Health New Zealand Te Whatu Ora Shared Care FHIR API
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Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.5) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: New Zealand Pharmacy Claim Response Example - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/ClaimResponse/NzPharmacyClaimResponseExample> a fhir:ClaimResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "NzPharmacyClaimResponseExample"] ;
  fhir:Resource.meta [
     fhir:Meta.source [ fhir:value "https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A" ] ;
     fhir:Meta.profile [
       fhir:value "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyClaimResponse" ;
       fhir:index 0 ;
       fhir:link <https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyClaimResponse>
     ] ;
     fhir:Meta.tag [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "https://hub.services.digital.health.nz/ns/correlation-id" ] ;
       fhir:Coding.code [ fhir:value "123e4567-e89b-12d3-a456-426614174011" ]
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse NzPharmacyClaimResponseExample</b></p><a name=\"NzPharmacyClaimResponseExample\"> </a><a name=\"hcNzPharmacyClaimResponseExample\"> </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\">Information Source: <a href=\"https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A\">https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A</a></p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-NzPharmacyClaimResponse.html\">New Zealand Pharmacy Claim Response</a></p><p style=\"margin-bottom: 0px\">Tag: </p></div><p><b>identifier</b>: <code>https://standards.digital.health.nz/ns/claim-response-identifier</code>/a1b2c3d4-e5f6-7890-abcd-ef1234567890 (use: official, )</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-type pharmacy}\">pharmacy</span></p><p><b>subType</b>: <span title=\"Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-subtypes ICP}\">ICP</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: Identifier: <a href=\"http://fhir.org.nz/ig/base/NamingSystem-nhi.html\" title=\"NHI number\">NHI</a>/ZZZ0008</p><p><b>created</b>: 2025-01-01 00:00:00+0000</p><p><b>insurer</b>: Identifier: <a href=\"http://fhir.org.nz/ig/base/NamingSystem-hpiOrganization.html\" title=\"HPI organizations\">HPIOrganization</a>/G0K357-H</p><p><b>requestor</b>: Identifier: <a href=\"http://fhir.org.nz/ig/base/NamingSystem-hpiOrganization.html\" title=\"HPI organizations\">HPIOrganization</a>/GZZ999-9</p><p><b>request</b>: <a href=\"Claim-NzPharmacyClaimExample2.html\">Claim: extension = AG12345,Community Residential Care,AG54321; identifier = https://provider-org-name.co.nz/ns/claim-identifier#C123456 (use: official, ); status = active; type = pharmacy; subType = ICPSA; use = claim; billablePeriod = 2025-01-01 --&gt; 2025-01-01; created = 2025-01-01 00:00:00+1300; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>item</b></p><p><b>Shared Care Product Or Service</b>: <span title=\"Codes:{https://standards.digital.health.nz/ns/purchase-unit PU1234}\">PU1234</span></p><blockquote><p><b>Shared Care Review Outcome</b></p><ul><li>decision: <span title=\"Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs approved}\">Approved</span></li></ul></blockquote><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category amountpaid}\">Amount Paid</span></p><p><b>reason</b>: <span title=\"Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/adjudication-reason-codes policy}\">policy</span></p><h3>Amounts</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>100</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>Pharmacy Claim Item Detail Product Or Service</b>: <span title=\"Codes:{https://standards.digital.health.nz/ns/pharmacode 123456}\">123456</span></p><blockquote><p><b>Pharmacy Claim Item Detail Review Outcome</b></p><ul><li>decision: <span title=\"Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs approved}\">Approved</span></li></ul></blockquote><p><b>Shared Care Claim Trace Number</b>: <code>https://example.com/system</code>/UUID-123456</p><p><b>detailSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category drugcost}\">Drug Cost</span></p><p><b>reason</b>: <span title=\"Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/adjudication-reason-codes