{"resourceType":"Claim","id":"960151","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Claim\u003c/div\u003e"},"identifier":[{"system":"http://happyhospital.com/claim","value":"96123451"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"institutional"}]},"use":"claim","patient":{"reference":"Patient/1"},"billablePeriod":{"start":"2014-08-15","end":"2014-08-16"},"created":"2014-08-16","enterer":{"identifier":{"system":"http://jurisdiction.org/facilities/HOSP1234/users","value":"UC1234"}},"insurer":{"reference":"Organization/2"},"provider":{"identifier":{"system":"http://npid.org/providerid","value":"NJ12345"}},"priority":{"coding":[{"code":"normal"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"facility":{"identifier":{"system":"http://jurisdiction.org/facilities","value":"HOSP1234"}},"diagnosisRelatedGroup":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup","code":"400","display":"Head trauma - concussion"}]},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"},"responsible":true,"role":{"coding":[{"system":"http://example.org/fhir/CodeSystem/claim-careteamrole","code":"primary"}]},"specialty":{"coding":[{"system":"http://example.org/fhir/CodeSystem/provider-qualification","code":"physician"}]}}],"supportingInfo":[{"sequence":1,"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claiminformationcategory","code":"employmentimpacted"}]},"timingPeriod":{"start":"2014-08-16","end":"2014-08-16"}},{"sequence":2,"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claiminformationcategory","code":"hospitalized"}]},"timingPeriod":{"start":"2014-08-15","end":"2014-08-16"}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"654456"}]},"type":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-diagnosistype","code":"admitting"}]}]}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"},"businessArrangement":"BA987123","preAuthRef":["PA2014G56473"]}],"accident":{"date":"2014-07-09","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode","code":"SPT","display":"Sporting Accident"}]},"locationAddress":{"text":"Grouse Mountain Ski Hill"}},"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-serviceproduct","code":"exam"}]},"servicedDate":"2014-08-16","unitPrice":{"value":125.00,"currency":"USD"},"net":{"value":125.00,"currency":"USD"}}],"total":{"value":125.00,"currency":"USD"}}
{"resourceType":"Claim","id":"860150","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Claim\u003c/div\u003e"},"identifier":[{"system":"http://happypdocs.com/claim","value":"8612345"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"professional"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"normal"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"654456"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-serviceproduct","code":"exam"}]},"servicedDate":"2014-08-16","unitPrice":{"value":75.00,"currency":"USD"},"net":{"value":75.00,"currency":"USD"}}]}
{"resourceType":"Claim","id":"100150","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Oral Health Claim\u003c/div\u003e"},"identifier":[{"system":"http://happyvalley.com/claim","value":"12345"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"oral"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"normal"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"123456"}]}}],"insurance":[{"sequence":1,"focal":true,"identifier":{"system":"http://happyvalley.com/claim","value":"12345"},"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"code":"1200"}]},"servicedDate":"2014-08-16","unitPrice":{"value":135.57,"currency":"USD"},"net":{"value":135.57,"currency":"USD"}}]}
{"resourceType":"Claim","id":"660150","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Vision Claim\u003c/div\u003e"},"identifier":[{"system":"http://happysight.com/claim","value":"6612345"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"vision"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"normal"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"654321"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"exam"}]},"servicedDate":"2014-08-16","unitPrice":{"value":80.00,"currency":"USD"},"net":{"value":80.00,"currency":"USD"}}]}
