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 #1

Generated Narrative: Claim 293094

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_293094

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
*1K01.1Principal 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: Periodic oral examination

serviced: 2021-10-07

quantity: 1

UnitPrices

-ValueCurrency
*200Saudi riyal

Nets

-ValueCurrency
*230Saudi riyal

item

Package Code: false

Tax: SAR45.00 (SAR)

Patient Share: SAR60.00 (SAR)

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

sequence: 2

careTeamSequence: 1

diagnosisSequence: 1

productOrService: Metallic restoration of tooth, one surface, direct

serviced: 2021-10-07

quantity: 1

UnitPrices

-ValueCurrency
*300Saudi riyal

Nets

-ValueCurrency
*345Saudi riyal

bodySite: UPPER RIGHT; PERMANENT TEETH # 3

item

Package Code: false

Tax: SAR195.00 (SAR)

Patient Share: SAR100.00 (SAR)

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

sequence: 3

careTeamSequence: 1

diagnosisSequence: 1

productOrService: Full crown metallic indirect

serviced: 2021-10-07

quantity: 1

UnitPrices

-ValueCurrency
*1300Saudi riyal

Nets

-ValueCurrency
*1495Saudi riyal

bodySite: LOWER LEFT; PERMANENT TEETH # 7

Totals

-ValueCurrency
*2070Saudi riyal