ClaimBundle-preauth-example-01
type: Bundle
node role: treeRoot
id:
  v: ClaimBundle-preauth-example-01
meta:
  version id:
    v: 1
  last updated:
    v: 2022-12-20T15:32:26.605+05:30
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimBundle
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimBundle
  security:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-Confidentiality
    code:
      v: V
    display:
      v: very restricted
identifier:
  system:
    v: http://hip.in
type:
  v: collection
timestamp:
  v: 2022-12-20T15:32:26.605+05:30
entry:
  full url:
    v: Claim/preauth-example-01
  resource: preauth-example-01
entry:
  full url:
    v: Patient/Patient-example-01
  resource: Patient-example-01
entry:
  full url:
    v: Organization/Organization-example-01
  resource: Organization-example-01
entry:
  full url:
    v: Organization/Organization-example-02
  resource: Organization-example-02
entry:
  full url:
    v: Coverage/Coverage-example-01
  resource: Coverage-example-01
entry:
  full url:
    v: Condition/Condition-example-01
  resource: Condition-example-01
entry:
  full url:
    v: Condition/Condition-example-02
  resource: Condition-example-02
entry:
  full url:
    v: DocumentReference/DocumentReference-example-01
  resource: DocumentReference-example-01

preauth-example-01
type: Claim
id:
  v: Claim-preauth-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
text:
  status:
    v: generated
  div: Generated Narrative: Claim Resource Claim "Claim-preauth-example-01" Profile: Claim identifier: id: 7612345 status: active type: Professional (Claim Type Codes#professional) use: preauthorization patient: Patient/example-01 "" created: 2022-07-20 11:01:00+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) DocumentReference/example-01 diagnosis sequence: 1 diagnosis: See above (Condition/Condition-example-01) type: Clinical Diagnosis (Example Diagnosis Type Codes#clinical) diagnosis sequence: 2 diagnosis: See above (Condition/Condition-example-02) type: Clinical Diagnosis (Example Diagnosis Type Codes#clinical) Insurances - Sequence Focal Coverage PreAuthRef * 1 true Coverage/example-01 12S52 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 * 25000 INR item sequence: 2 category: Medical care (SNOMED CT#781087000) productOrService: Chronic diarrhea (SNOMED CT#236071009) programCode: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) (Program Code#AB-PMJAY) UnitPrices - Value Currency * 15000 INR
identifier:
  system:
    v: http://happypharma.com/claim
  value:
    v: 7612345
status:
  v: active
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/claim-type
    code:
      v: professional
use:
  v: preauthorization
patient:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference:
    v: Patient/example-01
created:
  v: 2022-07-20T11:01:00+05:00
insurer:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-01
  reference:
    v: Organization/Organization-example-01
provider:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-02
  reference:
    v: Organization/Organization-example-02
priority:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/processpriority
    code:
      v: normal
supporting info:
  sequence:
    v: 1
  category:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category
      code:
        v: POI
      display:
        v: proof of identity
  code:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code
      code:
        v: ADN
      display:
        v: Adhaar number
  value: Reference
    link: https://nrces.in/ndhm/fhir/r4/DocumentReference/example-01
    reference:
      v: DocumentReference/example-01
diagnosis:
  sequence:
    v: 1
  diagnosis: Reference
    link: https://nrces.in/ndhm/fhir/r4/Condition/Condition-example-01
    reference:
      v: Condition/Condition-example-01
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
      code:
        v: clinical
      display:
        v: Clinical Diagnosis
diagnosis:
  sequence:
    v: 2
  diagnosis: Reference
    link: https://nrces.in/ndhm/fhir/r4/Condition/Condition-example-02
    reference:
      v: Condition/Condition-example-02
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
      code:
        v: clinical
      display:
        v: Clinical Diagnosis
insurance:
  sequence:
    v: 1
  focal:
    v: true
  coverage:
    link: https://nrces.in/ndhm/fhir/r4/Coverage/example-01
    reference:
      v: Coverage/example-01
  pre auth ref:
    v: 12S52
item:
  sequence:
    v: 1
  category:
    coding: http://snomed.info/id/225362009
      system:
        v: http://snomed.info/sct
      code:
        v: 225362009
      display:
        v: Dental care
  product or service:
    coding: http://snomed.info/id/10849003
      system:
        v: http://snomed.info/sct
      code:
        v: 10849003
      display:
        v: Removal of foreign body
  program code:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-program-code
      code:
        v: AB-PMJAY
      display:
        v: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
  unit price:
    value:
      v: 25000
    currency:
      v: INR
item:
  sequence:
    v: 2
  category:
    coding: http://snomed.info/id/781087000
      system:
        v: http://snomed.info/sct
      code:
        v: 781087000
      display:
        v: Medical care
  product or service:
    coding: http://snomed.info/id/236071009
      system:
        v: http://snomed.info/sct
      code:
        v: 236071009
      display:
        v: Chronic diarrhea
  program code:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-program-code
      code:
        v: AB-PMJAY
      display:
        v: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
  unit price:
    value:
      v: 15000
    currency:
      v: INR

