My Health Record FHIR IG
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My Health Record FHIR IG - Local Development build (v1.2.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## : Record of Claim against PBS for 03119E cephalexin 500 mg capsule, 20 for Ms. Sally Field 16 FEB 2020 - JSON Representation

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    {
      "resourceType" : "ExplanationOfBenefit",
      "id" : "pbs-cont-01",
      "meta" : {
        "profile" : [
          🔗 "http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-pbs-1"
        ]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ExplanationOfBenefit pbs-cont-01</b></p><a name=\"pbs-cont-01\"> </a><a name=\"hcpbs-cont-01\"> </a><a name=\"pbs-cont-01-en-AU\"> </a><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.0.0/NamingSystem-uri.html\" title=\"As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt \r\n\r\nThis oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid: \r\n\r\nNote that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.\r\n\r\nThis OID may also be used in CD.codeSystem.\">URI</a>/urn:uuid:296dcbd7-d763-4ecf-aa78-523bcc11ecda</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}\">Pharmacy</span></p><p><b>subType</b>: <span title=\"Codes:{https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1 pbs}\">PBS</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: Identifier: IHI/8003608833357361</p><p><b>created</b>: 2020-01-16</p><p><b>insurer</b>: <a href=\"Organization-healthau.html\">Australian Government Department of Health</a></p><p><b>provider</b>: Mr. Representative Pharmacist at Test Org -DigitalHealth 6 Pharmacy (Identifier: HPI-I/8003611566708354)</p><p><b>prescription</b>: <a href=\"#hcpbs-cont-01/claim-pbs-01\">MedicationRequest: status = unknown; intent = order; medication[x] = -&gt;Medication cephalexin 500 mg capsule, 20; authoredOn = 2020-01-15</a></p><p><b>outcome</b>: Processing Complete</p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td>Identifier: Medicare Number/3951032981</td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td style=\"display: none\">-</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 style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1 pbs}\">PBS</span></td><td><span title=\"Codes:{http://pbs.gov.au/code/item 03119E}\">cephalexin 500 mg capsule, 20</span></td><td>2020-01-16</td></tr></table><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: MedicationRequest  #claim-pbs-01</b></p><a name=\"pbs-cont-01/claim-pbs-01\"> </a><a name=\"hcpbs-cont-01/claim-pbs-01\"> </a><a name=\"pbs-cont-01/claim-pbs-01-en-AU\"> </a><p><b>status</b>: Unknown</p><p><b>intent</b>: Order</p><p><b>medication</b>: <a href=\"#hcpbs-cont-01/cephalexin-01\">Medication cephalexin 500 mg capsule, 20</a></p><p><b>subject</b>: Identifier: IHI/8003608833357361</p><p><b>authoredOn</b>: 2020-01-15</p><h3>DispenseRequests</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>NumberOfRepeatsAllowed</b></td><td><b>Quantity</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>20 capsule</td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Medication  #cephalexin-01</b></p><a name=\"pbs-cont-01/cephalexin-01\"> </a><a name=\"hcpbs-cont-01/cephalexin-01\"> </a><a name=\"pbs-cont-01/cephalexin-01-en-AU\"> </a><p><b>code</b>: <span title=\"Codes:{http://pbs.gov.au/code/item 03119E}\">cephalexin 500 mg capsule, 20</span></p><p><b>manufacturer</b>: Identifier: <code>http://pbs.gov.au/code/manufacturer</code>/MM</p></blockquote></div>"
      },
      "contained" : [
        {
          "resourceType" : "MedicationRequest",
          "id" : "claim-pbs-01",
          "status" : "unknown",
          "intent" : "order",
          "medicationReference" : {
            "reference" : "#cephalexin-01"
          },
          "subject" : {
            "identifier" : {
              "type" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                    "code" : "NI",
                    "display" : "National unique individual identifier"
                  }
                ],
                "text" : "IHI"
              },
              "system" : "http://ns.electronichealth.net.au/id/hi/ihi/1.0",
              "value" : "8003608833357361"
            }
          },
          "authoredOn" : "2020-01-15",
          "dispenseRequest" : {
            "numberOfRepeatsAllowed" : 1,
            "quantity" : {
              "value" : 20,
              "unit" : "capsule"
            }
          }
        },
        {
          "resourceType" : "Medication",
          "id" : "cephalexin-01",
          "code" : {
            "coding" : [
              {
                "system" : "http://pbs.gov.au/code/item",
                "code" : "03119E",
                "display" : "cephalexin 500 mg capsule, 20"
              }
            ]
          },
          "manufacturer" : {
            "identifier" : {
              "system" : "http://pbs.gov.au/code/manufacturer",
              "value" : "MM"
            }
          }
        }
      ],
      "identifier" : [
        // identifier for the PBR record from Medicare repository
        {
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:uuid:296dcbd7-d763-4ecf-aa78-523bcc11ecda"
        }
      ],
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
            "code" : "pharmacy"
          }
        ]
      },
      "subType" : {
        "coding" : [
          {
            "system" : "https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1",
            "code" : "pbs"
          }
        ]
      },
      "use" : "claim",
      "patient" : {
        "identifier" : {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "NI",
                "display" : "National unique individual identifier"
              }
            ],
            "text" : "IHI"
          },
          "system" : "http://ns.electronichealth.net.au/id/hi/ihi/1.0",
          "value" : "8003608833357361"
        }
      },
      "created" : "2020-01-16",
      "insurer" : {
        🔗 "reference" : "Organization/healthau",
        "identifier" : {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "XX"
              }
            ],
            "text" : "ABN"
          },
          "system" : "http://hl7.org.au/id/abn",
          "value" : "83605426759"
        },
        "display" : "Australian Government Department of Health"
      },
      "provider" : {
        "identifier" : {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "NPI",
                "display" : "National provider identifier"
              }
            ],
            "text" : "HPI-I"
          },
          "system" : "http://ns.electronichealth.net.au/id/hi/hpii/1.0",
          "value" : "8003611566708354"
        },
        "display" : "Mr. Representative Pharmacist at Test Org -DigitalHealth 6 Pharmacy"
      },
      "prescription" : {
        "reference" : "#claim-pbs-01"
      },
      "outcome" : "complete",
      "insurance" : [
        {
          "focal" : true,
          "coverage" : {
            "identifier" : {
              "type" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                    "code" : "MC"
                  }
                ],
                "text" : "Medicare Number"
              },
              "system" : "http://ns.electronichealth.net.au/id/medicare-number",
              "value" : "3951032981"
            }
          }
        }
      ],
      "item" : [
        {
          "sequence" : 1,
          "category" : {
            "coding" : [
              {
                "system" : "https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1",
                "code" : "pbs",
                "display" : "PBS"
              }
            ]
          },
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://pbs.gov.au/code/item",
                "code" : "03119E",
                "display" : "cephalexin 500 mg capsule, 20"
              }
            ]
          },
          "servicedDate" : "2020-01-16"
        }
      ]
    }