{"resourceType":"Claim","id":"660152","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Vision Claim for Glasses\u003c/div\u003e"},"contained":[{"resourceType":"Device","id":"device-frame"},{"resourceType":"Device","id":"device-lens"}],"identifier":[{"system":"http://happysight.com/claim","value":"6612347"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"vision"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"normal"}]},"prescription":{"reference":"http://www.optdocs.com/prescription/12345"},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"654321"}]}}],"insurance":[{"sequence":1,"focal":false,"coverage":{"reference":"Coverage/9876B1"},"preAuthRef":["PR7652387237"],"claimResponse":{"reference":"ClaimResponse/R3500"}},{"sequence":2,"focal":true,"coverage":{"reference":"Coverage/9876B1"},"preAuthRef":["AB543GTD7567"]}],"item":[{"sequence":1,"careTeamSequence":[1],"revenue":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-revenue-center","code":"0010","display":"Vision Clinic"}]},"category":{"coding":[{"system":"http://example.org/fhir/CodeSystem/benefit-subcategory","code":"F6","display":"Vision Coverage"}]},"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"glasses"}]},"modifier":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/modifiers","code":"rooh"}]}],"programCode":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-programcode","code":"none"}]}],"servicedDate":"2014-08-16","unitPrice":{"value":235.40,"currency":"USD"},"net":{"value":235.40,"currency":"USD"},"detail":[{"sequence":1,"revenue":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-revenue-center","code":"0010","display":"Vision Clinic"}]},"category":{"coding":[{"system":"http://example.org/fhir/CodeSystem/benefit-subcategory","code":"F6","display":"Vision Coverage"}]},"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"frame"}]},"modifier":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/modifiers","code":"rooh"}]}],"unitPrice":{"value":100.00,"currency":"USD"},"factor":1.1,"net":{"value":110.00,"currency":"USD"},"udi":[{"reference":"#device-frame"}]},{"sequence":2,"revenue":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-revenue-center","code":"0010","display":"Vision Clinic"}]},"category":{"coding":[{"system":"http://example.org/fhir/CodeSystem/benefit-subcategory","code":"F6","display":"Vision Coverage"}]},"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"lens"}]},"programCode":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-programcode","code":"none"}]}],"quantity":{"value":2},"unitPrice":{"value":55.00,"currency":"USD"},"net":{"value":110.00,"currency":"USD"},"subDetail":[{"sequence":1,"revenue":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-revenue-center","code":"0010","display":"Vision Clinic"}]},"category":{"coding":[{"system":"http://example.org/fhir/CodeSystem/benefit-subcategory","code":"F6","display":"Vision Coverage"}]},"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"lens"}]},"modifier":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/modifiers","code":"rooh"}]}],"programCode":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-programcode","code":"none"}]}],"quantity":{"value":2},"unitPrice":{"value":30.00,"currency":"USD"},"factor":1.1,"net":{"value":66.00,"currency":"USD"},"udi":[{"reference":"#device-lens"}]},{"sequence":2,"revenue":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-revenue-center","code":"0010","display":"Vision Clinic"}]},"category":{"coding":[{"system":"http://example.org/fhir/CodeSystem/benefit-subcategory","code":"F6","display":"Vision Coverage"}]},"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"hardening"}]},"modifier":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/modifiers","code":"rooh"}]}],"quantity":{"value":2},"unitPrice":{"value":15.00,"currency":"USD"},"factor":1.1,"net":{"value":33.00,"currency":"USD"}},{"sequence":3,"revenue":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-revenue-center","code":"0010","display":"Vision Clinic"}]},"category":{"coding":[{"system":"http://example.org/fhir/CodeSystem/benefit-subcategory","code":"F6","display":"Vision Coverage"}]},"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"UV coating"}]},"modifier":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/modifiers","code":"rooh"}]}],"quantity":{"value":2},"unitPrice":{"value":5.00,"currency":"USD"},"factor":1.1,"net":{"value":11.00,"currency":"USD"}}]},{"sequence":3,"revenue":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-revenue-center","code":"0010","display":"Vision Clinic"}]},"category":{"coding":[{"system":"http://example.org/fhir/CodeSystem/benefit-subcategory","code":"F6","display":"Vision Coverage"}]},"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"fst"}]},"unitPrice":{"value":220.00,"currency":"USD"},"factor":0.07,"net":{"value":15.40,"currency":"USD"}}]}]}
