@prefix fhir: . @prefix owl: . @prefix rdf: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:Claim ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "293093"] ; # fhir:meta [ fhir:profile ( [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/oral-priorauth"^^xsd:anyURI ; fhir:link ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "

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
"^^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:link ; fhir:reference [ fhir:v "Encounter/10123" ] ] ] ) ; # fhir:identifier ( [ fhir:system [ fhir:v "http://saudidentalclinic.com.sa/identifiers/authorization"^^xsd:anyURI ] ; fhir:value [ fhir:v "req_293093" ] ] ) ; # 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 "oral" ] ] ) ] ; # fhir:subType [ fhir:coding ( [ fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-subtype"^^xsd:anyURI ] ; fhir:code [ fhir:v "op" ] ] ) ] ; # fhir:use [ fhir:v "preauthorization"] ; # fhir:patient [ fhir:link ; fhir:reference [ fhir:v "Patient/453" ] ] ; # fhir:created [ fhir:v "2023-12-04T08:38:00+03:00"^^xsd:dateTime] ; # fhir:insurer [ fhir:link ; fhir:reference [ fhir:v "Organization/bff3aa1fbd3648619ac082357bf135db" ] ] ; # fhir:provider [ fhir:link ; fhir:reference [ fhir:v "Organization/215" ] ] ; # 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:link ; fhir:reference [ fhir:v "Practitioner/4" ] ] ; 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 "22.00" ] ] ) ] ] ) ; # 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 "K02.0" ] ] ) ] ; 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:link ; fhir:reference [ fhir:v "Coverage/1985" ] ] ] ) ; # 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 "40"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ] ) ; 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/oral-health-op"^^xsd:anyURI ] ; fhir:code [ fhir:v "97011-00-00" ] ; fhir:display [ fhir:v "Comprehensive oral examination" ] ] ) ] ; 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 "200"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ; fhir:net [ fhir:value [ fhir:v "200"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ] [ 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 "60"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ] ) ; fhir:sequence [ fhir:v "2"^^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/oral-health-op"^^xsd:anyURI ] ; fhir:code [ fhir:v "97043-00-00" ] ; fhir:display [ fhir:v "Dental antibiotic sensitivity test" ] ] ) ] ; 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 "300"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ; fhir:net [ fhir:value [ fhir:v "300"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ; fhir:bodySite [ fhir:coding ( [ fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/fdi-oral-region"^^xsd:anyURI ] ; fhir:code [ fhir:v "13" ] ; fhir:display [ fhir:v "UPPER RIGHT; PERMANENT TEETH # 3" ] ] ) ] ] [ 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 "100"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ] ) ; fhir:sequence [ fhir:v "3"^^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/oral-health-op"^^xsd:anyURI ] ; fhir:code [ fhir:v "97613-07-00" ] ; fhir:display [ fhir:v "Lithium disilicate ceramic crown (e max), indirect; per crown" ] ] ) ] ; 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 "1300"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ; fhir:net [ fhir:value [ fhir:v "1300"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ; fhir:bodySite [ fhir:coding ( [ fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/fdi-oral-region"^^xsd:anyURI ] ; fhir:code [ fhir:v "37" ] ; fhir:display [ fhir:v "LOWER LEFT; PERMANENT TEETH # 7" ] ] ) ] ] ) ; # fhir:total [ fhir:value [ fhir:v "1800"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] . # # -------------------------------------------------------------------------------------