LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@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:Resource.id [ fhir:value "CDMClaimFacilityInstance"];
fhir:Resource.meta [
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/tenant-id" ];
fhir:Extension.valueString [ fhir:value "tenant7209" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/ingestion-batch-id" ];
fhir:Extension.valueString [ fhir:value "rgVCJnQBxvghkKTI8Hzz" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/process-name" ];
fhir:Extension.valueString [ fhir:value "TREX" ] ], [
fhir:index 3;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/process-client-id" ];
fhir:Extension.valueString [ fhir:value "7209" ] ], [
fhir:index 4;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/process-record-id" ];
fhir:Extension.valueIdentifier [
fhir:Identifier.system [ fhir:value "http://acme-health.com/WellnessMedicalFacility" ];
fhir:Identifier.value [ fhir:value "7209_07869_e00080779_3938586_2516181" ] ] ], [
fhir:index 5;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/source-file-id" ];
fhir:Extension.valueString [ fhir:value "e00030779" ] ];
fhir:Meta.source [ fhir:value "http://acme-health.com/WellnessMedicalFacility" ];
fhir:Meta.profile [
fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-claim-facility";
fhir:index 0;
fhir:link <http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-claim-facility> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "extensions" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Claim</b><a name=\"CDMClaimFacilityInstance\"> </a></p><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\">Resource Claim \"CDMClaimFacilityInstance\" </p><p style=\"margin-bottom: 0px\">Information Source: http://acme-health.com/WellnessMedicalFacility!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-cdm-claim-facility.html\">CDM Claim Facility</a></p></div><p><b>Admit Count</b>: 1</p><p><b>Aggregate Claim Indicator</b>: N</p><p><b>Claim Category</b>: F0 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (claim-status-category-codes#F0)</span></p><p><b>Claim Status</b>: F0 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (claim-status-codes#F0)</span></p><p><b>Claim Snapshot Provider Name</b>: Dr Smith</p><p><b>Claim Snapshot Provider Zip Code</b>: 79912</p><p><b>Employer</b>: EmployerCode <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employer-code#EmployerCode)</span></p><p><b>Employee Business Unit</b>: EmpBusUnit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-business-unit#EmpBusUnit)</span></p><p><b>Financial System</b>: LocFinanceSys <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-financial-system#LocFinanceSys)</span></p><p><b>Last Claim Indicator</b>: Y</p><p><b>Participating Plan</b>: LocParticipatingPlan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-participating-plan#LocParticipatingPlan)</span></p><p><b>Referral Indicator</b>: N</p><p><b>Snapshot Age In Years</b>: 20</p><p><b>Submission Type</b>: SubmitType <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-submission-type#SubmitType)</span></p><p><b>Payer PCP Responsibility Indicator</b>: N</p><p><b>identifier</b>: Source System Row Identifier: 000000000000000000019721078(use: OFFICIAL), Source System Row Identifier: 99999999999(use: SECONDARY)</p><p><b>status</b>: active</p><p><b>type</b>: Medical claim; Institutional/Professional unknown <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-claim-type.html\">Payer Claim Type Codes</a>#medical; local-claim-type#Medical)</span></p><p><b>subType</b>: Emergency <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-subtype.html\">Claim Subtype Codes</a>#emergency)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-CDMPatientInstance.html\">Patient/CDMPatientInstance</a> \" MCLASTNAME\"</p><p><b>billablePeriod</b>: 2017-06-02 --> 2017-06-02</p><p><b>created</b>: 2017-07-25 05:31:00-0500</p><p><b>provider</b>: <a href=\"Organization-Provider1.html\">Organization/Provider1</a> \"Dr Smith\"</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><p><b>referral</b>: <a href=\"ServiceRequest-CDMServiceRequestInstance.html\">ServiceRequest/CDMServiceRequestInstance</a></p><blockquote><p><b>careTeam</b></p><p><b>sequence</b>: 1</p><p><b>provider</b>: <a href=\"Practitioner-DrKelly.html\">Practitioner/DrKelly</a> \" KELLY\"</p><p><b>role</b>: Ordering provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-care-team-role.html\">Claim Care Team Role Codes</a>#ordering)</span></p></blockquote><blockquote><p><b>careTeam</b></p><p><b>sequence</b>: 2</p><p><b>provider</b>: <a