Bundle ClaimBundle-example-01 of type collection

Entry 1 - fullUrl = Claim/Claim-example-01

Resource Claim:

Generated Narrative: Claim

Resource Claim "Claim-example-01"

Profile: Claim

identifier: id: 7612345

status: ACTIVE

type: Professional (Claim Type Codes#professional)

use: CLAIM

patient: See above (Patient/Patient-example-01)

created: 2022-12-22 16:01:08-0500

insurer: See above (Organization/Organization-example-01)

provider: See above (Organization/Organization-example-02)

priority: Normal (Process Priority Codes#normal)

SupportingInfos

-	Sequence	Category	Code	Value[x]
*	1	proof of identity (SupportingInfo Category#POI)	Adhaar number (Identifier Type Code#ADN)	See above (DocumentReference/DocumentReference-example-01)

Diagnoses

-	Sequence	Diagnosis[x]	Type
*	1	See above (Condition/Condition-example-01)	Self Diagnosis (Example Diagnosis Type Codes#self)

Insurances

-	Sequence	Focal	Coverage	PreAuthRef
*	1	true	See above (Coverage/Coverage-example-01)	1234

item

sequence: 1

category: Dental care (SNOMED CT#225362009)

productOrService: Removal of foreign body (SNOMED CT#10849003)

programCode: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) (Program Code#AB-PMJAY)

UnitPrices

-	Value	Currency
*	5000	INR

Entry 2 - fullUrl = Patient/Patient-example-01

Resource Patient:

Ayush Sharma Male, DoB: 1981-01-12 ( Adhaar number: 7225-4829-5255)

Entry 3 - fullUrl = Organization/Organization-example-01

Resource Organization:

Generated Narrative: Organization

Resource Organization "Organization-example-01"

Profile: Organization

identifier: Provider number: 4567878

name: Appolo Hospital

Contacts

-	Telecom
*	+91 243 2634 1234, contact@xyz.org

Entry 4 - fullUrl = Organization/Organization-example-02

Resource Organization:

Generated Narrative: Organization

Resource Organization "Organization-example-02"

Profile: Organization

identifier: Provider number: 555511

name: Star Health Corporation.

Contacts

-	Telecom
*	+91 555 2634 888, contact@xyz.org

Entry 5 - fullUrl = Coverage/Coverage-example-01

Resource Coverage:

Generated Narrative: Coverage

Resource Coverage "Coverage-example-01"

identifier: id: SP12345678

status: ACTIVE

type: PAY (Coverage SelfPay Codes#pay)

subscriber: Patient/example-01 ""

beneficiary: Patient/example-01 ""

relationship: Self (SubscriberPolicyholder Relationship Codes#self)

period: ?? --> 2023-03-17

Entry 6 - fullUrl = Condition/Condition-example-01

Resource Condition:

Generated Narrative: Condition

Resource Condition "Condition-example-01"

Profile: Condition

code: Dental caries (SNOMED CT#80967001)

subject: Patient/example-01 ""

Entry 7 - fullUrl = DocumentReference/DocumentReference-example-01

Resource DocumentReference:

Generated Narrative: DocumentReference

Resource DocumentReference "DocumentReference-example-01"

Profile: DocumentReference

status: CURRENT

docStatus: FINAL

subject: Patient/example-01 ""

content

Attachments

-	ContentType	Language	Data	Title	Creation
*	application/pdf	en-IN	(base64 data - 80793 bytes)	Adhar Card PDF	2019-05-29 14:58:58+0530