{"resourceType":"Claim","id":"960150","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Claim\u003c/div\u003e"},"identifier":[{"system":"http://happyhospital.com/claim","value":"9612345"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"institutional"}]},"subType":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-claimsubtype","code":"emergency"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","enterer":{"identifier":{"system":"http://jurisdiction.org/facilities/HOSP1234/users","value":"UC1234"}},"insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"normal"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"facility":{"identifier":{"system":"http://jurisdiction.org/facilities","value":"HOSP1234"}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"654456"}]}}],"procedure":[{"sequence":1,"type":[{"coding":[{"code":"primary"}]}],"date":"2014-08-16","procedureCodeableConcept":{"coding":[{"code":"SDI9901"}],"text":"Subcutaneous diagnostic implant"},"udi":[{"reference":"Device/example"}]}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-serviceproduct","code":"exam"}]},"servicedDate":"2014-08-16","unitPrice":{"value":125.00,"currency":"USD"},"net":{"value":125.00,"currency":"USD"},"encounter":[{"reference":"Encounter/example"}]}],"total":{"value":125.00,"currency":"USD"}}
{"resourceType":"Claim","id":"100152","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Oral Health Claim\u003c/div\u003e"},"contained":[{"resourceType":"Organization","id":"org-insurer","identifier":[{"system":"http://www.bindb.com/bin","value":"123456"}]},{"resourceType":"Organization","id":"org-org","identifier":[{"system":"http://www.jurisdiction.com/oralhealthoffices","value":"3456"}]},{"resourceType":"Practitioner","id":"provider-1","identifier":[{"system":"http://www.jurisdiction.com/oralhealthproviders","value":"123456789"}]},{"resourceType":"Patient","id":"patient-1","name":[{"use":"official","family":"Donald","given":["Duck"]}],"gender":"male","birthDate":"1986-05-17","address":[{"use":"home","line":["1234 Main Street"],"city":"Vancouver","postalCode":"V2H1Y3","country":"CAD"}]},{"resourceType":"Coverage","id":"coverage-1","identifier":[{"system":"http://benefitsinc.com/certificate","value":"12345"}],"status":"active","kind":"insurance","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/v3-ActCode","code":"EHCPOL"}]},"subscriber":{"reference":"#patient-1"},"beneficiary":{"reference":"#patient-1"},"dependent":"1","relationship":{"coding":[{"code":"self"}]},"insurer":{"identifier":{"system":"http://www.bindb.com/bin","value":"123456"}},"class":[{"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/coverage-class","code":"plan"}]},"value":{"value":"CBI35"},"name":"Corporate Baker\u0027s Inc. Plan#35"},{"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/coverage-class","code":"subplan"}]},"value":{"value":"123"},"name":"Trainee Part-time Benefits"},{"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/coverage-class","code":"sequence"}]},"value":{"value":"1"}}]}],"identifier":[{"system":"http://happyvalley.com/claim","value":"12347"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"oral"}]},"use":"claim","patient":{"reference":"#patient-1"},"created":"2014-08-16","insurer":{"reference":"#org-insurer"},"provider":{"reference":"#org-org"},"priority":{"coding":[{"code":"normal"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"#provider-1"}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"123456"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"#coverage-1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"code":"1200"}]},"servicedDate":"2014-08-16","unitPrice":{"value":135.57,"currency":"USD"},"net":{"value":135.57,"currency":"USD"}}]}