href=\"Practitioner-DrSmith.html\">Practitioner/DrSmith</a> \" SMITH\"</p><p><b>role</b>: Admitting provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-care-team-role.html\">Claim Care Team Role Codes</a>#admitting)</span></p></blockquote><blockquote><p><b>careTeam</b></p><p><b>sequence</b>: 3</p><p><b>provider</b>: <a href=\"Practitioner-DrKelly.html\">Practitioner/DrKelly</a> \" KELLY\"</p><p><b>role</b>: Attending provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-care-team-role.html\">Claim Care Team Role Codes</a>#attending)</span></p></blockquote><blockquote><p><b>careTeam</b></p><p><b>sequence</b>: 4</p><p><b>provider</b>: <a href=\"Organization-Provider1.html\">Organization/Provider1</a> \"Dr Smith\"</p><p><b>role</b>: Servicing provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-care-team-role.html\">Claim Care Team Role Codes</a>#servicing)</span></p><p><b>qualification</b>: 01 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-specialty#01)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: Information <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: Capitated service indicator <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#capitated-service-indicator)</span></p><p><b>value</b>: N</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: Other <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#other)</span></p><p><b>code</b>: Emergency Room <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-er-or-observation-room-service.html\">Er Or Observation Room Service Codes</a>#1)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: Hospitalized <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#hospitalized)</span></p><p><b>timing</b>: 2017-06-02 --> 2017-06-02</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 4</p><p><b>category</b>: Hospitalized <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#hospitalized)</span></p><p><b>code</b>: Emergency <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ub04-admit-type.html\">UB04 Admit Type Code System</a>#1)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 5</p><p><b>category</b>: Hospitalized <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#hospitalized)</span></p><p><b>code</b>: Hospital / Level I Intermediate Care / Admit Through Discharge Claim <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ub04-admit-bill-type.html\">UB04 Admit Bill Type Code System</a>#0151)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 6</p><p><b>category</b>: Hospitalized <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#hospitalized)</span></p><p><b>code</b>: Days count <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#days-count)</span></p><p><b>value</b>: 3 /d</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 7</p><p><b>category</b>: Discharge <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#discharge)</span></p><p><b>code</b>: 11 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (patient-discharge#11)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 8</p><p><b>category</b>: Other <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#other)</span></p><p><b>code</b>: Room and Board <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-room-and-board-service.html\">Room And Board Service Codes</a>#1)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 9</p><p><b>category</b>: Information <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: Network provider indicator <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#network-provider-indicator)</span></p><p><b>value</b>: Y</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 10</p><p><b>category</b>: Hospitalized <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#hospitalized)</span></p><p><b>code</b>: Admission hour <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#admission-hour)</span></p><p><b>value</b>: 07</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 11</p><p><b>category</b>: Hospitalized <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#hospitalized)</span></p><p><b>code</b>: Days count <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#days-count)</span></p><p><b>value</b>: 3 /d</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 12</p><p><b>category</b>: Hospitalized <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#hospitalized)</span></p><p><b>code</b>: Days not covered <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#days-not-covered)</span></p><p><b>value</b>: 1 /d</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 13</p><p><b>category</b>: Hospitalized <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#hospitalized)</span></p><p><b>code</b>: Days longterm