| Australian Digital Health Agency FHIR Implementation Guide 1.1.0

This page is part of the Australian Digital Health Agency FHIR Implementation Guide 1.1.0. It is based on FHIR® version 4.0.1. See the Directory of published versions for a list of available previous versions.

## Example: ExplanationOfBenefit-pbs-cont-01

Formats: Narrative, XML, JSON, Turtle

Raw xml

    <ExplanationOfBenefit xmlns="http://hl7.org/fhir">
      <id value="pbs-cont-01"/>
      <meta>
        <profile
                 value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"/>
      </meta>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name="pbs-cont-01"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource ExplanationOfBenefit "pbs-cont-01" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-dh-explanationofbenefit-medicare-pbs-1.html">ADHA Record of Claim against PBS or RPBS</a></p></div><p><b>identifier</b>: id: urn:uuid:296dcbd7-d763-4ecf-aa78-523bcc11ecda</p><p><b>status</b>: active</p><p><b>type</b>: Pharmacy <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html">Claim Type Codes</a>#pharmacy)</span></p><p><b>subType</b>: pbs <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (australian-benefit-payment-category-1#pbs)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <span></span></p><p><b>created</b>: 2020-01-16</p><p><b>insurer</b>: <a href="Organization-healthau.html">Organization/healthau: Australian Government Department of Health</a> "Australian Government Department of Health"</p><p><b>provider</b>: <span>: Mr. Representative Pharmacist at Test Org -DigitalHealth 6 Pharmacy</span></p><p><b>prescription</b>: <a name="claim-pbs-01"> </a></p><blockquote><p></p><p><a name="claim-pbs-01"> </a></p><p><b>status</b>: unknown</p><p><b>intent</b>: order</p><p><b>medication</b>: <a href="#cephalexin-01">#cephalexin-01</a></p><p><b>subject</b>: <span></span></p><p><b>authoredOn</b>: 2020-01-15</p><h3>DispenseRequests</h3><table class="grid"><tr><td>-</td><td><b>NumberOfRepeatsAllowed</b></td><td><b>Quantity</b></td></tr><tr><td>*</td><td>1</td><td>20 capsule</td></tr></table></blockquote><p><b>outcome</b>: complete</p><h3>Insurances</h3><table class="grid"><tr><td>-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>true</td><td><span></span></td></tr></table><h3>Items</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Serviced[x]</b></td></tr><tr><td>*</td><td>1</td><td>PBS <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (australian-benefit-payment-category-1#pbs)</span></td><td>cephalexin 500 mg capsule, 20 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org.au/fhir/4.0.0/CodeSystem-pbs-item-external.html">PBS Item Codes</a>#03119E)</span></td><td>2020-01-16</td></tr></table><hr/><blockquote><p><b>Generated Narrative: MedicationRequest #claim-pbs-01</b><a name="claim-pbs-01"> </a></p><p><b>status</b>: unknown</p><p><b>intent</b>: order</p><p><b>medication</b>: <a href="#cephalexin-01">#cephalexin-01</a></p><p><b>subject</b>: <span></span></p><p><b>authoredOn</b>: 2020-01-15</p><h3>DispenseRequests</h3><table class="grid"><tr><td>-</td><td><b>NumberOfRepeatsAllowed</b></td><td><b>Quantity</b></td></tr><tr><td>*</td><td>1</td><td>20 capsule</td></tr></table></blockquote><hr/><blockquote><p><b>Generated Narrative: Medication #cephalexin-01</b><a name="cephalexin-01"> </a></p><p><b>code</b>: cephalexin 500 mg capsule, 20 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org.au/fhir/4.0.0/CodeSystem-pbs-item-external.html">PBS Item Codes</a>#03119E)</span></p><p><b>manufacturer</b>: <span></span></p></blockquote></div>
      </text>
      <contained>
        <MedicationRequest>
          <id value="claim-pbs-01"/>
          <status value="unknown"/>
          <intent value="order"/>
          <medicationReference>
            <reference value="#cephalexin-01"/>
          </medicationReference>
          <subject>
            <identifier>
              <type>
                <coding>
                  <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
                  <code value="NI"/>
                  <display value="National unique individual identifier"/>
                </coding>
                <text value="IHI"/>
              </type>
              <system value="http://ns.electronichealth.net.au/id/hi/ihi/1.0"/>
              <value value="8003608833357361"/>
            </identifier>
          </subject>
          <authoredOn value="2020-01-15"/>
          <dispenseRequest>
            <numberOfRepeatsAllowed value="1"/>
            <quantity>
              <value value="20"/>
              <unit value="capsule"/>
            </quantity>
          </dispenseRequest>
        </MedicationRequest>
      </contained>
      <contained>
        <Medication>
          <id value="cephalexin-01"/>
          <code>
            <coding>
              <system value="http://pbs.gov.au/code/item"/>
              <code value="03119E"/>
              <display value="cephalexin 500 mg capsule, 20"/>
            </coding>
          </code>
          <manufacturer>
            <identifier>
              <system value="http://pbs.gov.au/code/manufacturer"/>
              <value value="MM"/>
            </identifier>
          </manufacturer>
        </Medication>
      </contained>
    <!-- identifier for the PBR record from Medicare repository -->
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:uuid:296dcbd7-d763-4ecf-aa78-523bcc11ecda"/>
      </identifier>
      <status value="active"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
          <code value="pharmacy"/>
        </coding>
      </type>
      <subType>
        <coding>
          <system
                  value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
          <code value="pbs"/>
        </coding>
      </subType>
      <use value="claim"/>
      <patient>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="NI"/>
              <display value="National unique individual identifier"/>
            </coding>
            <text value="IHI"/>
          </type>
          <system value="http://ns.electronichealth.net.au/id/hi/ihi/1.0"/>
          <value value="8003608833357361"/>
        </identifier>
      </patient>
      <created value="2020-01-16"/>
      <insurer>
        <reference value="Organization/healthau"/>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="XX"/>
            </coding>
            <text value="ABN"/>
          </type>
          <system value="http://hl7.org.au/id/abn"/>
          <value value="83605426759"/>
        </identifier>
        <display value="Australian Government Department of Health"/>
      </insurer>
      <provider>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="NPI"/>
              <display value="National provider identifier"/>
            </coding>
            <text value="HPI-I"/>
          </type>
          <system value="http://ns.electronichealth.net.au/id/hi/hpii/1.0"/>
          <value value="8003611566708354"/>
        </identifier>
        <display
                 value="Mr. Representative Pharmacist at Test Org -DigitalHealth 6 Pharmacy"/>
      </provider>
      <prescription>
        <reference value="#claim-pbs-01"/>
      </prescription>
      <outcome value="complete"/>
      <insurance>
        <focal value="true"/>
        <coverage>
          <identifier>
            <type>
              <coding>
                <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
                <code value="MC"/>
              </coding>
              <text value="Medicare Number"/>
            </type>
            <system value="http://ns.electronichealth.net.au/id/medicare-number"/>
            <value value="3951032981"/>
          </identifier>
        </coverage>
      </insurance>
      <item>
        <sequence value="1"/>
        <category>
          <coding>
            <system
                    value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
            <code value="pbs"/>
            <display value="PBS"/>
          </coding>
        </category>
        <productOrService>
          <coding>
            <system value="http://pbs.gov.au/code/item"/>
            <code value="03119E"/>
            <display value="cephalexin 500 mg capsule, 20"/>
          </coding>
        </productOrService>
        <servicedDate value="2020-01-16"/>
      </item>
    </ExplanationOfBenefit>