policy}\">policy</span></p><h3>Amounts</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>50</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category pharmaceuticalsubsidy}\">Pharmaceutical Subsidy</span></p><h3>Amounts</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>30</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category amountpaid}\">Amount Paid</span></p><h3>Amounts</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>100</td><td>New Zealand dollar</td></tr></table></blockquote></blockquote></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-paymenttype complete}\">Complete</span></p><p><b>date</b>: 2025-01-01</p><h3>Amounts</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>100</td><td>New Zealand dollar</td></tr></table></blockquote><h3>Errors</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ItemSequence</b></td><td><b>DetailSequence</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>1</td><td><span title=\"Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs DET055.002}\">NHI number cannot be found in our records</span></td></tr></table></div>"
  ] ;
  fhir:ClaimResponse.identifier [
     fhir:index 0 ;
     fhir:Identifier.use [ fhir:value "official" ] ;
     fhir:Identifier.system [ fhir:value "https://standards.digital.health.nz/ns/claim-response-identifier" ] ;
     fhir:Identifier.value [ fhir:value "a1b2c3d4-e5f6-7890-abcd-ef1234567890" ]
  ] ;
  fhir:ClaimResponse.status [ fhir:value "active"] ;
  fhir:ClaimResponse.type [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-type" ] ;
       fhir:Coding.code [ fhir:value "pharmacy" ]
     ]
  ] ;
  fhir:ClaimResponse.subType [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-subtypes" ] ;
       fhir:Coding.code [ fhir:value "ICP" ]
     ]
  ] ;
  fhir:ClaimResponse.use [ fhir:value "claim"] ;
  fhir:ClaimResponse.patient [
     fhir:Reference.type [ fhir:value "Patient" ] ;
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "https://standards.digital.health.nz/ns/nhi-id" ] ;
       fhir:Identifier.value [ fhir:value "ZZZ0008" ]
     ]
  ] ;
  fhir:ClaimResponse.created [ fhir:value "2025-01-01T00:00:00-00:00"^^xsd:dateTime] ;
  fhir:ClaimResponse.insurer [
     fhir:Reference.type [ fhir:value "Organization" ] ;
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "https://standards.digital.health.nz/ns/hpi-organisation-id" ] ;
       fhir:Identifier.value [ fhir:value "G0K357-H" ]
     ]
  ] ;
  fhir:ClaimResponse.requestor [
     fhir:Reference.type [ fhir:value "Organization" ] ;
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "https://standards.digital.health.nz/ns/hpi-organisation-id" ] ;
       fhir:Identifier.value [ fhir:value "GZZ999-9" ]
     ]
  ] ;
  fhir:ClaimResponse.request [
     fhir:link <http://hl7.org/fhir/Claim/NzPharmacyClaimExample2> ;
     fhir:Reference.reference [ fhir:value "Claim/NzPharmacyClaimExample2" ]
  ] ;
  fhir:ClaimResponse.outcome [ fhir:value "complete"] ;
  fhir:ClaimResponse.item [
     fhir:index 0 ;
     fhir:Element.extension [
       fhir:index 0 ;
       fhir:Extension.url [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service" ] ;
       fhir:Extension.valueCodeableConcept [
         fhir:CodeableConcept.coding [
           fhir:index 0 ;
           fhir:Coding.system [ fhir:value "https://standards.digital.health.nz/ns/purchase-unit" ] ;
           fhir:Coding.code [ fhir:value "PU1234" ]
         ]
       ]
     ], [
       fhir:index 1 ;
       fhir:Element.extension [
         fhir:index 0 ;
         fhir:Extension.url [ fhir:value "decision" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs" ] ;
             fhir:Coding.code [ fhir:value "approved" ]
           ]
         ]
       ] ;
       fhir:Extension.url [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome" ]
     ] ;
     fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ClaimResponse.item.adjudication [
       fhir:index 0 ;
       fhir:ClaimResponse.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index 0 ;
           fhir:Coding.system [ fhir:value "https://standards.digital.health.nz/ns/pharmacy-adjudication-category" ] ;
           fhir:Coding.code [ fhir:value "amountpaid" ]
         ]
       ] ;
       fhir:ClaimResponse.item.adjudication.reason [
         fhir:CodeableConcept.coding [
           fhir:index 0 ;
           fhir:Coding.system [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/adjudication-reason-codes" ] ;