Patient-example-01
type: Patient
id:
  v: Patient-example-01
meta:
  version id:
    v: 1
  last updated:
    v: 2020-07-09T14:58:58.181+05:30
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient
text:
  status:
    v: generated
  div: Generated Narrative: Patient Resource Patient "Patient-example-01" Version "1" Updated "2020-07-09 14:58:58+0530" Profile: Patient identifier: Adhaar number: 7225-4829-5255 name: Ayush Sharma telecom: +919818512600 gender: male birthDate: 1981-01-12
identifier:
  type:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code
      code:
        v: ADN
      display:
        v: Adhaar number
  system:
    v: https://uidai.gov.in/
  value:
    v: 7225-4829-5255
name:
  text:
    v: Ayush Sharma
telecom:
  system:
    v: phone
  value:
    v: +919818512600
  use:
    v: home
gender:
  v: male
birth date:
  v: 1981-01-12

Organization-example-01
type: Organization
id:
  v: Organization-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
text:
  status:
    v: generated
  div: Generated Narrative: Organization Resource Organization "Organization-example-01" Profile: Organization identifier: Provider number: 4567878 name: Appolo Hospital telecom: +91 243 2634 1234, contact@xyz.org
identifier:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: PRN
      display:
        v: Provider number
  system:
    v: https://facility.ndhm.gov.in
  value:
    v: 4567878
name:
  v: Appolo Hospital
telecom:
  system:
    v: phone
  value:
    v: +91 243 2634 1234
  use:
    v: work
telecom:
  system:
    v: email
  use:
    v: work

Organization-example-02
type: Organization
id:
  v: Organization-example-02
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
text:
  status:
    v: generated
  div: Generated Narrative: Organization Resource Organization "Organization-example-02" Profile: Organization identifier: Provider number: 555511 name: Star Health Corporation. telecom: +91 555 2634 888, contact@xyz.org
identifier:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: PRN
      display:
        v: Provider number
  system:
    v: https://facility.ndhm.gov.in
  value:
    v: 555511
name:
  v: Star Health Corporation.
telecom:
  system:
    v: phone
  value:
    v: +91 555 2634 888
  use:
    v: work
telecom:
  system:
    v: email
  use:
    v: work

Coverage-example-01
type: Coverage
id:
  v: Coverage-example-01
text:
  status:
    v: generated
  div: 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: ?? --> 2025-03-17 payor: Organization/example-01 "XYZ Lab Pvt.Ltd."
identifier:
  system:
    v: http://hospitalx.com/selfpayagreement
  value:
    v: SP12345678
status:
  v: active
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/coverage-selfpay
    code:
      v: pay
    display:
      v: PAY
subscriber:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference:
    v: Patient/example-01
beneficiary:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference:
    v: Patient/example-01
relationship:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/subscriber-relationship
    code:
      v: self
period:
  end:
    v: 2025-03-17
payor:
  link: https://nrces.in/ndhm/fhir/r4/Organization/example-01
  reference:
    v: Organization/example-01

Condition-example-01
type: Condition
id:
  v: Condition-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition
text:
  status:
    v: generated
  div: Generated Narrative: Condition Resource Condition "Condition-example-01" Profile: Condition code: Dental caries (SNOMED CT#80967001) subject: Patient/example-01 ""
code:
  coding: http://snomed.info/id/80967001
    system:
      v: http://snomed.info/sct
    code:
      v: 80967001
    display:
      v: Dental caries
subject:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference:
    v: Patient/example-01

Condition-example-02
type: Condition
id:
  v: Condition-example-02
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition
text:
  status:
    v: generated
  div: Generated Narrative: Condition Resource Condition "Condition-example-02" Profile: Condition code: Chronic diarrhea of unknown origin (disorder) (SNOMED CT#17551007) subject: Patient/example-01 ""
code:
  coding: http://snomed.info/id/17551007
    system:
      v: http://snomed.info/sct
    code:
      v: 17551007
    display:
      v: Chronic diarrhea of unknown origin (disorder)
subject:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference:
    v: Patient/example-01

DocumentReference-example-01
type: DocumentReference
id:
  v: DocumentReference-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/DocumentReference
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/DocumentReference
text:
  status:
    v: generated
  div: 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
status:
  v: current
doc status:
  v: final
subject:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference:
    v: Patient/example-01
content:
  attachment:
    content type:
      v: application/pdf
    language:
      v: en-IN
    title:
      v: Adhar Card PDF
    creation:
      v: 2019-05-29T14:58:58.181+05:30