{"resourceType":"Claim","id":"760151","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Pharmacy Claim\u003c/div\u003e"},"identifier":[{"system":"http://happypharma.com/claim","value":"7612345"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"pharmacy"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"stat"}]},"prescription":{"reference":"http://pharmacy.org/MedicationRequest/AB1234G"},"originalPrescription":{"reference":"http://pharmacy.org/MedicationRequest/AB1202B"},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"supportingInfo":[{"sequence":1,"category":{"coding":[{"code":"pharmacyrefill"}]},"code":{"coding":[{"system":"http://example.org/fhir/CodeSystem/pharmacy-refill","code":"new"}]}},{"sequence":2,"category":{"coding":[{"code":"pharmacyinformation"}]},"code":{"coding":[{"system":"http://example.org/fhir/CodeSystem/pharmacy-information","code":"refillsremaining"}]},"valueQuantity":{"value":2}},{"sequence":3,"category":{"coding":[{"code":"pharmacyinformation"}]},"code":{"coding":[{"system":"http://example.org/fhir/CodeSystem/pharmacy-information","code":"dayssupply"}]},"valueQuantity":{"value":90}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"654456"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"informationSequence":[1,2,3],"productOrService":{"coding":[{"system":"http://www.nlm.nih.gov/research/umls/rxnorm","code":"562721","display":"Alprazolam 0.25mg (Xanax)"}]},"servicedDate":"2014-08-16","quantity":{"value":90,"unit":"TAB","system":"http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm","code":"TAB"},"net":{"value":90.00,"currency":"USD"},"detail":[{"sequence":1,"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-pharmaservice","code":"drugcost"}]},"net":{"value":45.00,"currency":"USD"}},{"sequence":2,"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-pharmaservice","code":"markup"}]},"net":{"value":9.00,"currency":"USD"}},{"sequence":3,"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-pharmaservice","code":"dispensefee"}]},"net":{"value":36.00,"currency":"USD"}}]}],"total":{"value":90.00,"currency":"USD"}}
{"resourceType":"Claim","id":"100153","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Oral Health Claim\u003c/div\u003e"},"identifier":[{"system":"http://happyvalley.com/claim","value":"12355"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"oral"}]},"use":"preauthorization","patient":{"reference":"Patient/1"},"created":"2015-03-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"normal"}]},"fundsReserve":{"coding":[{"code":"provider"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"system":"http://hl7.org/fhir/sid/icd-10","code":"K07.3"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"diagnosisSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"ORTHPLAN"}]},"servicedDate":"2015-05-16","unitPrice":{"value":9000.00,"currency":"USD"},"net":{"value":9000.00,"currency":"USD"},"detail":[{"sequence":1,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"ORTHOEXAM"}]},"unitPrice":{"value":1000.00,"currency":"USD"},"net":{"value":1000.00,"currency":"USD"}},{"sequence":2,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"ORTHODIAG"}]},"unitPrice":{"value":1500.00,"currency":"USD"},"net":{"value":1500.00,"currency":"USD"}},{"sequence":3,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"ORTHOINITIAL"}]},"unitPrice":{"value":500.00,"currency":"USD"},"net":{"value":500.00,"currency":"USD"}},{"sequence":4,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"ORTHOMONTHS"}]},"quantity":{"value":24}},{"sequence":5,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"ORTHOPERIODIC"}]},"quantity":{"value":24},"unitPrice":{"value":250.00,"currency":"USD"},"net":{"value":250.00,"currency":"USD"}}]},{"sequence":2,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"21211"}]},"servicedDate":"2014-08-16","unitPrice":{"value":105.00,"currency":"USD"},"net":{"value":105.00,"currency":"USD"},"bodySite":[{"site":[{"concept":{"coding":[{"system":"http://fdi.org/fhir/oraltoothcodes","code":"21"}]}}],"subSite":[{"coding":[{"system":"http://fdi.org/fhir/oralsurfacecodes","code":"L"}]}]}]},{"sequence":3,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"27211"}]},"servicedDate":"2014-08-16","unitPrice":{"value":1100.00,"currency":"USD"},"net":{"value":1100.00,"currency":"USD"},"bodySite":[{"site":[{"concept":{"coding":[{"system":"http://fdi.org/fhir/oraltoothcodes","code":"36"}]}}]}],"detail":[{"sequence":1,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"27211"}]},"unitPrice":{"value":750.00,"currency":"USD"},"net":{"value":750.00,"currency":"USD"}},{"sequence":2,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"lab"}]},"unitPrice":{"value":350.00,"currency":"USD"},"net":{"value":350.00,"currency":"USD"}}]}]}
