FHIR Implementation Guide for HCX - Local Development build (v0.7.0). 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:Bundle;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "ClaimResponseDocument-example-01"];
fhir:Resource.meta [
fhir:Meta.versionId [ fhir:value "1" ];
fhir:Meta.lastUpdated [ fhir:value "2021-12-22T15:32:26.605+05:30"^^xsd:dateTime ]
];
fhir:Bundle.identifier [
fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ];
fhir:Identifier.value [ fhir:value "urn:uuiad:9699444a" ]
];
fhir:Bundle.type [ fhir:value "document"];
fhir:Bundle.timestamp [ fhir:value "2021-12-22T15:32:26.605+05:30"^^xsd:dateTime];
fhir:Bundle.entry [
fhir:index 0;
fhir:Bundle.entry.fullUrl [ fhir:value "Composition/1" ];
fhir:Bundle.entry.resource <Composition/1>
], [
fhir:index 1;
fhir:Bundle.entry.fullUrl [ fhir:value "ClaimResponse/ress-id-1" ];
fhir:Bundle.entry.resource <ClaimResponse/ress-id-1>
], [
fhir:index 2;
fhir:Bundle.entry.fullUrl [ fhir:value "Patient/1" ];
fhir:Bundle.entry.resource <Patient/1>
], [
fhir:index 3;
fhir:Bundle.entry.fullUrl [ fhir:value "Organization/MaxSaket01" ];
fhir:Bundle.entry.resource <Organization/MaxSaket01>
], [
fhir:index 4;
fhir:Bundle.entry.fullUrl [ fhir:value "Organization/2" ];
fhir:Bundle.entry.resource <Organization/2>
], [
fhir:index 5;
fhir:Bundle.entry.fullUrl [ fhir:value "Practitioner/1" ];
fhir:Bundle.entry.resource <Practitioner/1>
].
<Composition/1> a fhir:Composition;
fhir:Resource.id [ fhir:value "1"];
fhir:Resource.meta [
fhir:Meta.versionId [ fhir:value "1" ];
fhir:Meta.lastUpdated [ fhir:value "2021-12-22T15:32:26.605+05:30"^^xsd:dateTime ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Composition</b><a name=\"1\"> </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 Composition \"1\" Version \"1\" Updated \"2021-12-22 03:32:26+0530\" </p></div><p><b>identifier</b>: id: urn:uuid:28b6b35e</p><p><b>status</b>: final</p><p><b>type</b>: Claim Response <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (document-types#HCXClaimResponse)</span></p><p><b>date</b>: 2021-12-22 03:32:26+0530</p><p><b>author</b>: <a href=\"#Practitioner_1\">See above (Practitioner/1: Dr. Sudhir Naik (PMJAY Gujrat))</a></p><p><b>title</b>: Claim Request</p><h3>Attesters</h3><table class=\"grid\"><tr><td>-</td><td><b>Mode</b></td><td><b>Time</b></td><td><b>Party</b></td></tr><tr><td>*</td><td>official</td><td>2021-12-22 02:10:14+0000</td><td><a href=\"#Organization_2\">See above (Organization/2: PMJAY, MoHFW, Govt Of India)</a></td></tr></table></div>"
];
fhir:Composition.identifier [
fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ];
fhir:Identifier.value [ fhir:value "urn:uuid:28b6b35e" ]
];
fhir:Composition.status [ fhir:value "final"];
fhir:Composition.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://hcx.org/document-types" ];
fhir:Coding.code [ fhir:value "HCXClaimResponse" ];
fhir:Coding.display [ fhir:value "Claim Response" ] ];
fhir:CodeableConcept.text [ fhir:value "Claim Response" ]
];
fhir:Composition.subject [
fhir:Reference.reference [ fhir:value "Patient/1" ];
fhir:Reference.display [ fhir:value "Hina Patel" ]
];
fhir:Composition.date [ fhir:value "2021-12-22T15:32:26.605+05:30"^^xsd:dateTime];
fhir:Composition.author [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Practitioner/1" ];
fhir:Reference.display [ fhir:value "Dr. Sudhir Naik (PMJAY Gujrat)" ]
];
fhir:Composition.title [ fhir:value "Claim Request"];
fhir:Composition.attester [
fhir:index 0;
fhir:Composition.attester.mode [ fhir:value "official" ];
fhir:Composition.attester.time [ fhir:value "2021-12-22T14:10:14Z"^^xsd:dateTime ];
fhir:Composition.attester.party [
fhir:Reference.reference [ fhir:value "Organization/2" ];
fhir:Reference.display [ fhir:value "PMJAY, MoHFW, Govt Of India" ] ]
];
fhir:Composition.section [
fhir:index 0;
fhir:Composition.section.title [ fhir:value "Claim Response" ];
fhir:Composition.section.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.hl7.org/fhir/valueset-resource-types" ];
fhir:Coding.code [ fhir:value "ClaimResponse" ];
fhir:Coding.display [ fhir:value "Claim Response" ] ];
fhir:CodeableConcept.text [ fhir:value "ClaimResponse" ] ];
fhir:Composition.section.entry [
fhir:index 0;
fhir:Reference.reference [ fhir:value "ClaimResponse/res-id-1" ] ]
].
