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: Record of Claim against PBS for 03119E cephalexin 500 mg capsule, 20 for Ms. Sally Field 16 FEB 2020 - XML Representation

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<ExplanationOfBenefit xmlns="http://hl7.org/fhir">
  <id value="pbs-cont-02"/>
  <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 class="res-header-id"><b>Generated Narrative: ExplanationOfBenefit pbs-cont-02</b></p><a name="pbs-cont-02"> </a><a name="hcpbs-cont-02"> </a><a name="pbs-cont-02-en-AU"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.0.0/NamingSystem-uri.html" title="As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt 

This oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid: 

Note that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.

This OID may also be used in CD.codeSystem.">URI</a>/urn:uuid:73f7a30b-add3-4673-a4e9-65b0d8670a36</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}">Pharmacy</span></p><p><b>subType</b>: <span title="Codes:{https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1 pbs}">PBS</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: Identifier: IHI/8003608833357361</p><p><b>created</b>: 2020-02-16</p><p><b>insurer</b>: <a href="Organization-healthau.html">Australian Government Department of Health</a></p><p><b>provider</b>: Mr. Representative Pharmacist at Test Org -DigitalHealth 6 Pharmacy (Identifier: HPI-I/8003611566708354)</p><p><b>prescription</b>: <a href="#hcpbs-cont-02/claim-pbs-02">MedicationRequest: status = unknown; intent = order; medication[x] = -&gt;Medication cephalexin 500 mg capsule, 20; authoredOn = 2020-01-15</a></p><p><b>outcome</b>: Processing Complete</p><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>true</td><td>Identifier: Medicare Number/3951032981</td></tr></table><h3>Items</h3><table class="grid"><tr><td style="display: none">-</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 style="display: none">*</td><td>1</td><td><span title="Codes:{https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1 pbs}">PBS</span></td><td><span title="Codes:{http://pbs.gov.au/code/item 03119R}">cephalexin 500 mg capsule, 20</span></td><td>2020-02-16</td></tr></table><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: MedicationRequest  #claim-pbs-02</b></p><a name="pbs-cont-02/claim-pbs-02"> </a><a name="hcpbs-cont-02/claim-pbs-02"> </a><a name="pbs-cont-02/claim-pbs-02-en-AU"> </a><p><b>status</b>: Unknown</p><p><b>intent</b>: Order</p><p><b>medication</b>: <a href="#hcpbs-cont-02/cephalexin-01">Medication cephalexin 500 mg capsule, 20</a></p><p><b>subject</b>: Identifier: IHI/8003608833357361</p><p><b>authoredOn</b>: 2020-01-15</p><h3>DispenseRequests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>NumberOfRepeatsAllowed</b></td><td><b>Quantity</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>500 tablet</td></tr></table></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Medication  #cephalexin-01</b></p><a name="pbs-cont-02/cephalexin-01"> </a><a name="hcpbs-cont-02/cephalexin-01"> </a><a name="pbs-cont-02/cephalexin-01-en-AU"> </a><p><b>code</b>: <span title="Codes:{http://pbs.gov.au/code/item 03119E}">cephalexin 500 mg capsule, 20</span></p><p><b>manufacturer</b>: Identifier: <code>http://pbs.gov.au/code/manufacturer</code>/MM</p></blockquote></div>
  </text>
  <contained>
    <MedicationRequest>
      <id value="claim-pbs-02"/>
      <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="500"/>
          <unit value="tablet"/>
        </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:73f7a30b-add3-4673-a4e9-65b0d8670a36"/>
  </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="2020-02-16"/>
  <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-02"/>
  </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="03119R"/>
        <display value="cephalexin 500 mg capsule, 20"/>
      </coding>
    </productOrService>
    <servicedDate value="2020-02-16"/>
  </item>
</ExplanationOfBenefit>