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: Authorization Oral Request #1

Generated Narrative: Claim 293093

Encounter: Encounter: extension = Initial client service event; identifier = http://saudidentalclinic.com.sa/identifiers/encounter#AB0001; status = in-progress; class = ambulatory (ActCode#AMB); serviceType = Acute Care; priority = elective; period = 2023-12-04 --> (ongoing)

identifier: http://saudidentalclinic.com.sa/identifiers/authorization/req_293093

status: Active

type: Oral

subType: OutPatient

use: Preauthorization

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
*1K02.0Principal 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

Patient Share: SAR40.00 (SAR)

sequence: 1

careTeamSequence: 1

diagnosisSequence: 1

productOrService: Comprehensive oral examination

serviced: 2023-12-04

quantity: 1

UnitPrices

-ValueCurrency
*200Saudi riyal

Nets

-ValueCurrency
*200Saudi riyal

item

Package Code: false

Patient Share: SAR60.00 (SAR)

sequence: 2

careTeamSequence: 1

diagnosisSequence: 1

productOrService: Dental antibiotic sensitivity test

serviced: 2023-12-04

quantity: 1

UnitPrices

-ValueCurrency
*300Saudi riyal

Nets

-ValueCurrency
*300Saudi riyal

bodySite: UPPER RIGHT; PERMANENT TEETH # 3

item

Package Code: false

Patient Share: SAR100.00 (SAR)

sequence: 3

careTeamSequence: 1

diagnosisSequence: 1

productOrService: Lithium disilicate ceramic crown (e max), indirect; per crown

serviced: 2023-12-04

quantity: 1

UnitPrices

-ValueCurrency
*1300Saudi riyal

Nets

-ValueCurrency
*1300Saudi riyal

bodySite: LOWER LEFT; PERMANENT TEETH # 7

Totals

-ValueCurrency
*1800Saudi riyal