care recipient on leave <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#days-long-term-care-recipient-on-leave)</span></p><p><b>value</b>: 0 /d</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 14</p><p><b>category</b>: Hospitalized <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#hospitalized)</span></p><p><b>code</b>: Newbord length of stay <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#newborn-length-of-stay)</span></p><p><b>value</b>: 0 /d</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 15</p><p><b>category</b>: Information <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: Onset of symptoms/illness <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-v2-0350.html\">nubc-OccurrenceCode-cs</a>#11)</span></p><p><b>timing</b>: 2017-06-02 --> 2017-06-02</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 16</p><p><b>category</b>: Information <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: Acquired Condition Indicator <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#acquired-condition-indicator)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 17</p><p><b>category</b>: Hospitalized <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#hospitalized)</span></p><p><b>code</b>: Discharge hour <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#discharge-hour)</span></p><p><b>value</b>: 22</p></blockquote><blockquote><p><b>diagnosis</b></p><p><b>sequence</b>: 1</p><p><b>diagnosis</b>: Headache <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#R51)</span></p><p><b>type</b>: Principal Diagnosis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-ex-diagnosistype.html\">Example Diagnosis Type Codes</a>#principal)</span></p><p><b>onAdmission</b>: Yes, present ad admission <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-diagnosis-present-on-admission.html\">Diagnosis Present On Admission Codes</a>#Y)</span></p><p><b>packageCode</b>: 102 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (P0002.html#102)</span></p></blockquote><blockquote><p><b>diagnosis</b></p><p><b>sequence</b>: 2</p><p><b>diagnosis</b>: Migraine, Unspecified, not Intractable, without Status Migrainosus <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G43.909)</span></p><p><b>type</b>: Discharge Diagnosis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-ex-diagnosistype.html\">Example Diagnosis Type Codes</a>#discharge)</span></p><p><b>onAdmission</b>: No, not present at admission <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-diagnosis-present-on-admission.html\">Diagnosis Present On Admission Codes</a>#N)</span></p></blockquote><blockquote><p><b>diagnosis</b></p><p><b>sequence</b>: 3</p><p><b>diagnosis</b>: Migraine, unspecified <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G43.9)</span></p><p><b>type</b>: Admitting Diagnosis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-ex-diagnosistype.html\">Example Diagnosis Type Codes</a>#admitting)</span></p></blockquote><blockquote><p><b>diagnosis</b></p><p><b>sequence</b>: 4</p><p><b>diagnosis</b>: Fall on and from ladder, initial encounter <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#W11.XXXA)</span></p><p><b>type</b>: External Cause <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-diagnosis-type.html\">Diagnosis Type Codes</a>#external-cause)</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 1</p><p><b>type</b>: surgical <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-procedure-type.html\">Procedure Type Codes</a>#surgical)</span></p><p><b>procedure</b>: Special EEG Tests <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT®)</a>#95958)</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 2</p><p><b>type</b>: surgical <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-procedure-type.html\">Procedure Type Codes</a>#surgical)</span></p><p><b>procedure</b>: Autologous blood or component, collection processing and storage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT®)</a>#86891)</span></p></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Identifier</b></td><td><b>Coverage</b></td><td><b>PreAuthRef</b></td></tr><tr><td>*</td><td>, </td><td>1</td><td>true</td><td>id: PPOB</td><td><a href=\"Coverage-CoverageExample.html\">Coverage/CoverageExample</a></td><td>PreAuth12345</td></tr></table><h3>Accidents</h3><table class=\"grid\"><tr><td>-</td><td><b>Date</b></td><td><b>Type</b></td></tr><tr><td>*</td><td>1900-01-01</td><td>No <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-indicators.html\">Payer Indicator