{"resourceType":"Claim","id":"MED-00050","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of a CMS 1500 Claim\u003c/div\u003e"},"contained":[{"resourceType":"Patient","id":"patient-1","name":[{"use":"official","family":"Ashcraft","given":["Alvina"]}],"gender":"female","birthDate":"1954-06-11","address":[{"use":"home","line":["123 Main Street"],"city":"Portland","state":"OR","postalCode":"97125","country":"USA"}]},{"resourceType":"Coverage","id":"coverage-1","identifier":[{"system":"http://benefitsinc.com/certificate","value":"10138556"}],"status":"active","kind":"insurance","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/v3-ActCode","code":"HIP","display":"health insurance plan policy"}]},"subscriber":{"reference":"#patient-1"},"beneficiary":{"reference":"#patient-1"},"relationship":{"coding":[{"code":"self"}]},"period":{"start":"2015-01-01T00:00:00-07:00","end":"2016-01-01T00:00:00-07:00"},"insurer":{"identifier":{"system":"http://www.bindb.com/bin","value":"123456"},"display":"Humana Inc."},"class":[{"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/coverage-class","code":"group"}]},"value":{"value":"80902206"}}]}],"identifier":[{"system":"http://CedarArmsMedicalCenter.com/claim","value":"MED-00050"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"institutional"}]},"subType":{"coding":[{"system":"https://www.cms.gov/codes/billtype","code":"831","display":"Hospital Outpatient Surgery performed in an Ambulatory ​Surgical Center"}]},"use":"claim","patient":{"reference":"#patient-1"},"created":"2015-10-16T00:00:00-07:00","insurer":{"identifier":{"system":"http://www.bindb.com/bin","value":"123456"},"display":"Humana Inc."},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"normal"}]},"payee":{"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/payeetype","code":"provider"}]},"party":{"reference":"Organization/1"}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"supportingInfo":[{"sequence":1,"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claiminformationcategory","code":"hospitalized"}]},"timingPeriod":{"start":"2015-10-01T00:00:00-07:00","end":"2015-10-05T00:00:00-07:00"}},{"sequence":2,"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claiminformationcategory","code":"discharge"}]},"code":{"coding":[{"system":"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0801.pdf","code":"01","display":"Discharge to Home or Self Care"}]}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"system":"http://hl7.org/fhir/sid/icd-10-cm","code":"M96.1","display":"Postlaminectomy syndrome, not elsewhere classified"}]}},{"sequence":2,"diagnosisCodeableConcept":{"coding":[{"system":"http://hl7.org/fhir/sid/icd-10-cm","code":"G89.4","display":"Chronic pain syndrome"}]}},{"sequence":3,"diagnosisCodeableConcept":{"coding":[{"system":"http://hl7.org/fhir/sid/icd-10-cm","code":"M53.88","display":"Other specified dorsopathies, sacral and sacrococcygeal region"}]}},{"sequence":4,"diagnosisCodeableConcept":{"coding":[{"system":"http://hl7.org/fhir/sid/icd-10-cm","code":"M47.816","display":"Spondylosis without myelopathy or radiculopathy, lumbar region"}]}}],"insurance":[{"sequence":1,"focal":true,"identifier":{"system":"http://CedarArmsMedicalCenter.com/claim","value":"MED-00050"},"coverage":{"reference":"#coverage-1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"diagnosisSequence":[2,4],"informationSequence":[1],"productOrService":{"coding":[{"system":"http://www.ama-assn.org/go/cpt","code":"62264","display":"Surgical Procedures on the Spine and Spinal Cord"}]},"servicedDate":"2015-10-13","locationCodeableConcept":{"coding":[{"system":"https://www.cms.gov/medicare/coding/place-of-service-codes/place_of_service_code_set.html","code":"24","display":"Ambulatory Surgical Center"}]},"unitPrice":{"value":12500.00,"currency":"USD"},"net":{"value":12500.00,"currency":"USD"}}],"total":{"value":12500.00,"currency":"USD"}}
