{
  "resourceType" : "Claim",
  "id" : "PraxisPreliminaryBillingClaimExample",
  "meta" : {
    "profile" : ["https://fhir.cognovis.de/praxis/StructureDefinition/praxis-preliminary-billing-claim-de"]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim PraxisPreliminaryBillingClaimExample</b></p><a name=\"PraxisPreliminaryBillingClaimExample\"> </a><a name=\"hcPraxisPreliminaryBillingClaimExample\"> </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-praxis-preliminary-billing-claim-de.html\">Praxis Preliminary Billing Claim DE</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>subType</b>: <span title=\"Codes:{https://fhir.cognovis.de/praxis/CodeSystem/billing-claim-subtype vorlaeufig}\">Preliminary Billing Claim</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-BillingClaimPatientExample.html\">Erika Musterfrau  Female, DoB: 1965-07-20 ( http://fhir.de/NamingSystem/gkv/kvid-10#A987654321)</a></p><p><b>created</b>: 2024-04-01 08:00:00+0200</p><p><b>insurer</b>: <a href=\"Organization-BillingClaimGKVInsurerExample.html\">Organization Techniker Krankenkasse</a></p><p><b>provider</b>: <a href=\"Practitioner-BillingClaimPractitionerExample.html\">Practitioner Hans Mueller </a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><blockquote><p><b>diagnosis</b></p><p><b>sequence</b>: 1</p><p><b>diagnosis</b>: <a href=\"Condition-BillingClaimQuarterDiabetesConfirmedCondition.html\">Condition Diabetes mellitus, Typ 2, ohne Komplikationen</a></p></blockquote><blockquote><p><b>diagnosis</b></p><p><b>sequence</b>: 2</p><p><b>diagnosis</b>: <a href=\"Condition-BillingClaimQuarterDiabetesSuspectedCondition.html\">Condition Diabetes mellitus, Typ 2, ohne Komplikationen</a></p></blockquote><blockquote><p><b>diagnosis</b></p><p><b>sequence</b>: 3</p><p><b>diagnosis</b>: <a href=\"Condition-BillingClaimQuarterBackPainRightCondition.html\">Condition Lumboischialgie</a></p></blockquote><blockquote><p><b>diagnosis</b></p><p><b>sequence</b>: 4</p><p><b>diagnosis</b>: <a href=\"Condition-BillingClaimQuarterBackPainLeftCondition.html\">Condition Lumboischialgie</a></p></blockquote><blockquote><p><b>diagnosis</b></p><p><b>sequence</b>: 5</p><p><b>diagnosis</b>: <a href=\"Condition-BillingClaimQuarterBackPainDuplicateACondition.html\">Condition Lumboischialgie</a></p></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td>TK GKV-Versicherung</td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_EBM 03000}\">Hausarztpauschale</span></p><p><b>quantity</b>: 1 1<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code1 = '1')</span></p></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: <span title=\"Codes:{https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_EBM 03220}\">Chronikerzuschlag</span></p><p><b>quantity</b>: 1 1<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code1 = '1')</span></p></blockquote></div>"
  },
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "professional"
    }]
  },
  "subType" : {
    "coding" : [{
      "system" : "https://fhir.cognovis.de/praxis/CodeSystem/billing-claim-subtype",
      "code" : "vorlaeufig"
    }]
  },
  "use" : "predetermination",
  "patient" : {
    "reference" : "Patient/BillingClaimPatientExample"
  },
  "created" : "2024-04-01T08:00:00+02:00",
  "insurer" : {
    "reference" : "Organization/BillingClaimGKVInsurerExample"
  },
  "provider" : {
    "reference" : "Practitioner/BillingClaimPractitionerExample"
  },
  "priority" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
      "code" : "normal"
    }]
  },
  "diagnosis" : [{
    "sequence" : 1,
    "diagnosisReference" : {
      "reference" : "Condition/BillingClaimQuarterDiabetesConfirmedCondition"
    }
  },
  {
    "sequence" : 2,
    "diagnosisReference" : {
      "reference" : "Condition/BillingClaimQuarterDiabetesSuspectedCondition"
    }
  },
  {
    "sequence" : 3,
    "diagnosisReference" : {
      "reference" : "Condition/BillingClaimQuarterBackPainRightCondition"
    }
  },
  {
    "sequence" : 4,
    "diagnosisReference" : {
      "reference" : "Condition/BillingClaimQuarterBackPainLeftCondition"
    }
  },
  {
    "sequence" : 5,
    "diagnosisReference" : {
      "reference" : "Condition/BillingClaimQuarterBackPainDuplicateACondition"
    }
  }],
  "insurance" : [{
    "sequence" : 1,
    "focal" : true,
    "coverage" : {
      "display" : "TK GKV-Versicherung"
    }
  }],
  "item" : [{
    "sequence" : 1,
    "productOrService" : {
      "coding" : [{
        "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_EBM",
        "code" : "03000",
        "display" : "Hausarztpauschale"
      }]
    },
    "quantity" : {
      "value" : 1,
      "system" : "http://unitsofmeasure.org",
      "code" : "1"
    }
  },
  {
    "sequence" : 2,
    "productOrService" : {
      "coding" : [{
        "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_EBM",
        "code" : "03220",
        "display" : "Chronikerzuschlag"
      }]
    },
    "quantity" : {
      "value" : 1,
      "system" : "http://unitsofmeasure.org",
      "code" : "1"
    }
  }]
}