Codes</a>#N)</span></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>Revenue</b></td><td><b>ProductOrService</b></td><td><b>Modifier</b></td><td><b>Serviced[x]</b></td><td><b>Location[x]</b></td><td><b>Quantity</b></td></tr><tr><td>*</td><td>, , , </td><td>1</td><td>2</td><td>Emergency Room <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (RevenueCodes#0450)</span></td><td>superficial muscle biopsy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT®)</a>#20200; local-service-type#LocalServiceType)</span></td><td>Primary physician <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-procedure-modifier.html\">Procedure Modifier Codes</a>#AG)</span></td><td>2017-06-02</td><td>Office <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-CMSPlaceofServiceCodes.html\">CMS Place of Service Codes (POS)</a>#11; local-place-of-service#LocalPlcOfService)</span></td><td>3</td></tr></table></div>"
];
fhir:DomainResource.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/admit-count" ];
fhir:Extension.valueInteger [ fhir:value "1"^^xsd:integer ]
], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/aggregate-claim-indicator" ];
fhir:Extension.valueString [ fhir:value "N" ]
], [
fhir:index 2;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-category" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://x12.org/codes/claim-status-category-codes" ];
fhir:Coding.code [ fhir:value "F0" ] ] ]
], [
fhir:index 3;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://x12.org/codes/claim-status-codes" ];
fhir:Coding.code [ fhir:value "F0" ] ] ]
], [
fhir:index 4;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-snapshot-provider-name" ];
fhir:Extension.valueString [ fhir:value "Dr Smith" ]
], [
fhir:index 5;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-snapshot-provider-zip-code" ];
fhir:Extension.valueString [ fhir:value "79912" ]
], [
fhir:index 6;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employer" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-employer-code" ];
fhir:Coding.code [ fhir:value "EmployerCode" ] ] ]
], [
fhir:index 7;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-business-unit" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-employee-business-unit" ];
fhir:Coding.code [ fhir:value "EmpBusUnit" ] ] ]
], [
fhir:index 8;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/financial-system" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-financial-system" ];
fhir:Coding.code [ fhir:value "LocFinanceSys" ] ] ]
], [
fhir:index 9;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/last-claim-indicator" ];
fhir:Extension.valueString [ fhir:value "Y" ]
], [
fhir:index 10;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/participating-plan" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-participating-plan" ];
fhir:Coding.code [ fhir:value "LocParticipatingPlan" ] ] ]
], [
fhir:index 11;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/referral-indicator" ];
fhir:Extension.valueString [ fhir:value "N" ]
], [
fhir:index 12;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-years" ];
fhir:Extension.valueUnsignedInt [ fhir:value "20"^^xsd:nonNegativeInteger ]
], [
fhir:index 13;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/submission-type" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-submission-type" ];
fhir:Coding.code [ fhir:value "SubmitType" ] ] ]
], [
fhir:index 14;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/payer-pcp-responsibility-indicator" ];
fhir:Extension.valueString [ fhir:value "N" ]
];
fhir:Claim.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "official" ];
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/identifier-type" ];
fhir:Coding.code [ fhir:value "SSRI" ] ] ];
fhir:Identifier.system [ fhir:value "http://acme-health.com/CodeSystem/local-claim-identifier" ];
fhir:Identifier.value [ fhir:value "000000000000000000019721078" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "Acme Health - Wellness Medical Facility" ] ]
], [
fhir:index 1;
fhir:Identifier.use [ fhir:value "secondary" ];
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/identifier-type" ];
fhir:Coding.code [ fhir:value "SSRI" ] ] ];
fhir:Identifier.system [ fhir:value "http://acme-health.com/CodeSystem/local-authorization-identifier" ];
fhir:Identifier.value [ fhir:value "99999999999" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "Acme Health - Wellness Medical Facility Corporate Office" ] ]
];
fhir:Claim.status [ fhir:value "active"];
fhir:Claim.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-type" ];
fhir:Coding.code [ fhir:value "medical" ] ], [
fhir:index 1;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-claim-type" ];
fhir:Coding.code [ fhir:value "Medical" ] ]
];