{"resourceType":"Claim","id":"100151","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Oral Health Claim\u003c/div\u003e"},"identifier":[{"system":"http://happyvalley.com/claim","value":"12346"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"oral"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"normal"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"supportingInfo":[{"sequence":1,"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claiminformationcategory","code":"missingtooth"}]},"code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-tooth","code":"15"}]},"timingDate":"2012-04-07","reason":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/missingtoothreason","code":"e"}]}},{"sequence":2,"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claiminformationcategory","code":"exception"}]},"code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-exception","code":"student"}]},"valueString":"Happy Valley Community College"}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"123456"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"1200"}]},"servicedDate":"2014-08-16","unitPrice":{"value":135.57,"currency":"USD"},"net":{"value":135.57,"currency":"USD"}},{"sequence":2,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"21211"}]},"servicedDate":"2014-08-16","unitPrice":{"value":105.00,"currency":"USD"},"net":{"value":105.00,"currency":"USD"},"bodySite":[{"site":[{"concept":{"coding":[{"system":"http://fdi.org/fhir/oraltoothcodes","code":"21"}]}}],"subSite":[{"coding":[{"system":"http://fdi.org/fhir/oralsurfacecodes","code":"L"}]}]}]},{"sequence":3,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"27211"}]},"servicedDate":"2014-08-16","unitPrice":{"value":1100.00,"currency":"USD"},"net":{"value":1100.00,"currency":"USD"},"bodySite":[{"site":[{"concept":{"coding":[{"system":"http://fdi.org/fhir/oraltoothcodes","code":"36"}]}}]}],"detail":[{"sequence":1,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"27211"}]},"unitPrice":{"value":1000.00,"currency":"USD"},"factor":0.75,"net":{"value":750.00,"currency":"USD"}},{"sequence":2,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"lab"}]},"unitPrice":{"value":350.00,"currency":"USD"},"net":{"value":350.00,"currency":"USD"}}]}]}
{"resourceType":"Claim","id":"660151","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Vision Claim for Glasses\u003c/div\u003e"},"identifier":[{"system":"http://happysight.com/claim","value":"6612346"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"vision"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"normal"}]},"prescription":{"reference":"http://www.optdocs.com/prescription/12345"},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"654321"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"glasses"}]},"servicedDate":"2014-08-16","unitPrice":{"value":214.00,"currency":"USD"},"net":{"value":214.00,"currency":"USD"},"detail":[{"sequence":1,"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"frame"}]},"unitPrice":{"value":100.00,"currency":"USD"},"net":{"value":100.00,"currency":"USD"}},{"sequence":2,"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"lens"}]},"quantity":{"value":2},"unitPrice":{"value":50.00,"currency":"USD"},"net":{"value":100.00,"currency":"USD"}},{"sequence":3,"productOrService":{"coding":[{"system":"http://example.org/fhir/CodeSystem/ex-visionservice","code":"fst"}]},"unitPrice":{"value":200.00,"currency":"USD"},"factor":0.07,"net":{"value":14.00,"currency":"USD"}}]}]}
{"resourceType":"Claim","id":"100154","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eThis example assumes a national health care scheme where patients, providers and organizations have known business identifiers.\u003c/div\u003e"},"identifier":[{"system":"http://happyvalley.com/claim","value":"12347"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"oral"}]},"use":"claim","patient":{"identifier":{"system":"http://www.jurisdiction.com/nationalId","value":"123AB345"}},"created":"2014-08-16","insurer":{"identifier":{"system":"http://www.jurisdiction.com/insurers","value":"123456"}},"provider":{"identifier":{"system":"http://www.jurisdiction.com/careorganizations","value":"HOSP12345"}},"priority":{"coding":[{"code":"normal"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"identifier":{"system":"http://www.jurisdiction.com/providerId","value":"MD98765"}}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"123456"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"identifier":{"system":"http://www.jurisdiction.com/nationalplan","value":"123AB345"}}}],"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"code":"1200"}]},"servicedDate":"2014-08-16","unitPrice":{"value":135.57,"currency":"USD"},"net":{"value":135.57,"currency":"USD"}}]}
