Example: ExplanationOfBenefit-explanationofbenefit-pbs-example-02

Formats: Narrative,XML, JSON, Turtle

Raw xml

<ExplanationOfBenefit xmlns="http://hl7.org/fhir">
  <id value="explanationofbenefit-pbs-example-02"/>
  <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-pbs-example-02</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>: Pharmacy <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/ex-claimtype code 'pharmacy' = 'Pharmacy)</span></p><p><b>subType</b>: pbs <span style="background: LightGoldenRodYellow">(Details : {https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1 code 'pbs' = 'pbs)</span></p><p><b>patient</b>: </p><p><b>created</b>: 16/01/2017</p><p><b>prescription</b>: unknown resource contained</p><h3>Items</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Service</b></td><td><b>Serviced[x]</b></td></tr><tr><td>*</td><td>1</td><td>cephalexin 500 mg capsule, 20 <span style="background: LightGoldenRodYellow">(Details : {urn:oid:1.2.36.1.2001.1005.22 code '03119E' = '03119E', given as 'cephalexin 500 mg capsule, 20'})</span></td><td>16/01/2017</td></tr></table></div>
  </text>
  <contained>
    <Organization>
      <id value="Organization2"/>
      <identifier>
        <system value="http://pbs.gov.au/code/manufacturer"/>
        <value value="MM"/>
      </identifier>
    </Organization>
  </contained>
  <contained>
    <Medication>
      <id value="Medication2"/>
      <code>
        <coding>
          <system value="urn:oid:1.2.36.1.2001.1005.22"/>
          <code value="03119E"/>
        </coding>
      </code>
      <manufacturer>
        <reference value="#Organization2"/>
      </manufacturer>
    </Medication>
  </contained>
  <contained>
    <MedicationRequest>
      <id value="MedicationRequest2"/>
      <meta>
        <profile
                 value="http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/medicationrequest-pbs"/>
      </meta>
      <status value="active"/>
      <intent value="order"/>
      <medicationReference>
        <reference value="#Medication2"/>
      </medicationReference>
      <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>
      <authoredOn value="2017-01-15"/>
      <dispenseRequest>
        <quantity>
          <value value="100"/>
          <unit value="tablet"/>
        </quantity>
      </dispenseRequest>
    </MedicationRequest>
  </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="pharmacy"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system
              value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
      <code value="pbs"/>
    </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="2017-01-16"/>
  <prescription>
    <reference value="#MedicationRequest2"/>
  </prescription>
  <item>
    <sequence value="1"/>
    <service>
      <coding>
        <system value="urn:oid:1.2.36.1.2001.1005.22"/>
        <code value="03119E"/>
        <display value="cephalexin 500 mg capsule, 20"/>
      </coding>
    </service>
    <servicedDate value="2017-01-16"/>
  </item>
</ExplanationOfBenefit>