fhir:Claim.subType [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-subtype" ];
fhir:Coding.code [ fhir:value "emergency" ] ]
];
fhir:Claim.use [ fhir:value "claim"];
fhir:Claim.patient [
fhir:Reference.reference [ fhir:value "Patient/CDMPatientInstance" ]
];
fhir:Claim.billablePeriod [
fhir:Period.start [ fhir:value "2017-06-02"^^xsd:date ];
fhir:Period.end [ fhir:value "2017-06-02"^^xsd:date ]
];
fhir:Claim.created [ fhir:value "2017-07-25T17:31:00-05:00"^^xsd:dateTime];
fhir:Claim.provider [
fhir:Reference.reference [ fhir:value "Organization/Provider1" ]
];
fhir:Claim.priority [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ];
fhir:Coding.code [ fhir:value "normal" ] ]
];
fhir:Claim.referral [
fhir:Reference.reference [ fhir:value "ServiceRequest/CDMServiceRequestInstance" ]
];
fhir:Claim.careTeam [
fhir:index 0;
fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.careTeam.provider [
fhir:Reference.reference [ fhir:value "Practitioner/DrKelly" ] ];
fhir:Claim.careTeam.role [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-care-team-role" ];
fhir:Coding.code [ fhir:value "ordering" ] ] ]
], [
fhir:index 1;
fhir:Claim.careTeam.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.careTeam.provider [
fhir:Reference.reference [ fhir:value "Practitioner/DrSmith" ] ];
fhir:Claim.careTeam.role [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-care-team-role" ];
fhir:Coding.code [ fhir:value "admitting" ] ] ]
], [
fhir:index 2;
fhir:Claim.careTeam.sequence [ fhir:value "3"^^xsd:positiveInteger ];
fhir:Claim.careTeam.provider [
fhir:Reference.reference [ fhir:value "Practitioner/DrKelly" ] ];
fhir:Claim.careTeam.role [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-care-team-role" ];
fhir:Coding.code [ fhir:value "attending" ] ] ]
], [
fhir:index 3;
fhir:Claim.careTeam.sequence [ fhir:value "4"^^xsd:positiveInteger ];
fhir:Claim.careTeam.provider [
fhir:Reference.reference [ fhir:value "Organization/Provider1" ] ];
fhir:Claim.careTeam.role [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-care-team-role" ];
fhir:Coding.code [ fhir:value "servicing" ] ] ];
fhir:Claim.careTeam.qualification [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-specialty" ];
fhir:Coding.code [ fhir:value "01" ] ] ]
];
fhir:Claim.supportingInfo [
fhir:index 0;
fhir:Claim.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "info" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "capitated-service-indicator" ] ] ];
fhir:Claim.supportingInfo.valueString [ fhir:value "N" ]
], [
fhir:index 1;
fhir:Claim.supportingInfo.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "other" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/er-or-observation-room-service" ];
fhir:Coding.code [ fhir:value "1" ] ] ]
], [
fhir:index 2;
fhir:Claim.supportingInfo.sequence [ fhir:value "3"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "hospitalized" ] ] ];
fhir:Claim.supportingInfo.timingPeriod [
fhir:Period.start [ fhir:value "2017-06-02"^^xsd:date ];
fhir:Period.end [ fhir:value "2017-06-02"^^xsd:date ] ]
], [
fhir:index 3;
fhir:Claim.supportingInfo.sequence [ fhir:value "4"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "hospitalized" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/ub04-admit-type" ];
fhir:Coding.code [ fhir:value "1" ] ] ]
], [
fhir:index 4;
fhir:Claim.supportingInfo.sequence [ fhir:value "5"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "hospitalized" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/ub04-admit-bill-type" ];
fhir:Coding.code [ fhir:value "0151" ] ] ]
], [
fhir:index 5;
fhir:Claim.supportingInfo.sequence [ fhir:value "6"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "hospitalized" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "days-count" ] ] ];
fhir:Claim.supportingInfo.valueQuantity [
fhir:Quantity.value [ fhir:value "3"^^xsd:decimal ];
fhir:Quantity.unit [ fhir:value "/d" ];
fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org" ] ]
], [
fhir:index 6;
fhir:Claim.supportingInfo.sequence [ fhir:value "7"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "discharge" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.nubc.org/patient-discharge" ];
fhir:Coding.code [ fhir:value "11" ] ] ]
], [
fhir:index 7;
fhir:Claim.supportingInfo.sequence [ fhir:value "8"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "other" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/room-and-board-service" ];
fhir:Coding.code [ fhir:value "1" ] ] ]
], [
fhir:index 8;
fhir:Claim.supportingInfo.sequence [ fhir:value "9"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "info" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "network-provider-indicator" ] ] ];
