Healthcare Financial Services IG Edition 1
0.3.0 - ci-build
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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
: Claim Pharmacy Request #1 - TTL Representation
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:Claim ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "483078"] ; #
fhir:meta [
( fhir:profile [
fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/pharmacy-claim"^^xsd:anyURI ;
fhir:link <http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/pharmacy-claim> ] )
] ; #
fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim 483078</b></p><a name=\"483078\"> </a><a name=\"hc483078\"> </a><a name=\"483078-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-pharmacy-claim.html\">Nphies Claim Pharmacy</a></p></div><p><b>Claim Batch Identifier</b>: <code>http://saudicentralpharmacy.sa.com/identifiers/batch</code>/123456787879zxc2345678ujh</p><p><b>Claim Batch Number</b>: 1</p><p><b>Claim Batch Period</b>: 2023-12-06 --> 2023-12-06</p><p><b>Authorization Offline Date</b>: 2023-12-05 11:05:48+0300</p><p><b>Episode</b>: <code>http://saudicentralpharmacy.sa.com/identifiers/episode</code>/EpisodeID-209-0120</p><p><b>identifier</b>: <code>http://saudicentralpharmacy.sa.com/identifiers/claim</code>/req_1902483080</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}\">Pharmacy</span></p><p><b>subType</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-subtype op}\">OutPatient</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-123454186.html\">Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)</a></p><p><b>created</b>: 2023-12-05 09:20:15+0300</p><p><b>insurer</b>: <a href=\"Organization-bff3aa1fbd3648619ac082357bf135db.html\">Organization Saudi National Insurance</a></p><p><b>provider</b>: <a href=\"Organization-6025.html\">Organization Saudi Pharmacy</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td></tr></table><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category days-supply}\">Days Supply</span></td><td>30 d<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM coded = 'd')</span></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-am B34.9}\">Viral infection, unspecified</span></td><td><span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/diagnosis-type principal}\">Principal Diagnosis</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td><td><b>PreAuthRef</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-1333.html\">Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000001; status = active; type = extended healthcare; dependent = 01; relationship = Self; network = Golden C</a></td><td>Pseudo-payer-Portal-Auth-02</td></tr></table><blockquote><p><b>item</b></p><p><b>Patient Share</b>: <span title=\"Saudi Riyal\">SAR0.00</span> (SAR)</p><p><b>Package Code</b>: false</p><p><b>Tax</b>: <span title=\"Saudi Riyal\">SAR9.00</span> (SAR)</p><p><b>Patient Invoice</b>: <code>http://saudicentralpharmacy.sa.com/identifiers/patientInvoice</code>/Invc-20220120-90408</p><p><b>Prescribed Medication</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/medication-codes 06285096001627}\">06285096001627</span></p><p><b>Pharmacist Selection Reason</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/pharmacist-selection-reason patient-request}\">patient request</span></p><p><b>Maternity</b>: false</p><p><b>sequence</b>: 1</p><p><b>diagnosisSequence</b>: 1</p><p><b>informationSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/medication-codes 06285096001627}\">RELENZA 5MG POWDER FOR INHALATION</span></p><p><b>serviced</b>: 2023-12-04</p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>60</td><td>Saudi riyal</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>69</td><td>Saudi riyal</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>69</td><td>Saudi riyal</td></tr></table></div>"^^rdf:XMLLiteral
] ; #
fhir:extension ( [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier"^^xsd:anyURI ] ;
fhir:value [
a fhir:Identifier ;
fhir:system [ fhir:v "http://saudicentralpharmacy.sa.com/identifiers/batch"^^xsd:anyURI ] ;
fhir:value [ fhir:v "123456787879zxc2345678ujh" ] ]
] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-number"^^xsd:anyURI ] ;
fhir:value [
a fhir:positiveInt ;
fhir:v "1"^^xsd:positiveInteger ]
] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-period"^^xsd:anyURI ] ;
fhir:value [
a fhir:Period ;
fhir:start [ fhir:v "2023-12-06"^^xsd:date ] ;
fhir:end [ fhir:v "2023-12-06"^^xsd:date ] ]
] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-authorization-offline-date"^^xsd:anyURI ] ;
fhir:value [
a fhir:dateTime ;
fhir:v "2023-12-05T11:05:48+03:00"^^xsd:dateTime ]
] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-episode"^^xsd:anyURI ] ;
fhir:value [
a fhir:Identifier ;
fhir:system [ fhir:v "http://saudicentralpharmacy.sa.com/identifiers/episode"^^xsd:anyURI ] ;
fhir:value [ fhir:v "EpisodeID-209-0120" ] ]
] ) ; #
fhir:identifier ( [
fhir:system [ fhir:v "http://saudicentralpharmacy.sa.com/identifiers/claim"^^xsd:anyURI ] ;
fhir:value [ fhir:v "req_1902483080" ]
] ) ; #
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 "pharmacy" ] ] )
] ; #
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 "claim"] ; #
fhir:patient [
fhir:reference [ fhir:v "Patient/123454186" ]
] ; #
fhir:created [ fhir:v "2023-12-05T09:20:15.23+03:00"^^xsd:dateTime] ; #
fhir:insurer [
fhir:reference [ fhir:v "Organization/bff3aa1fbd3648619ac082357bf135db" ]
] ; #
fhir:provider [
fhir:reference [ fhir:v "Organization/6025" ]
] ; #
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:supportingInfo ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:category [
( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "days-supply" ] ] ) ] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "30"^^xsd:decimal ] ;
fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "d" ] ]
] ) ; #
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 "B34.9" ] ;
fhir:display [ fhir:v "Viral infection, unspecified" ] ] ) ] ;
( 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:reference [ fhir:v "Coverage/1333" ] ] ;
( fhir:preAuthRef [ fhir:v "Pseudo-payer-Portal-Auth-02" ] )
] ) ; #
fhir:item ( [
( fhir:extension [
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 "0"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ] ] ] [
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-tax"^^xsd:anyURI ] ;
fhir:value [
a fhir:Money ;
fhir:value [ fhir:v "9"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ] ] ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice"^^xsd:anyURI ] ;
fhir:value [
a fhir:Identifier ;
fhir:system [ fhir:v "http://saudicentralpharmacy.sa.com/identifiers/patientInvoice"^^xsd:anyURI ] ;
fhir:value [ fhir:v "Invc-20220120-90408" ] ] ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/medication-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "06285096001627" ] ] ) ] ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/pharmacist-selection-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "patient-request" ] ] ) ] ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-maternity"^^xsd:anyURI ] ;
fhir:value [
a fhir:boolean ;
fhir:v false ] ] ) ;
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
( fhir:diagnosisSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
( fhir:informationSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/medication-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "06285096001627" ] ;
fhir:display [ fhir:v "RELENZA 5MG POWDER FOR INHALATION" ] ] ) ] ;
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 "60"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ] ] ;
fhir:net [
fhir:value [ fhir:v "69"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ] ]
] ) ; #
fhir:total [
fhir:value [ fhir:v "69"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]
] . #
IG © 2024+ HL7 Saudi Arabia. Package nphies-fs#0.3.0 based on FHIR 4.0.1. Generated 2025-06-23
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