{"resourceType":"Claim","id":"760150","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Pharmacy Claim\u003c/div\u003e"},"identifier":[{"system":"http://happypharma.com/claim","value":"7612345"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"pharmacy"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"stat"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"654456"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-pharmaservice","code":"smokecess"}]},"servicedDate":"2014-08-16","unitPrice":{"value":60.00,"currency":"USD"},"net":{"value":60.00,"currency":"USD"}}]}
{"resourceType":"Claim","id":"100155","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eThis example assumes a national health care scheme where patients, providers and organizations have known business identifiers.\u003c/div\u003e"},"contained":[{"resourceType":"Patient","id":"patient-1","name":[{"use":"official","family":"Donald","given":["Duck"]}],"gender":"male","birthDate":"1986-05-17","address":[{"use":"home","line":["1234 Main Street"],"city":"Vancouver","postalCode":"V2H1Y3","country":"CAD"}]}],"identifier":[{"system":"http://happyvalley.com/claim","value":"12347"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"oral"}]},"use":"claim","patient":{"reference":"#patient-1"},"created":"2014-08-16","insurer":{"identifier":{"system":"http://www.jurisdiction.com/insurers","value":"123456"}},"provider":{"identifier":{"system":"http://www.jurisdiction.com/careorganizations","value":"HOSP12345"}},"priority":{"coding":[{"code":"normal"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"identifier":{"system":"http://www.jurisdiction.com/providerId","value":"MD98765"}}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"123456"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"http://www.jurisdiction.com/nationalplan/123AB345"}}],"item":[{"sequence":1,"careTeamSequence":[1],"productOrService":{"coding":[{"code":"1200"}]},"servicedDate":"2014-08-16","unitPrice":{"value":135.57,"currency":"USD"},"net":{"value":135.57,"currency":"USD"}}]}
{"resourceType":"Claim","id":"100156","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Oral Health Claim\u003c/div\u003e"},"contained":[{"resourceType":"Device","id":"device-bridge"},{"resourceType":"ServiceRequest","id":"referral","status":"active","intent":"order","subject":{"reference":"Patient/1"}}],"identifier":[{"system":"http://happyvalley.com/claim","value":"123466"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"oral"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"normal"}]},"related":[{"claim":{"reference":"Claim/100151"},"relationship":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship","code":"associated"}]},"reference":{"value":"CASE156746B"}}],"payee":{"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/payeetype","code":"other"}]},"party":{"reference":"RelatedPerson/peter"}},"referral":{"reference":"#referral"},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"supportingInfo":[{"sequence":1,"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claiminformationcategory","code":"prosthesis"}]},"code":{"coding":[{"system":"http://hl7.org/fhir/ex-oralprostho","code":"2","display":"Maryland Bridge"}]},"timingDate":"2001-04-07"}],"procedure":[{"sequence":1,"date":"2014-07-04","procedureCodeableConcept":{"text":"Resection of gum to increase exposed tooth."}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"informationSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"67221","display":"Maryland Bridge"}]},"servicedDate":"2014-08-16","locationCodeableConcept":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-serviceplace","code":"11"}]},"unitPrice":{"value":1400.00,"currency":"USD"},"factor":0.75,"net":{"value":1050.00,"currency":"USD"},"udi":[{"reference":"#device-bridge"}],"bodySite":[{"site":[{"concept":{"coding":[{"system":"http://fdi.org/fhir/oraltoothcodes","code":"01"}]}}]}]},{"sequence":2,"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"21211"}]},"servicedDate":"2014-08-16","locationCodeableConcept":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-serviceplace","code":"11"}]},"unitPrice":{"value":105.00,"currency":"USD"},"net":{"value":105.00,"currency":"USD"},"bodySite":[{"site":[{"concept":{"coding":[{"system":"http://fdi.org/fhir/oraltoothcodes","code