Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot 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 #2

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)

Transfer: true

identifier: http://saudidentalclinic.com.sa/identifiers/authorization/req_298044

status: Active

type: Oral

subType: OutPatient

use: Preauthorization

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

created: 2021-10-07

insurer: Organization Saudi National Insurance

provider: Organization Saudi Dental Clinic

priority: Normal

Payees

-Type
*Provider

CareTeams

-SequenceProviderRoleQualification
*1Practitioner Dr. Ashraf NaeemPrimary providerDental

SupportingInfos

-SequenceCategoryCode
*1chief complaintPeriodic oral examination

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: SAR0.00 (SAR)

Patient Share: SAR0.00 (SAR)

sequence: 1

careTeamSequence: 1

diagnosisSequence: 1

productOrService: Root canal

serviced: 2021-10-07

quantity: 1

UnitPrices

-ValueCurrency
*0Saudi riyal

Nets

-ValueCurrency
*0Saudi riyal

bodySite: UPPER RIGHT; PERMANENT TEETH # 3

Totals

-ValueCurrency
*0Saudi riyal