This page is part of the Australian Digital Health Agency FHIR Implementation Guide 1.1.0. It is based on FHIR® version 4.0.1. See the Directory of published versions for a list of available previous versions.

Example: ExplanationOfBenefit-pbs-cont-01

Formats: Narrative, XML, JSON, Turtle

Raw json

{
  "resourceType" : "ExplanationOfBenefit",
  "id" : "pbs-cont-01",
  "meta" : {
    "profile" : [
      "http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name=\"pbs-cont-01\"> </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 ExplanationOfBenefit \"pbs-cont-01\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html\">ADHA Record of Claim against PBS or RPBS</a></p></div><p><b>identifier</b>: id: urn:uuid:296dcbd7-d763-4ecf-aa78-523bcc11ecda</p><p><b>status</b>: active</p><p><b>type</b>: Pharmacy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#pharmacy)</span></p><p><b>subType</b>: pbs <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (australian-benefit-payment-category-1#pbs)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <span></span></p><p><b>created</b>: 2020-01-16</p><p><b>insurer</b>: <a href=\"Organization-healthau.html\">Organization/healthau: Australian Government Department of Health</a> \"Australian Government Department of Health\"</p><p><b>provider</b>: <span>: Mr. Representative Pharmacist at Test Org -DigitalHealth 6 Pharmacy</span></p><p><b>prescription</b>: <a name=\"claim-pbs-01\"> </a></p><blockquote><p></p><p><a name=\"claim-pbs-01\"> </a></p><p><b>status</b>: unknown</p><p><b>intent</b>: order</p><p><b>medication</b>: <a href=\"#cephalexin-01\">#cephalexin-01</a></p><p><b>subject</b>: <span></span></p><p><b>authoredOn</b>: 2020-01-15</p><h3>DispenseRequests</h3><table class=\"grid\"><tr><td>-</td><td><b>NumberOfRepeatsAllowed</b></td><td><b>Quantity</b></td></tr><tr><td>*</td><td>1</td><td>20 capsule</td></tr></table></blockquote><p><b>outcome</b>: complete</p><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>true</td><td><span></span></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Serviced[x]</b></td></tr><tr><td>*</td><td>1</td><td>PBS <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (australian-benefit-payment-category-1#pbs)</span></td><td>cephalexin 500 mg capsule, 20 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org.au/fhir/4.0.0/CodeSystem-pbs-item-external.html\">PBS Item Codes</a>#03119E)</span></td><td>2020-01-16</td></tr></table><hr/><blockquote><p><b>Generated Narrative: MedicationRequest #claim-pbs-01</b><a name=\"claim-pbs-01\"> </a></p><p><b>status</b>: unknown</p><p><b>intent</b>: order</p><p><b>medication</b>: <a href=\"#cephalexin-01\">#cephalexin-01</a></p><p><b>subject</b>: <span></span></p><p><b>authoredOn</b>: 2020-01-15</p><h3>DispenseRequests</h3><table class=\"grid\"><tr><td>-</td><td><b>NumberOfRepeatsAllowed</b></td><td><b>Quantity</b></td></tr><tr><td>*</td><td>1</td><td>20 capsule</td></tr></table></blockquote><hr/><blockquote><p><b>Generated Narrative: Medication #cephalexin-01</b><a name=\"cephalexin-01\"> </a></p><p><b>code</b>: cephalexin 500 mg capsule, 20 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org.au/fhir/4.0.0/CodeSystem-pbs-item-external.html\">PBS Item Codes</a>#03119E)</span></p><p><b>manufacturer</b>: <span></span></p></blockquote></div>"
  },
  "contained" : [
    {
      "resourceType" : "MedicationRequest",
      "id" : "claim-pbs-01",
      "status" : "unknown",
      "intent" : "order",
      "medicationReference" : {
        "reference" : "#cephalexin-01"
      },
      "subject" : {
        "identifier" : {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "NI",
                "display" : "National unique individual identifier"
              }
            ],
            "text" : "IHI"
          },
          "system" : "http://ns.electronichealth.net.au/id/hi/ihi/1.0",
          "value" : "8003608833357361"
        }
      },
      "authoredOn" : "2020-01-15",
      "dispenseRequest" : {
        "numberOfRepeatsAllowed" : 1,
        "quantity" : {
          "value" : 20,
          "unit" : "capsule"
        }
      }
    },
    {
      "resourceType" : "Medication",
      "id" : "cephalexin-01",
      "code" : {
        "coding" : [
          {
            "system" : "http://pbs.gov.au/code/item",
            "code" : "03119E",
            "display" : "cephalexin 500 mg capsule, 20"
          }
        ]
      },
      "manufacturer" : {
        "identifier" : {
          "system" : "http://pbs.gov.au/code/manufacturer",
          "value" : "MM"
        }
      }
    }
  ],
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:uuid:296dcbd7-d763-4ecf-aa78-523bcc11ecda"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "pharmacy"
      }
    ]
  },
  "subType" : {
    "coding" : [
      {
        "system" : "https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1",
        "code" : "pbs"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    "identifier" : {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "NI",
            "display" : "National unique individual identifier"
          }
        ],
        "text" : "IHI"
      },
      "system" : "http://ns.electronichealth.net.au/id/hi/ihi/1.0",
      "value" : "8003608833357361"
    }
  },
  "created" : "2020-01-16",
  "insurer" : {
    "reference" : "Organization/healthau",
    "identifier" : {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "XX"
          }
        ],
        "text" : "ABN"
      },
      "system" : "http://hl7.org.au/id/abn",
      "value" : "83605426759"
    },
    "display" : "Australian Government Department of Health"
  },
  "provider" : {
    "identifier" : {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "NPI",
            "display" : "National provider identifier"
          }
        ],
        "text" : "HPI-I"
      },
      "system" : "http://ns.electronichealth.net.au/id/hi/hpii/1.0",
      "value" : "8003611566708354"
    },
    "display" : "Mr. Representative Pharmacist at Test Org -DigitalHealth 6 Pharmacy"
  },
  "prescription" : {
    "reference" : "#claim-pbs-01"
  },
  "outcome" : "complete",
  "insurance" : [
    {
      "focal" : true,
      "coverage" : {
        "identifier" : {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "MC"
              }
            ],
            "text" : "Medicare Number"
          },
          "system" : "http://ns.electronichealth.net.au/id/medicare-number",
          "value" : "3951032981"
        }
      }
    }
  ],
  "item" : [
    {
      "sequence" : 1,
      "category" : {
        "coding" : [
          {
            "system" : "https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1",
            "code" : "pbs",
            "display" : "PBS"
          }
        ]
      },
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://pbs.gov.au/code/item",
            "code" : "03119E",
            "display" : "cephalexin 500 mg capsule, 20"
          }
        ]
      },
      "servicedDate" : "2020-01-16"
    }
  ]
}