":"21"}]}}],"subSite":[{"coding":[{"system":"http://fdi.org/fhir/oralsurfacecodes","code":"L"}]}]}]},{"sequence":3,"careTeamSequence":[1],"procedureSequence":[1],"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"27211"}]},"servicedDate":"2014-08-16","locationCodeableConcept":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-serviceplace","code":"11"}]},"unitPrice":{"value":1100.00,"currency":"USD"},"net":{"value":1100.00,"currency":"USD"},"bodySite":[{"site":[{"concept":{"coding":[{"system":"http://fdi.org/fhir/oraltoothcodes","code":"24"}]}}]}],"detail":[{"sequence":1,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"27211"}]},"unitPrice":{"value":1000.00,"currency":"USD"},"factor":0.75,"net":{"value":750.00,"currency":"USD"}},{"sequence":2,"productOrService":{"coding":[{"system":"http://example.org/fhir/oralservicecodes","code":"lab"}]},"unitPrice":{"value":350.00,"currency":"USD"},"net":{"value":350.00,"currency":"USD"}}]}],"total":{"value":2255.00,"currency":"USD"}}
{"resourceType":"Claim","id":"760152","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the Pharmacy Claim\u003c/div\u003e"},"identifier":[{"system":"http://happypharma.com/claim","value":"7612345"}],"status":"active","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"pharmacy"}]},"use":"claim","patient":{"reference":"Patient/1"},"created":"2014-08-16","insurer":{"reference":"Organization/2"},"provider":{"reference":"Organization/1"},"priority":{"coding":[{"code":"stat"}]},"payee":{"type":{"coding":[{"code":"provider"}]}},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/example"}}],"supportingInfo":[{"sequence":1,"category":{"coding":[{"code":"pharmacyrefill"}]},"code":{"coding":[{"system":"http://example.org/fhir/CodeSystem/pharmacy-refill","code":"new"}]}},{"sequence":2,"category":{"coding":[{"code":"pharmacyinformation"}]},"code":{"coding":[{"system":"http://example.org/fhir/CodeSystem/pharmacy-information","code":"refillsremaining"}]},"valueQuantity":{"value":0}},{"sequence":3,"category":{"coding":[{"code":"pharmacyinformation"}]},"code":{"coding":[{"system":"http://example.org/fhir/CodeSystem/pharmacy-information","code":"dayssupply"}]},"valueQuantity":{"value":10}},{"sequence":4,"category":{"coding":[{"code":"pharmacy"}]},"code":{"coding":[{"system":"http://example.org/fhir/CodeSystem/pharmacy-form","code":"capsule"}]}}],"diagnosis":[{"sequence":1,"diagnosisCodeableConcept":{"coding":[{"code":"654456"}]}}],"insurance":[{"sequence":1,"focal":true,"coverage":{"reference":"Coverage/9876B1"}}],"item":[{"sequence":1,"careTeamSequence":[1],"informationSequence":[1,2,3,4],"productOrService":{"coding":[{"system":"http://localdruglist.org","code":"compound","display":"Custom compound"}]},"servicedDate":"2014-08-16","quantity":{"value":30,"unit":"TAB","system":"http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm","code":"TAB"},"net":{"value":155.00,"currency":"USD"},"detail":[{"sequence":1,"productOrService":{"coding":[{"system":"http://localdruglist.org","code":"44001","display":"Acetaminophen 250mg"}]},"quantity":{"value":250,"unit":"mg"},"net":{"value":20.00,"currency":"USD"},"subDetail":[{"sequence":1,"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-pharmaservice","code":"drugcost"}]},"net":{"value":20.00,"currency":"USD"}}]},{"sequence":2,"productOrService":{"coding":[{"system":"http://localdruglist.org","code":"44035","display":"Phenacetin 50mg"}]},"quantity":{"value":50,"unit":"mg"},"net":{"value":25.00,"currency":"USD"},"subDetail":[{"sequence":1,"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-pharmaservice","code":"drugcost"}]},"net":{"value":25.00,"currency":"USD"}}]},{"sequence":3,"productOrService":{"coding":[{"system":"http://localdruglist.org","code":"44057","display":"Codeine 25mg"}]},"quantity":{"value":25,"unit":"mg"},"net":{"value":28.00,"currency":"USD"},"subDetail":[{"sequence":1,"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-pharmaservice","code":"drugcost"}]},"net":{"value":28.00,"currency":"USD"}}]},{"sequence":2,"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-pharmaservice","code":"markup"}]},"net":{"value":22.00,"currency":"USD"}},{"sequence":3,"productOrService":{"coding":[{"system":"http://hl7.org/fhir/ex-pharmaservice","code":"compoundfee"}]},"net":{"value":60.00,"currency":"USD"}}]}],"total":{"value":155.00,"currency":"USD"}}