Bundle ClaimBundle-predetermination-example-01 of type collection

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

Resource Claim:

Generated Narrative: Claim

Resource Claim "Claim-predetermination-example-01"

Profile: Claim

identifier: id: 7612345

status: ACTIVE

type: Inpatient care management (procedure) (SNOMED CT#737481003)

subType: Emergency Claim (Example Claim SubType Codes#emergency)

use: PREDETERMINATION

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

billablePeriod: 2023-12-09 11:01:00+0500 --> 2023-12-30 11:01:00+0500

created: 2023-12-11 11:01:00+0500

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

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

priority: Normal (Process Priority Codes#normal)

prescription: See above (MedicationRequest/MedicationRequest-example-01)

CareTeams

-	Sequence	Provider	Role
*	1	See above (Practitioner/Practitioner-example-01)	Healthcare professional (occupation) (SNOMED CT#223366009)

SupportingInfos

-	Sequence	Category	Code	Value[x]
*	1	Document Type - Investigation (SupportingInfo Category#INV)	Angiography (SNOMED CT#77343006)	See above (DocumentReference/DocumentReference-example-01)

Diagnoses

-	Sequence	Diagnosis[x]	Type
*	1	Cardiac arrest, unspecified (ICD-10#I46.9)	Final diagnosis (discharge) (contextual qualifier) (qualifier value) (SNOMED CT#89100005)

procedure

sequence: 1

procedure: Angiography (SNOMED CT#77343006)

procedure

sequence: 2

procedure: Angioplasty of blood vessel (SNOMED CT#418285008)

Insurances

-	Sequence	Focal	Coverage	PreAuthRef
*	1	true	See above (Coverage/Coverage-example-01)	123456

item

sequence: 1

careTeamSequence: 1

productOrService: Angiography (SNOMED CT#77343006)

serviced: 2023-12-09

UnitPrices

-	Value	Currency
*	10000.00	INR

Nets

-	Value	Currency
*	10000.00	INR

item

sequence: 2

careTeamSequence: 1

productOrService: Angioplasty of blood vessel (SNOMED CT#418285008)

UnitPrices

-	Value	Currency
*	40000	INR

Nets

-	Value	Currency
*	40000	INR

item

sequence: 3

careTeamSequence: 1

productOrService: Intensive care unit (SNOMED CT#309904001)

serviced: 2023-12-11

quantity: 10 day

UnitPrices

-	Value	Currency
*	2000	INR

Nets

-	Value	Currency
*	20000	INR

item

sequence: 4

careTeamSequence: 1

productOrService: Aspirin 75 mg oral tablet (SNOMED CT#319775004)

UnitPrices

-	Value	Currency
*	100	INR

Nets

-	Value	Currency
*	100	INR

Totals

-	Value	Currency
*	70100	INR

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

Resource Patient:

Adarsh Agrawal 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

type: Insurance Company (Organization type#ins)

name: XYZ Insurance Co. Ltd.

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: 45675454

type: Healthcare Provider (Organization type#prov)

name: XYZ Hospital Co. Ltd.

Contacts

-	Telecom
*	+91 243 2634 1278, contact@xyz.org

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

Resource MedicationRequest:

Generated Narrative: MedicationRequest

Resource MedicationRequest "MedicationRequest-example-01"

Profile: MedicationRequest

status: ACTIVE

intent: ORDER

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

authoredOn: 2023-12-11

requester: See above (Practitioner/Practitioner-example-01)

DosageInstructions

-	Text	AdditionalInstruction	Timing	Route	Method
*	One tablet at once	With or after food (SNOMED CT#311504000)	Once per 1 days	Oral Route (SNOMED CT#26643006)	Swallow (SNOMED CT#421521009)

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

Resource Practitioner:

Generated Narrative: Practitioner

Resource Practitioner "Practitioner-example-01" Version "1" Updated "2023-09-07 14:58:58+0530"

Profile: Practitioner

identifier: Medical License number: 21-1521-3828-3227

name: Dr. Aayush Agrawal

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

Resource Coverage:

Generated Narrative: Coverage

Resource Coverage "Coverage-example-01"

Profile: Coverage

identifier: id: 235037120

status: ACTIVE

type: PAY (Coverage SelfPay Codes#pay)

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

subscriberId: id: ABC123456BI007

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

relationship: Self (SubscriberPolicyholder Relationship Codes#self)

period: ?? --> 2026-03-17

Entry 8 - fullUrl = Condition/Condition-example-01

Resource Condition:

Generated Narrative: Condition

Resource Condition "Condition-example-01"

Profile: Condition

code: Cardiac arrest, unspecified (ICD-10#I46.9)

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

onset: 2days

Entry 9 - fullUrl = DocumentReference/DocumentReference-example-01

Resource DocumentReference:

Generated Narrative: DocumentReference

Resource DocumentReference "DocumentReference-example-01"

Profile: DocumentReference

status: CURRENT

docStatus: FINAL

subject: See above (Patient/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