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 xml

<ExplanationOfBenefit xmlns="http://hl7.org/fhir">
  <id value="pbs-cont-01"/>
  <meta>
    <profile
             value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"/>
  </meta>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <contained>
    <MedicationRequest>
      <id value="claim-pbs-01"/>
      <status value="unknown"/>
      <intent value="order"/>
      <medicationReference>
        <reference value="#cephalexin-01"/>
      </medicationReference>
      <subject>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="NI"/>
              <display value="National unique individual identifier"/>
            </coding>
            <text value="IHI"/>
          </type>
          <system value="http://ns.electronichealth.net.au/id/hi/ihi/1.0"/>
          <value value="8003608833357361"/>
        </identifier>
      </subject>
      <authoredOn value="2020-01-15"/>
      <dispenseRequest>
        <numberOfRepeatsAllowed value="1"/>
        <quantity>
          <value value="20"/>
          <unit value="capsule"/>
        </quantity>
      </dispenseRequest>
    </MedicationRequest>
  </contained>
  <contained>
    <Medication>
      <id value="cephalexin-01"/>
      <code>
        <coding>
          <system value="http://pbs.gov.au/code/item"/>
          <code value="03119E"/>
          <display value="cephalexin 500 mg capsule, 20"/>
        </coding>
      </code>
      <manufacturer>
        <identifier>
          <system value="http://pbs.gov.au/code/manufacturer"/>
          <value value="MM"/>
        </identifier>
      </manufacturer>
    </Medication>
  </contained>
<!-- identifier for the PBR record from Medicare repository -->
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:296dcbd7-d763-4ecf-aa78-523bcc11ecda"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <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>
  <use value="claim"/>
  <patient>
    <identifier>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
          <code value="NI"/>
          <display value="National unique individual identifier"/>
        </coding>
        <text value="IHI"/>
      </type>
      <system value="http://ns.electronichealth.net.au/id/hi/ihi/1.0"/>
      <value value="8003608833357361"/>
    </identifier>
  </patient>
  <created value="2020-01-16"/>
  <insurer>
    <reference value="Organization/healthau"/>
    <identifier>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
          <code value="XX"/>
        </coding>
        <text value="ABN"/>
      </type>
      <system value="http://hl7.org.au/id/abn"/>
      <value value="83605426759"/>
    </identifier>
    <display value="Australian Government Department of Health"/>
  </insurer>
  <provider>
    <identifier>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/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="8003611566708354"/>
    </identifier>
    <display
             value="Mr. Representative Pharmacist at Test Org -DigitalHealth 6 Pharmacy"/>
  </provider>
  <prescription>
    <reference value="#claim-pbs-01"/>
  </prescription>
  <outcome value="complete"/>
  <insurance>
    <focal value="true"/>
    <coverage>
      <identifier>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
            <code value="MC"/>
          </coding>
          <text value="Medicare Number"/>
        </type>
        <system value="http://ns.electronichealth.net.au/id/medicare-number"/>
        <value value="3951032981"/>
      </identifier>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
        <code value="pbs"/>
        <display value="PBS"/>
      </coding>
    </category>
    <productOrService>
      <coding>
        <system value="http://pbs.gov.au/code/item"/>
        <code value="03119E"/>
        <display value="cephalexin 500 mg capsule, 20"/>
      </coding>
    </productOrService>
    <servicedDate value="2020-01-16"/>
  </item>
</ExplanationOfBenefit>