fhir:Claim.supportingInfo.valueString [ fhir:value "Y" ]
], [
fhir:index 9;
fhir:Claim.supportingInfo.sequence [ fhir:value "10"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "hospitalized" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "admission-hour" ] ] ];
fhir:Claim.supportingInfo.valueString [ fhir:value "07" ]
], [
fhir:index 10;
fhir:Claim.supportingInfo.sequence [ fhir:value "11"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "hospitalized" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "days-count" ] ] ];
fhir:Claim.supportingInfo.valueQuantity [
fhir:Quantity.value [ fhir:value "3"^^xsd:decimal ];
fhir:Quantity.unit [ fhir:value "/d" ];
fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org" ] ]
], [
fhir:index 11;
fhir:Claim.supportingInfo.sequence [ fhir:value "12"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "hospitalized" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "days-not-covered" ] ] ];
fhir:Claim.supportingInfo.valueQuantity [
fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ];
fhir:Quantity.unit [ fhir:value "/d" ];
fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org" ] ]
], [
fhir:index 12;
fhir:Claim.supportingInfo.sequence [ fhir:value "13"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "hospitalized" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "days-long-term-care-recipient-on-leave" ] ] ];
fhir:Claim.supportingInfo.valueQuantity [
fhir:Quantity.value [ fhir:value "0"^^xsd:decimal ];
fhir:Quantity.unit [ fhir:value "/d" ];
fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org" ] ]
], [
fhir:index 13;
fhir:Claim.supportingInfo.sequence [ fhir:value "14"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "hospitalized" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "newborn-length-of-stay" ] ] ];
fhir:Claim.supportingInfo.valueQuantity [
fhir:Quantity.value [ fhir:value "0"^^xsd:decimal ];
fhir:Quantity.unit [ fhir:value "/d" ];
fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org" ] ]
], [
fhir:index 14;
fhir:Claim.supportingInfo.sequence [ fhir:value "15"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "info" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0350" ];
fhir:Coding.code [ fhir:value "11" ] ] ];
fhir:Claim.supportingInfo.timingPeriod [
fhir:Period.start [ fhir:value "2017-06-02"^^xsd:date ];
fhir:Period.end [ fhir:value "2017-06-02"^^xsd:date ] ]
], [
fhir:index 15;
fhir:Claim.supportingInfo.sequence [ fhir:value "16"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "info" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "acquired-condition-indicator" ] ] ]
], [
fhir:index 16;
fhir:Claim.supportingInfo.sequence [ fhir:value "17"^^xsd:positiveInteger ];
fhir:Claim.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "hospitalized" ] ] ];
fhir:Claim.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "discharge-hour" ] ] ];
fhir:Claim.supportingInfo.valueString [ fhir:value "22" ]
];
fhir:Claim.diagnosis [
fhir:index 0;
fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.diagnosis.diagnosisCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ];
fhir:Coding.code [ fhir:value "R51" ];
fhir:Coding.display [ fhir:value "Headache" ] ] ];
fhir:Claim.diagnosis.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ];
fhir:Coding.code [ fhir:value "principal" ] ] ];
fhir:Claim.diagnosis.onAdmission [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/diagnosis-present-on-admission" ];
fhir:Coding.code [ fhir:value "Y" ] ] ];
fhir:Claim.diagnosis.packageCode [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.cms.gov/icd10m/version37-fullcode-cms/fullcode_cms/P0002.html" ];
fhir:Coding.code [ fhir:value "102" ] ] ]
], [
fhir:index 1;
fhir:Claim.diagnosis.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.diagnosis.diagnosisCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ];
fhir:Coding.code [ fhir:value "G43.909" ];
fhir:Coding.display [ fhir:value "Migraine, Unspecified, not Intractable, without Status Migrainosus" ] ] ];
fhir:Claim.diagnosis.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ];
fhir:Coding.code [ fhir:value "discharge" ] ] ];
fhir:Claim.diagnosis.onAdmission [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/diagnosis-present-on-admission" ];
fhir:Coding.code [ fhir:value "N" ] ] ]
], [
fhir:index 2;
fhir:Claim.diagnosis.sequence [ fhir:value "3"^^xsd:positiveInteger ];
fhir:Claim.diagnosis.diagnosisCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ];
fhir:Coding.code [ fhir:value "G43.9" ];
fhir:Coding.display [ fhir:value "Migraine, unspecified" ] ] ];
