced</b>: 2023-12-05</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>500</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>575</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>575</td><td>Saudi riyal</td></tr></table></div>"
},
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter",
"valueReference" : {
🔗 "reference" : "Encounter/10131"
}
},
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-authorization-offline-date",
"valueDateTime" : "2023-12-05T11:05:48+03:00"
},
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-episode",
"valueIdentifier" : {
"system" : "http://saudiprofessionalclinic.com.sa/identifiers/episode",
"value" : "provider_EpisodeID_2314596"
}
}
],
"identifier" : [
{
"system" : "http://saudiprofessionalclinic.com.sa/identifiers/claim",
"value" : "req_17307786"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional"
}
]
},
"subType" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-subtype",
"code" : "emr"
}
]
},
"use" : "claim",
"patient" : {
🔗 "reference" : "Patient/3662364643"
},
"created" : "2023-12-05T12:21:15.23+03:00",
"insurer" : {
🔗 "reference" : "Organization/bff3aa1fbd3648619ac082357bf135db"
},
"provider" : {
🔗 "reference" : "Organization/5025"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"payee" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider"
}
]
}
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
🔗 "reference" : "Practitioner/2"
},
"role" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code" : "primary"
}
]
},
"qualification" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/practice-codes",
"code" : "08.02"
}
]
}
}
],
"supportingInfo" : [
{
"sequence" : 1,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "vital-sign-systolic"
}
]
},
"timingPeriod" : {
"start" : "2023-12-05T12:21:15.23+03:00",
"end" : "2023-12-05T12:21:15.23+03:00"
},
"valueQuantity" : {
"value" : 120,
"system" : "http://unitsofmeasure.org",
"code" : "mm[Hg]"
}
},
{
"sequence" : 2,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "vital-sign-diastolic"
}
]
},
"timingPeriod" : {
"start" : "2023-12-05T12:21:15.23+03:00",
"end" : "2023-12-05T12:21:15.23+03:00"
},
"valueQuantity" : {
"value" : 80,
"system" : "http://unitsofmeasure.org",
"code" : "mm[Hg]"
}
},
{
"sequence" : 3,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "vital-sign-height"
}
]
},
"timingPeriod" : {
"start" : "2023-12-05T12:21:15.23+03:00",
"end" : "2023-12-05T12:21:15.23+03:00"
},
"valueQuantity" : {
"value" : 133,
"system" : "http://unitsofmeasure.org",
"code" : "cm"
}
},
{
"sequence" : 4,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "vital-sign-weight"
}
]
},
"timingPeriod" : {
"start" : "2023-12-05T12:21:15.23+03:00",
"end" : "2023-12-05T12:21:15.23+03:00"
},
"valueQuantity" : {
"value" : 50,
"system" : "http://unitsofmeasure.org",
"code" : "kg"
}
},
{
"sequence" : 5,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "pulse"
}
]
},
"timingPeriod" : {
"start" : "2023-12-05T12:21:15.23+03:00",
"end" : "2023-12-05T12:21:15.23+03:00"
},
"valueQuantity" : {
"value" : 100,
"system" : "http://unitsofmeasure.org",
"code" : "/min"
}
},
{
"sequence" : 6,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "temperature"
}
]
},
"timingPeriod" : {
"start" : "2023-12-05T12:21:15.23+03:00",
"end" : "2023-12-05T12:21:15.23+03:00"
},
"valueQuantity" : {
"value" : 37,
"system" : "http://unitsofmeasure.org",
"code" : "Cel"
}
},
{
"sequence" : 7,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "chief-complaint"
}
]
},
"code" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "426749004",
"display" : "Chronic atrial fibrillation (disorder)"
}
]
}
},
{
"sequence" : 8,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "oxygen-saturation"
}
]
},
"timingPeriod" : {
"start" : "2023-12-05T12:21:15.23+03:00",
"end" : "2023-12-05T12:21:15.23+03:00"
},
"valueQuantity" : {
"value" : 100,
"system" : "http://unitsofmeasure.org",
"code" : "%"
}
},
{
"sequence" : 9,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "respiratory-rate"
}
]
},
"timingPeriod" : {
"start" : "2023-12-05T12:21:15.23+03:00",
"end" : "2023-12-05T12:21:15.23+03:00"
},
"valueQuantity" : {
"value" : 18,
"system" : "http://unitsofmeasure.org",
"code" : "/min"
}
},
{
"sequence" : 10,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "patient-history"
}
]
},
"valueString" : "No systemic disease"
},
{
"sequence" : 11,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "investigation-result"
}
]
},
"code" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/investigation-result",
"code" : "INP",
"display" : "Investigation(s) not performed"
}
]
}
},
{
"sequence" : 12,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "treatment-plan"
}
]
},
"valueString" : "Analgesic Drugs"
},
{
"sequence" : 13,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "physical-examination"
}
]
},
"valueString" : "Stable"
},
{
"sequence" : 14,
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-information-category",
"code" : "history-of-present-illness"
}
]
},
"valueString" : "No history"
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10-am",
"code" : "I48.2",
"display" : "Chronic atrial fibrillation"
}
]
},
"type" : [
{
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/diagnosis-type",
"code" : "principal"
}
]
}
]
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
🔗 "reference" : "Coverage/1445"
},
"preAuthRef" : [
"DEF987"
]
}
],
"item" : [
{
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-share",
"valueMoney" : {
"value" : 20,
"currency" : "SAR"
}
},
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package",
"valueBoolean" : false
},
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax",
"valueMoney" : {
"value" : 75,
"currency" : "SAR"
}
},
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier" : {
"system" : "http://saudiprofessionalclinic.com.sa/identifiers/patientInvoice",
"value" : "Invc-20220120/OP-883923"
}
},
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-maternity",
"valueBoolean" : false
}
],
"sequence" : 1,
"careTeamSequence" : [
1
],
"diagnosisSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/services",
"code" : "83600-00-10",
"display" : "Office Assessment for diagnosis treatment and counselling of a new or established patient by Specialist"
}
]
},
"servicedDate" : "2023-12-05",
"quantity" : {
"value" : 1
},
"unitPrice" : {
"value" : 500,
"currency" : "SAR"
},
"net" : {
"value" : 575,
"currency" : "SAR"
}
}
],
"total" : {
"value" : 575,
"currency" : "SAR"
}
}