pbs-cont-01
type: ExplanationOfBenefit
node role: treeRoot
resource.id:
  value: pbs-cont-01
resource.meta:
  meta.profile:
    value: http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1
    index: 0
    link: http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: ExplanationOfBenefit Resource ExplanationOfBenefit "pbs-cont-01" Profile: ADHA Record of Claim against PBS or RPBS identifier: id: urn:uuid:296dcbd7-d763-4ecf-aa78-523bcc11ecda status: active type: Pharmacy (Claim Type Codes#pharmacy) subType: pbs (australian-benefit-payment-category-1#pbs) use: claim patient: created: 2020-01-16 insurer: Organization/healthau: Australian Government Department of Health "Australian Government Department of Health" provider: : Mr. Representative Pharmacist at Test Org -DigitalHealth 6 Pharmacy prescription: status: unknown intent: order medication: #cephalexin-01 subject: authoredOn: 2020-01-15 DispenseRequests - NumberOfRepeatsAllowed Quantity * 1 20 capsule outcome: complete Insurances - Focal Coverage * true Items - Sequence Category ProductOrService Serviced[x] * 1 PBS (australian-benefit-payment-category-1#pbs) cephalexin 500 mg capsule, 20 (PBS Item Codes#03119E) 2020-01-16 Generated Narrative: MedicationRequest #claim-pbs-01 status: unknown intent: order medication: #cephalexin-01 subject: authoredOn: 2020-01-15 DispenseRequests - NumberOfRepeatsAllowed Quantity * 1 20 capsule Generated Narrative: Medication #cephalexin-01 code: cephalexin 500 mg capsule, 20 (PBS Item Codes#03119E) manufacturer:
domain resource.contained: MedicationRequest
  index: 0
  resource.id:
    value: claim-pbs-01
  medication request.status:
    value: unknown
  medication request.intent:
    value: order
  medication request.medication reference:
    reference.reference:
      value: #cephalexin-01
  medication request.subject:
    reference.identifier:
      identifier.system:
        value: http://ns.electronichealth.net.au/id/hi/ihi/1.0
      identifier.value:
        value: 8003608833357361
  medication request.authored on:
    value: 2020-01-15
  medication request.dispense request:
    medication request.dispense request.number of repeats allowed:
      value: 1
    medication request.dispense request.quantity:
      quantity.value:
        value: 20
      quantity.unit:
        value: capsule
domain resource.contained: Medication
  index: 1
  resource.id:
    value: cephalexin-01
  medication.code:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://pbs.gov.au/code/item
      coding.code:
        value: 03119E
      coding.display:
        value: cephalexin 500 mg capsule, 20
  medication.manufacturer:
    reference.identifier:
      identifier.system:
        value: http://pbs.gov.au/code/manufacturer
      identifier.value:
        value: MM
explanation of benefit.identifier:
  index: 0
  identifier.system:
    value: urn:ietf:rfc:3986
explanation of benefit.status:
  value: active
explanation of benefit.type:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/claim-type
    coding.code:
      value: pharmacy
explanation of benefit.sub type:
  codeable concept.coding:
    index: 0
    coding.system:
      value: https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1
    coding.code:
      value: pbs
explanation of benefit.use:
  value: claim
explanation of benefit.patient:
  reference.identifier:
    identifier.type:
      codeable concept.coding:
        index: 0
      codeable concept.text:
        value: IHI
    identifier.system:
      value: http://ns.electronichealth.net.au/id/hi/ihi/1.0
    identifier.value:
      value: 8003608833357361
explanation of benefit.created:
  value: 2020-01-16
explanation of benefit.insurer:
  link: http://ns.electronichealth.net.au/fhir/Organization/healthau
  reference.reference:
    value: Organization/healthau
  reference.identifier:
    identifier.type:
      codeable concept.coding:
        index: 0
      codeable concept.text:
        value: ABN
    identifier.system:
      value: http://hl7.org.au/id/abn
    identifier.value:
      value: 83605426759
  reference.display:
    value: Australian Government Department of Health
explanation of benefit.provider:
  reference.identifier:
    identifier.type:
      codeable concept.coding:
        index: 0
      codeable concept.text:
        value: HPI-I
    identifier.system:
      value: http://ns.electronichealth.net.au/id/hi/hpii/1.0
    identifier.value:
      value: 8003611566708354
  reference.display:
    value: Mr. Representative Pharmacist at Test Org -DigitalHealth 6 Pharmacy
explanation of benefit.prescription:
  reference.reference:
    value: #claim-pbs-01
explanation of benefit.outcome:
  value: complete
explanation of benefit.insurance:
  index: 0
  explanation of benefit.insurance.focal:
    value: true
  explanation of benefit.insurance.coverage:
    reference.identifier:
      identifier.system:
        value: http://ns.electronichealth.net.au/id/medicare-number
      identifier.value:
        value: 3951032981
explanation of benefit.item:
  index: 0
  explanation of benefit.item.sequence:
    value: 1
  explanation of benefit.item.category:
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1
      coding.code:
        value: pbs
      coding.display:
        value: PBS
  explanation of benefit.item.product or service:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://pbs.gov.au/code/item
      coding.code:
        value: 03119E
      coding.display:
        value: cephalexin 500 mg capsule, 20
  explanation of benefit.item.serviced date:
    value: 2020-01-16

index: 0
coding.system:
  value: http://terminology.hl7.org/CodeSystem/v2-0203
coding.code:
  value: NI
coding.display:
  value: National unique individual identifier

value: IHI

value: NI

value: National unique individual identifier

value: XX

value: NPI

value: National provider identifier

index: 0
coding.system:
  value: http://terminology.hl7.org/CodeSystem/v2-0203
coding.code:
  value: MC

value: Medicare Number