fhir:Claim.diagnosis.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ];
fhir:Coding.code [ fhir:value "admitting" ] ] ]
], [
fhir:index 3;
fhir:Claim.diagnosis.sequence [ fhir:value "4"^^xsd:positiveInteger ];
fhir:Claim.diagnosis.diagnosisCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ];
fhir:Coding.code [ fhir:value "W11.XXXA" ];
fhir:Coding.display [ fhir:value "Fall on and from ladder, initial encounter" ] ] ];
fhir:Claim.diagnosis.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/diagnosis-type" ];
fhir:Coding.code [ fhir:value "external-cause" ] ] ]
];
fhir:Claim.procedure [
fhir:index 0;
fhir:Claim.procedure.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.procedure.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/procedure-type" ];
fhir:Coding.code [ fhir:value "surgical" ] ] ];
fhir:Claim.procedure.procedureCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://www.ama-assn.org/go/cpt" ];
fhir:Coding.code [ fhir:value "95958" ];
fhir:Coding.display [ fhir:value "Special EEG Tests" ] ] ]
], [
fhir:index 1;
fhir:Claim.procedure.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.procedure.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/procedure-type" ];
fhir:Coding.code [ fhir:value "surgical" ] ] ];
fhir:Claim.procedure.procedureCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://www.ama-assn.org/go/cpt" ];
fhir:Coding.code [ fhir:value "86891" ];
fhir:Coding.display [ fhir:value "Autologous blood or component, collection processing and storage" ] ] ]
];
fhir:Claim.insurance [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/crossover-indicator" ];
fhir:Extension.valueString [ fhir:value "N" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/prior-authorization-indicator" ];
fhir:Extension.valueString [ fhir:value "Y" ] ];
fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
fhir:Claim.insurance.identifier [
fhir:Identifier.system [ fhir:value "http://acme-health.com/BCBS" ];
fhir:Identifier.value [ fhir:value "PPOB" ] ];
fhir:Claim.insurance.coverage [
fhir:Reference.reference [ fhir:value "Coverage/CoverageExample" ] ];
fhir:Claim.insurance.preAuthRef [
fhir:value "PreAuth12345";
fhir:index 0 ]
];
fhir:Claim.accident [
fhir:Claim.accident.date [ fhir:value "1900-01-01"^^xsd:date ];
fhir:Claim.accident.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-indicators" ];
fhir:Coding.code [ fhir:value "N" ] ] ]
];
fhir:Claim.item [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/capitated-service-indicator" ];
fhir:Extension.valueString [ fhir:value "N" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/fully-insured-indicator" ];
fhir:Extension.valueString [ fhir:value "Y" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/nursing-home-indicator" ];
fhir:Extension.valueString [ fhir:value "N" ] ], [
fhir:index 3;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/service-bill-days-count" ];
fhir:Extension.valueUnsignedInt [ fhir:value "20"^^xsd:nonNegativeInteger ] ];
fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.item.careTeamSequence [
fhir:value "2"^^xsd:positiveInteger;
fhir:index 0 ];
fhir:Claim.item.revenue [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.nubc.org/RevenueCodes" ];
fhir:Coding.code [ fhir:value "0450" ];
fhir:Coding.display [ fhir:value "Emergency Room" ] ] ];
fhir:Claim.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://www.ama-assn.org/go/cpt" ];
fhir:Coding.code [ fhir:value "20200" ];
fhir:Coding.display [ fhir:value "superficial muscle biopsy" ] ], [
fhir:index 1;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-service-type" ];
fhir:Coding.code [ fhir:value "LocalServiceType" ] ] ];
fhir:Claim.item.modifier [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/procedure-modifier" ];
fhir:Coding.code [ fhir:value "AG" ] ] ];
fhir:Claim.item.servicedDate [ fhir:value "2017-06-02"^^xsd:date ];
fhir:Claim.item.locationCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set" ];
fhir:Coding.code [ fhir:value "11" ];
fhir:Coding.display [ fhir:value "Office" ] ], [
fhir:index 1;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-place-of-service" ];
fhir:Coding.code [ fhir:value "LocalPlcOfService" ] ] ];
fhir:Claim.item.quantity [
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/local-number-of-units-per-service" ];
fhir:Extension.valueQuantity [
fhir:Quantity.value [ fhir:value "5"^^xsd:decimal ] ] ];
fhir:Quantity.value [ fhir:value "3"^^xsd:decimal ] ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2021+ LinuxForHealth Team. Package linuxforhealth.fhir.ig#8.0.0 based on FHIR 4.0.1. Generated 2022-11-10
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