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
Example Claim: Authorization Institutional Request #1
Generated Narrative: Claim 483069
Profile: Nphies Authorization Institutional
Eligibility Offline Reference: EligResp-31212432
Eligibility Offline Date: 2023-12-04
identifier: http://saudigeneralhospital.com.sa/identifiers/authorization/req_1124856069
status: Active
type: Institutional
subType: InPatient
use: Preauthorization
patient: Muhammad Khaled Abbas(official) Male, DoB: 2010-08-21 ( Permanent Resident Card Number: 2000000002)
created: 2023-12-04 06:38:00+0300
insurer: Organization Saudi National Insurance
provider: Organization Saudi General Hospital
priority: Normal
Payees
| Type |
| Provider |
CareTeams
| Sequence | Provider | Role | Qualification |
| 1 | Practitioner Dr. Ameera Hassan(official) | Primary provider | General Medicine |
supportingInfo
sequence: 1
category: Systolic
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 120 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')
supportingInfo
sequence: 2
category: Diastolic
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 80 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')
supportingInfo
sequence: 3
category: Height
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 160 cm (Details: UCUM codecm = 'cm')
supportingInfo
sequence: 4
category: Weight
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 129 kg (Details: UCUM codekg = 'kg')
supportingInfo
sequence: 5
category: Pulse
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 100 /min (Details: UCUM code/min = '/min')
supportingInfo
sequence: 6
category: Temperature
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 37 Cel (Details: UCUM codeCel = 'Cel')
supportingInfo
sequence: 7
category: chief complaint
code: Acute appendicitis with generalized peritonitis
supportingInfo
sequence: 8
category: Oxygen Saturation
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 100 % (Details: UCUM code% = '%')
supportingInfo
sequence: 9
category: Respiratory Rate
timing: 2023-12-04 10:00:00+0300 --> 2023-12-04 11:00:00+0300
value: 70 /min (Details: UCUM code/min = '/min')
supportingInfo
sequence: 10
category: Admission Weight
value: 129 kg (Details: UCUM codekg = 'kg')
supportingInfo
sequence: 11
category: Estimated Length Of Stay
value: 1 d (Details: UCUM coded = 'd')
supportingInfo
sequence: 12
category: patient history
value: No systemic disease
supportingInfo
sequence: 13
category: Investigation Result
code: Investigation(s) not performed
supportingInfo
sequence: 14
category: Treatment Plan
value: Appendectomy
supportingInfo
sequence: 15
category: Physical Examination
value: Stable
supportingInfo
sequence: 16
category: history Of Present Illness
value: No history
Diagnoses
| Sequence | Diagnosis[x] | Type | OnAdmission |
| 1 | Acute appendicitis with generalized peritonitis | Principal Diagnosis | No |
Insurances
| Sequence | Focal | Coverage |
| 1 | true | Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000002; status = active; type = extended healthcare; relationship = Child; network = Golden C |
item
Package Code: false
Patient Share: SAR0.00 (SAR)
Payer Share: SAR400.00 (SAR)
Maternity: false
Tax: SAR100.00 (SAR)
sequence: 1
careTeamSequence: 1
diagnosisSequence: 1
informationSequence: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16
productOrService: Appendicectomy
serviced: 2023-12-04
quantity: 1
UnitPrices
Value Currency 300 Saudi riyal Nets
Value Currency 400 Saudi riyal
Totals
| Value | Currency |
| 400 | Saudi riyal |