<ClaimResponse/ress-id-1> a fhir:ClaimResponse;
fhir:Resource.id [ fhir:value "1355110"];
fhir:Resource.meta [
fhir:Meta.versionId [ fhir:value "1" ];
fhir:Meta.lastUpdated [ fhir:value "2020-07-03T22:50:39.698+00:00"^^xsd:dateTime ];
fhir:Meta.source [ fhir:value "#JrkobxCRdZUI6QNh" ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</b><a name=\"1355110\"> </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 ClaimResponse \"1355110\" Version \"1\" Updated \"2020-07-03 10:50:39+0000\" </p><p style=\"margin-bottom: 0px\">Information Source: #JrkobxCRdZUI6QNh!</p></div><p><b>status</b>: active</p><p><b>type</b>: institutional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#institutional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"Patient/1353519\">Patient/1353519</a></p><p><b>created</b>: 2020-07-03 06:50:39-0400</p><p><b>insurer</b>: <a href=\"Organization/185\">Organization/185</a></p><p><b>request</b>: <a href=\"Claim/1355109\">Claim/1355109</a></p><p><b>outcome</b>: complete</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: eligible <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#eligible)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>500000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: copay <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#copay)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>50000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: eligpercent <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#eligpercent)</span></p><p><b>value</b>: 80.00</p></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: benefit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#benefit)</span></p><p><b>reason</b>: Plan Limit Reached <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-adjudication-reason.html\">Adjudication Reason Codes</a>#ar002)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>360000</td><td>INR</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: submitted <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#submitted)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>500000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: benefit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#benefit)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>360000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: Complete <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-ex-paymenttype.html\">Example Payment Type Codes</a>#complete)</span></p><p><b>date</b>: 2014-08-31</p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>410000</td><td>INR</td></tr></table><p><b>identifier</b>: id: 201408-2-1569478</p></blockquote></div>"
];
fhir:ClaimResponse.status [ fhir:value "active"];
fhir:ClaimResponse.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "institutional" ] ]
];
fhir:ClaimResponse.use [ fhir:value "preauthorization"];
fhir:ClaimResponse.patient [
fhir:Reference.reference [ fhir:value "Patient/1353519" ];
fhir:Reference.type [ fhir:value "Patient" ]
];
fhir:ClaimResponse.created [ fhir:value "2020-07-03T18:50:39-04:00"^^xsd:dateTime];
fhir:ClaimResponse.insurer [
fhir:Reference.reference [ fhir:value "Organization/185" ];
fhir:Reference.type [ fhir:value "Organization" ]
];
fhir:ClaimResponse.request [
fhir:Reference.reference [ fhir:value "Claim/1355109" ]
];
fhir:ClaimResponse.outcome [ fhir:value "complete"];
fhir:ClaimResponse.item [
fhir:index 0;
fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ClaimResponse.item.adjudication [
fhir:index 0;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "eligible" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "500000"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "INR" ] ] ], [
fhir:index 1;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "copay" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "50000"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "INR" ] ] ], [
fhir:index 2;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "eligpercent" ] ] ];
fhir:ClaimResponse.item.adjudication.value [ fhir:value "80.00"^^xsd:decimal ] ], [
fhir:index 3;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ] ] ];
fhir:ClaimResponse.item.adjudication.reason [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication-reason" ];
fhir:Coding.code [ fhir:value "ar002" ];
fhir:Coding.display [ fhir:value "Plan Limit Reached" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "360000"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "INR" ] ] ]
];
fhir:ClaimResponse.total [
fhir:index 0;
fhir:ClaimResponse.total.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "submitted" ] ] ];
fhir:ClaimResponse.total.amount [
fhir:Money.value [ fhir:value "500000"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "INR" ] ]
], [
fhir:index 1;
fhir:ClaimResponse.total.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ] ] ];
fhir:ClaimResponse.total.amount [
fhir:Money.value [ fhir:value "360000"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "INR" ] ]
];
fhir:ClaimResponse.payment [
fhir:ClaimResponse.payment.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-paymenttype" ];
fhir:Coding.code [ fhir:value "complete" ] ] ];
fhir:ClaimResponse.payment.date [ fhir:value "2014-08-31"^^xsd:date ];
fhir:ClaimResponse.payment.amount [
fhir:Money.value [ fhir:value "410000"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "INR" ] ];
fhir:ClaimResponse.payment.identifier [
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/paymentidentifier" ];
fhir:Identifier.value [ fhir:value "201408-2-1569478" ] ]
].
