{
"resourceType": "Claim", "id": "660151", "text": { "status": "generated", "div": "<div>A human-readable rendering of the Vision Claim for Glasses</div>" }, "type": "vision", "identifier": [ { "system": "http://happysight.com/claim", "value": "6612346" } ], "created": "2014-08-16", "target": { "reference": "Organization/2" }, "organization": { "reference": "Organization/1" }, "use": "complete", "priority": { "code": "normal" }, "prescription": { "reference": "http://www.optdocs.com/prescription/12345" }, "payee": { "type": { "code": "provider" } }, "diagnosis": [ { "sequence": 1, "diagnosis": { "code": "654321" } } ], "patient": { "reference": "Patient/1" }, "coverage": [ { "sequence": 1, "focal": true, "coverage": { "reference": "Coverage/9876B1" }, "relationship": { "code": "self" } } ], "item": [ { "sequence": 1, "type": { "code": "CPNDDRGING" }, "provider": { "reference": "Practitioner/example" }, "service": { "system": "http://hl7.org/fhir/ex-visionservice", "code": "glasses" }, "serviceDate": "2014-08-16", "unitPrice": { "value": 214.00, "system": "urn:iso:std:iso:4217", "code": "USD" }, "net": { "value": 214.00, "system": "urn:iso:std:iso:4217", "code": "USD" }, "detail": [ { "sequence": 1, "type": { "code": "CPINV" }, "service": { "system": "http://hl7.org/fhir/ex-visionservice", "code": "frame" }, "unitPrice": { "value": 100.00, "system": "urn:iso:std:iso:4217", "code": "USD" }, "net": { "value": 100.00, "system": "urn:iso:std:iso:4217", "code": "USD" } }, { "sequence": 2, "type": { "code": "CPINV" }, "service": { "system": "http://hl7.org/fhir/ex-visionservice", "code": "lens" }, "quantity": { "value": 2 }, "unitPrice": { "value": 50.00, "system": "urn:iso:std:iso:4217", "code": "USD" }, "net": { "value": 100.00, "system": "urn:iso:std:iso:4217", "code": "USD" } }, { "sequence": 3, "type": { "code": "VRXINV" }, "service": { "system": "http://hl7.org/fhir/ex-visionservice", "code": "fst" }, "unitPrice": { "value": 200.00, "system": "urn:iso:std:iso:4217", "code": "USD" }, "factor": 0.07, "net": { "value": 14.00, "system": "urn:iso:std:iso:4217", "code": "USD" } } ] } ]
}