Example: ExplanationOfBenefit-explanationofbenefit-mbs-example-01

Formats: Narrative,XML, JSON, Turtle

Raw xml

<ExplanationOfBenefit xmlns="http://hl7.org/fhir">
  <id value="explanationofbenefit-mbs-example-01"/>
  <meta>
    <profile
             value="http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/explanationofbenefit-medicare"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: explanationofbenefit-mbs-example-01</p><p><b>meta</b>: </p><p><b>contained</b>: , , </p><p><b>identifier</b>: urn:oid:2.25.129844986816735724544008039950138526110</p><p><b>type</b>: Professional <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/ex-claimtype code 'professional' = 'Professional)</span></p><p><b>subType</b>: mbs <span style="background: LightGoldenRodYellow">(Details : {https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1 code 'mbs' = 'mbs)</span></p><p><b>patient</b>: </p><p><b>created</b>: 21/06/2016</p><p><b>provider</b>: unknown resource contained</p><p><b>referral</b>: unknown resource contained</p><h3>Items</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Service</b></td><td><b>Serviced[x]</b></td><td><b>Location[x]</b></td></tr><tr><td>*</td><td>1</td><td>MBS <span style="background: LightGoldenRodYellow">(Details : {https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1 code 'mbs' = 'mbs', given as 'MBS'})</span></td><td>Radiation oncology treatment <span style="background: LightGoldenRodYellow">(Details : {urn:oid:1.2.36.1.2001.1005.21 code '15275' = '15275', given as 'Radiation oncology treatment'})</span></td><td>16/06/2016</td><td>Inpatient Hospital <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/ex-serviceplace code '21' = 'Inpatient Hospital', given as 'Inpatient Hospital'})</span></td></tr></table></div>
  </text>
  <contained>
    <ReferralRequest>
      <id value="ReferralRequest1"/>
      <meta>
        <profile
                 value="http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/referralrequest-mbsdva"/>
      </meta>
      <status value="completed"/>
      <intent value="order"/>
      <subject>
        <identifier>
          <type>
            <coding>
              <system value="http://hl7.org/fhir/v2/0203"/>
              <code value="NI"/>
              <display value="National unique individual identifier"/>
            </coding>
          </type>
          <system value="http://ns.electronichealth.net.au/id/hi/ihi/1.0"/>
          <value value="8003608166690503"/>
        </identifier>
      </subject>
      <requester>
        <agent>
          <reference value="#Practitioner2"/>
        </agent>
      </requester>
    </ReferralRequest>
  </contained>
  <contained>
    <Practitioner>
      <id value="Practitioner1"/>
      <meta>
        <profile
                 value="http://hl7.org.au/fhir/StructureDefinition/au-practitioner"/>
      </meta>
      <identifier>
        <type>
          <coding>
            <system value="http://hl7.org/fhir/v2/0203"/>
            <code value="NPI"/>
            <display value="National provider identifier"/>
          </coding>
          <text value="HPI-I"/>
        </type>
        <system value="http://ns.electronichealth.net.au/id/hi/hpii/1.0"/>
        <value value="8003610833334085"/>
      </identifier>
    </Practitioner>
  </contained>
  <contained>
    <Practitioner>
      <id value="Practitioner2"/>
      <meta>
        <profile
                 value="http://hl7.org.au/fhir/StructureDefinition/au-practitioner"/>
      </meta>
      <identifier>
        <type>
          <coding>
            <system value="http://hl7.org.au/fhir/v2/0203"/>
            <code value="PRES"/>
            <display value="Prescriber Number"/>
          </coding>
          <text value="Prescriber Number"/>
        </type>
        <system value="http://ns.electronichealth.net.au/id/prescriber-number"/>
        <value value="453221"/>
      </identifier>
      <name>
        <family value="Good"/>
        <given value="Fab"/>
        <prefix value="Dr"/>
      </name>
    </Practitioner>
  </contained>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.25.129844986816735724544008039950138526110"/>
  </identifier>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-claimtype"/>
      <code value="professional"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system
              value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
      <code value="mbs"/>
    </coding>
  </subType>
  <patient>
    <identifier>
      <type>
        <coding>
          <system value="http://hl7.org/fhir/v2/0203"/>
          <code value="NI"/>
          <display value="National unique individual identifier"/>
        </coding>
      </type>
      <system value="http://ns.electronichealth.net.au/id/hi/ihi/1.0"/>
      <value value="8003608166690503"/>
    </identifier>
  </patient>
  <created value="2016-06-21"/>
  <provider>
    <reference value="#Practitioner1"/>
  </provider>
  <referral>
    <reference value="#ReferralRequest1"/>
  </referral>
  <item>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
        <code value="mbs"/>
        <display value="MBS"/>
      </coding>
    </category>
    <service>
      <coding>
        <system value="urn:oid:1.2.36.1.2001.1005.21"/>
        <code value="15275"/>
        <display value="Radiation oncology treatment"/>
      </coding>
    </service>
    <servicedDate value="2016-06-16"/>
    <locationCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/ex-serviceplace"/>
        <code value="21"/>
        <display value="Inpatient Hospital"/>
      </coding>
    </locationCodeableConcept>
  </item>
</ExplanationOfBenefit>