<?xml version="1.0" encoding="UTF-8"?>

<ChargeItem xmlns="http://hl7.org/fhir">
  <id value="ExampleGozChargeItem"/>
  <meta>
    <profile value="https://fhir.cognovis.de/dental/StructureDefinition/goz-charge-item"/>
  </meta>
  <text>
    <status value="extensions"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ChargeItem ExampleGozChargeItem</b></p><a name="ExampleGozChargeItem"> </a><a name="hcExampleGozChargeItem"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-goz-charge-item.html">GOZ Leistungsposition (DE)</a></p></div><p><b>Steuerkategorie</b>: <span title="Codes:{urn:un:unece:uncefact:codelist:standard:5305 E}">Steuerfrei</span></p><p><b>FDI Zahnnummer</b>: 15</p><p><b>Zahnflächen</b>: <span title="Codes:{https://fhir.cognovis.de/dental/CodeSystem/tooth-surfaces M}">Mesial</span></p><p><b>Zahnflächen</b>: <span title="Codes:{https://fhir.cognovis.de/dental/CodeSystem/tooth-surfaces O}">Okklusal</span></p><blockquote><p><b>Privatgebühr Steigerungsfaktor</b></p><ul><li>faktor: 2.3</li><li>schwellenwert: 2.3</li><li>leistungsart: persoenlich</li></ul></blockquote><blockquote><p><b>Privatgebühr Analogleistung</b></p><ul><li>analoge-nummer: 2150</li><li>gebuehrenordnung: goz</li><li>begruendung: Keramik-Inlay CAD/CAM, Analogabrechnung nach §6 GOZ</li></ul></blockquote><p><b>Umsatzsteuerbefreiungsgrund</b>: <span title="Codes:{https://fhir.cognovis.de/praxis/CodeSystem/ust-befreiungsgrund para4-nr14a}">§ 4 Nr. 14a UStG</span></p><p><b>status</b>: Billable</p><p><b>code</b>: <span title="Codes:{http://fhir.de/CodeSystem/bzaek/goz 2150}">Aufbaufüllung</span></p><p><b>subject</b>: <a href="Patient-pat-pkv-01.html">Charlotte von Hohenstein (official) Female, DoB: 1975-09-03</a></p><p><b>context</b>: <a href="Encounter-enc-dental-02-privatschein.html">Encounter: identifier = https://example-dental-practice.de/fall-id#DENTAL-2026-0002; status = finished; class = ambulatory (v3 Code System ActCode#AMB); period = 2026-01-22 --&gt; 2026-01-22</a></p><p><b>occurrence</b>: 2026-01-22</p><p><b>bodysite</b>: <span title="Codes:{https://fhir.cognovis.de/dental/CodeSystem/tooth-identification-fdi 15}">Zahn 15 — zweiter oberer rechter Prämolar</span></p><p><b>factorOverride</b>: 2.3</p><h3>PriceOverrides</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>187.45</td><td>Euro</td></tr></table><p><b>account</b>: <a href="Account-acct-dental-02-pkv-q1.html">Account: identifier = https://fhir.cognovis.de/praxis/sid/scheinNummer#ScheinNummer#PKV-2026-Q1-00002; status = active; type = PKV; servicePeriod = 2026-01-01 --&gt; 2026-03-31</a></p></div>
  </text>
  <extension url="https://fhir.cognovis.de/praxis/StructureDefinition/ext-tax-category">
    <valueCodeableConcept>
      <coding>
        <system value="urn:un:unece:uncefact:codelist:standard:5305"/>
        <code value="E"/>
        <display value="Steuerfrei"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension url="https://fhir.cognovis.de/dental/StructureDefinition/fdi-tooth-number">
    <valueCode value="15"/>
  </extension>
  <extension url="https://fhir.cognovis.de/dental/StructureDefinition/tooth-surfaces">
    <valueCodeableConcept>
      <coding>
        <system value="https://fhir.cognovis.de/dental/CodeSystem/tooth-surfaces"/>
        <code value="M"/>
        <display value="Mesial"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension url="https://fhir.cognovis.de/dental/StructureDefinition/tooth-surfaces">
    <valueCodeableConcept>
      <coding>
        <system value="https://fhir.cognovis.de/dental/CodeSystem/tooth-surfaces"/>
        <code value="O"/>
        <display value="Okklusal"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension url="https://fhir.cognovis.de/dental/StructureDefinition/privatgebuehr-steigerungsfaktor">
    <extension url="faktor">
      <valueDecimal value="2.3"/>
    </extension>
    <extension url="schwellenwert">
      <valueDecimal value="2.3"/>
    </extension>
    <extension url="leistungsart">
      <valueCode value="persoenlich"/>
    </extension>
  </extension>
  <extension url="https://fhir.cognovis.de/dental/StructureDefinition/privatgebuehr-analog-reference">
    <extension url="analoge-nummer">
      <valueString value="2150"/>
    </extension>
    <extension url="gebuehrenordnung">
      <valueCode value="goz"/>
    </extension>
    <extension url="begruendung">
      <valueString value="Keramik-Inlay CAD/CAM, Analogabrechnung nach §6 GOZ"/>
    </extension>
  </extension>
  <extension url="https://fhir.cognovis.de/praxis/StructureDefinition/ext-tax-exemption-reason">
    <valueCodeableConcept>
      <coding>
        <system value="https://fhir.cognovis.de/praxis/CodeSystem/ust-befreiungsgrund"/>
        <code value="para4-nr14a"/>
        <display value="§ 4 Nr. 14a UStG"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <status value="billable"/>
  <code>
    <coding>
      <system value="http://fhir.de/CodeSystem/bzaek/goz"/>
      <code value="2150"/>
      <display value="Aufbaufüllung"/>
    </coding>
  </code>
  <subject>
    <reference value="Patient/pat-pkv-01"/>
  </subject>
  <context>
    <reference value="Encounter/enc-dental-02-privatschein"/>
  </context>
  <occurrenceDateTime value="2026-01-22"/>
  <bodysite>
    <coding>
      <system value="https://fhir.cognovis.de/dental/CodeSystem/tooth-identification-fdi"/>
      <code value="15"/>
      <display value="15"/>
    </coding>
    <text value="Zahn 15 — zweiter oberer rechter Prämolar"/>
  </bodysite>
  <factorOverride value="2.3"/>
  <priceOverride>
    <value value="187.45"/>
    <currency value="EUR"/>
  </priceOverride>
  <account>
    <reference value="Account/acct-dental-02-pkv-q1"/>
  </account>
</ChargeItem>