<Patient/1> a fhir:Patient;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</b><a name=\"1\"> </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 Patient \"1\" </p></div><p><b>identifier</b>: PHRADDR: 654321, PMJAYID: QWRT12345</p><p><b>name</b>: Hina Patel (OFFICIAL)</p><p><b>gender</b>: female</p><p><b>birthDate</b>: 1974-12-25</p></div>"
];
fhir:Patient.identifier [
fhir:index 0;
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://ndhm.gov.in/ValueSet/identifier-type" ];
fhir:Coding.code [ fhir:value "PHRADDR" ] ] ];
fhir:Identifier.system [ fhir:value "http://ndhm.gov.in/healthId" ];
fhir:Identifier.value [ fhir:value "654321" ]
], [
fhir:index 1;
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://ndhm.gov.in/ValueSet/identifier-type" ];
fhir:Coding.code [ fhir:value "PMJAYID" ] ] ];
fhir:Identifier.system [ fhir:value "http://ndhm.gov.in/pmjay" ];
fhir:Identifier.value [ fhir:value "QWRT12345" ]
];
fhir:Patient.name [
fhir:index 0;
fhir:HumanName.use [ fhir:value "official" ];
fhir:HumanName.family [ fhir:value "Patel" ];
fhir:HumanName.given [
fhir:value "Hina";
fhir:index 0 ]
];
fhir:Patient.gender [ fhir:value "female"];
fhir:Patient.birthDate [ fhir:value "1974-12-25"^^xsd:date].
<Organization/MaxSaket01> a fhir:Organization;
fhir:Resource.id [ fhir:value "MaxSaket01"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"MaxSaket01\"> </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 Organization \"MaxSaket01\" </p></div><p><b>identifier</b>: id: HFR-10000005</p><p><b>name</b>: Max Super Speciality Hospital, Saket</p></div>"
];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "https://ndhm.gov.in/hfr" ];
fhir:Identifier.value [ fhir:value "HFR-10000005" ]
];
fhir:Organization.name [ fhir:value "Max Super Speciality Hospital, Saket"].
<Organization/2> a fhir:Organization;
fhir:Resource.id [ fhir:value "2"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"2\"> </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 Organization \"2\" </p></div><p><b>identifier</b>: id: PMJAY</p><p><b>name</b>: PMJAY, MoHFW, Govt Of India</p></div>"
];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "https://hcx.org/orgs" ];
fhir:Identifier.value [ fhir:value "PMJAY" ]
];
fhir:Organization.name [ fhir:value "PMJAY, MoHFW, Govt Of India"].
<Practitioner/1> a fhir:Practitioner;
fhir:Resource.id [ fhir:value "1"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Practitioner</b><a name=\"1\"> </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 Practitioner \"1\" </p></div><p><b>identifier</b>: id: NPR-6897</p><p><b>name</b>: Sudhir Naik (PMJAY Gujrat)</p></div>"
];
fhir:Practitioner.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "https://ndhm.gov.in/npr" ];
fhir:Identifier.value [ fhir:value "NPR-6897" ]
];
fhir:Practitioner.name [
fhir:index 0;
fhir:HumanName.text [ fhir:value "Sudhir Naik (PMJAY Gujrat)" ];
fhir:HumanName.prefix [
fhir:value "Dr";
fhir:index 0 ];
fhir:HumanName.suffix [
fhir:value "MD";
fhir:index 0 ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.7.0 based on FHIR 4.0.1. Generated 2022-11-04
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