           fhir:Coding.code [ fhir:value "policy" ]
         ]
       ] ;
       fhir:ClaimResponse.item.adjudication.amount [
         fhir:Money.value [ fhir:value "100"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "NZD" ]
       ]
     ] ;
     fhir:ClaimResponse.item.detail [
       fhir:index 0 ;
       fhir:Element.extension [
         fhir:index 0 ;
         fhir:Extension.url [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "https://standards.digital.health.nz/ns/pharmacode" ] ;
             fhir:Coding.code [ fhir:value "123456" ]
           ]
         ]
       ], [
         fhir:index 1 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "decision" ] ;
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index 0 ;
               fhir:Coding.system [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs" ] ;
               fhir:Coding.code [ fhir:value "approved" ]
             ]
           ]
         ] ;
         fhir:Extension.url [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome" ]
       ], [
         fhir:index 2 ;
         fhir:Extension.url [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number" ] ;
         fhir:Extension.valueIdentifier [
           fhir:Identifier.system [ fhir:value "https://example.com/system" ] ;
           fhir:Identifier.value [ fhir:value "UUID-123456" ]
         ]
       ] ;
       fhir:ClaimResponse.item.detail.detailSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
       fhir:ClaimResponse.item.detail.adjudication [
         fhir:index 0 ;
         fhir:ClaimResponse.item.adjudication.category [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "https://standards.digital.health.nz/ns/pharmacy-adjudication-category" ] ;
             fhir:Coding.code [ fhir:value "drugcost" ]
           ]
         ] ;
         fhir:ClaimResponse.item.adjudication.reason [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/adjudication-reason-codes" ] ;
             fhir:Coding.code [ fhir:value "policy" ]
           ]
         ] ;
         fhir:ClaimResponse.item.adjudication.amount [
           fhir:Money.value [ fhir:value "50"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "NZD" ]
         ]
       ], [
         fhir:index 1 ;
         fhir:ClaimResponse.item.adjudication.category [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "https://standards.digital.health.nz/ns/pharmacy-adjudication-category" ] ;
             fhir:Coding.code [ fhir:value "pharmaceuticalsubsidy" ]
           ]
         ] ;
         fhir:ClaimResponse.item.adjudication.amount [
           fhir:Money.value [ fhir:value "30"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "NZD" ]
         ]
       ], [
         fhir:index 2 ;
         fhir:ClaimResponse.item.adjudication.category [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "https://standards.digital.health.nz/ns/pharmacy-adjudication-category" ] ;
             fhir:Coding.code [ fhir:value "amountpaid" ]
           ]
         ] ;
         fhir:ClaimResponse.item.adjudication.amount [
           fhir:Money.value [ fhir:value "100"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "NZD" ]
         ]
       ]
     ]
  ] ;
  fhir:ClaimResponse.payment [
     fhir:ClaimResponse.payment.type [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-paymenttype" ] ;
         fhir:Coding.code [ fhir:value "complete" ]
       ]
     ] ;
     fhir:ClaimResponse.payment.date [ fhir:value "2025-01-01"^^xsd:date ] ;
     fhir:ClaimResponse.payment.amount [
       fhir:Money.value [ fhir:value "100"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "NZD" ]
     ]
  ] ;
  fhir:ClaimResponse.error [
     fhir:index 0 ;
     fhir:ClaimResponse.error.itemSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ClaimResponse.error.detailSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ClaimResponse.error.code [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs" ] ;
         fhir:Coding.code [ fhir:value "DET055.002" ]
       ] ;
       fhir:CodeableConcept.text [ fhir:value "NHI number cannot be found in our records" ]
     ]
  ] .

<http://hl7.org/fhir/Claim/NzPharmacyClaimExample2> a fhir:Claim .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/ClaimResponse/NzPharmacyClaimResponseExample.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/ClaimResponse/NzPharmacyClaimResponseExample.ttl> .