description: null
package_name: uk.nhsdigital.r4
derivation: constraint
name: NHSDigitalClaim
type: Claim
elements:
  patient:
    constraint:
      patient-reference: {human: An identifier reference or resource reference must be provided, source: 'https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim', severity: error, expression: (reference.exists() or identifier.exists())}
      patient-nhs: {human: Supplied NHS Number is outside the English and Welsh NHS Number range or length of the number is wrong., source: 'https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim', severity: error, expression: 'identifier.where(system=''https://fhir.nhs.uk/Id/nhs-number'').exists().not() or (identifier.where(system=''https://fhir.nhs.uk/Id/nhs-number'').exists()  and identifier.where(system=''https://fhir.nhs.uk/Id/nhs-number'').value.matches(''^([456789]{1}[0-9]{9})$''))'}
    mustSupport: true
    index: 12
    elements:
      identifier:
        index: 13
        elements:
          system:
            pattern: {type: Uri, value: 'https://fhir.nhs.uk/Id/nhs-number'}
            index: 14
          value: {index: 15}
        required: [value, system]
    required: [identifier]
  insurance:
    mustSupport: true
    index: 44
    elements:
      coverage:
        elements:
          identifier:
            index: 45
            elements:
              system:
                pattern: {type: Uri, value: 'https://fhir.nhs.uk/Id/ods-organization-code'}
                index: 46
              value:
                pattern: {type: String, value: T1450}
                index: 47
            required: [value, system]
        required: [identifier]
  use:
    pattern: {type: Code, value: claim}
    index: 11
  item:
    mustSupport: true
    index: 48
    extensions:
      prescriptionStatus: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus', min: 1, max: 1, type: Extension, mustSupport: true, index: 50}
      prescriptionStatusReason: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason', min: 0, max: 1, short: Prescription Status Reason, type: Extension, mustSupport: true, index: 51}
    elements:
      extension:
        index: 49
        slicing:
          rules: open
          discriminator:
          - {path: url, type: value}
          min: 1
          slices:
            prescriptionStatus:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus', index: 50}
              min: 1
              max: 1
            prescriptionStatusReason:
              match: {url: null}
              schema: {short: Prescription Status Reason, type: Extension, mustSupport: true, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason', index: 51}
              min: 0
              max: 1
      sequence:
        pattern: {type: PositiveInt, value: 1}
        index: 52
      productOrService:
        index: 53
        elements:
          coding:
            index: 54
            elements:
              system:
                pattern: {type: Uri, value: 'http://snomed.info/sct'}
                index: 55
              code:
                pattern: {type: Code, value: '16076005'}
                index: 56
              display:
                pattern: {type: String, value: Prescription}
                index: 57
            required: [display, system, code]
        required: [coding]
      programCode:
        short: PrescriptionChargeExemption
        mustSupport: true
        index: 58
        elements:
          coding:
            index: 59
            elements:
              system: {index: 60}
              code: {index: 61}
            required: [system, code]
        required: [coding]
        slicing:
          rules: open
          discriminator:
          - {path: coding.system, type: value}
          min: null
          slices:
            exemptionEvidence:
              match:
                coding: {system: 'https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence'}
              schema:
                binding: {strength: extensible, valueSet: 'https://fhir.nhs.uk/ValueSet/DM-vs-exemption-evidence'}
                mustSupport: true
                index: 62
                elements:
                  coding:
                    elements:
                      system:
                        pattern: {type: Uri, value: 'https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence'}
                        index: 63
                      code: {index: 64}
                    required: [system, code]
            prescriptionChargeExemption:
              match:
                coding: {system: 'https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption'}
              schema:
                binding: {strength: required, valueSet: 'https://fhir.nhs.uk/ValueSet/DM-prescription-charge-exemption'}
                mustSupport: true
                _required: true
                index: 65
                elements:
                  coding:
                    elements:
                      system:
                        pattern: {type: Uri, value: 'https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption'}
                        index: 66
                      code: {index: 67}
                    required: [system, code]
      detail:
        mustSupport: true
        index: 68
        extensions:
          medicationRequest: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference', min: 1, max: 1, short: MedicationRequest reference, type: Extension, mustSupport: true, index: 70}
          sequenceIdentifier: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-ClaimSequenceIdentifier', min: 1, max: 1, type: Extension, mustSupport: true, index: 71}
          repeatInformation: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation', min: 0, max: 1, type: Extension, index: 72}
        elements:
          extension:
            array: true
            min: 2
            index: 69
            slicing:
              rules: open
              discriminator:
              - {path: url, type: value}
              min: 2
              slices:
                medicationRequest:
                  match: {url: null}
                  schema: {short: MedicationRequest reference, type: Extension, mustSupport: true, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference', index: 70}
                  min: 1
                  max: 1
                sequenceIdentifier:
                  match: {url: null}
                  schema: {type: Extension, mustSupport: true, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-ClaimSequenceIdentifier', index: 71}
                  min: 1
                  max: 1
                repeatInformation:
                  match: {url: null}
                  schema: {type: Extension, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation', index: 72}
                  min: 0
                  max: 1
          sequence: {mustSupport: true, index: 73}
          productOrService:
            binding: {strength: required, valueSet: 'https://fhir.nhs.uk/ValueSet/NHSDigital-MedicationRequest-Code'}
            mustSupport: true
            index: 74
          modifier:
            binding: {strength: required, valueSet: 'https://fhir.nhs.uk/ValueSet/DM-medicationdispense-type'}
            mustSupport: true
            index: 75
          programCode:
            short: Dispensing Endorsement and Charge Payment
            mustSupport: true
            index: 76
            elements:
              coding:
                mustSupport: true
                index: 77
                elements:
                  system: {index: 78}
                  code: {index: 79}
                required: [system, code]
            required: [coding]
            slicing:
              rules: open
              discriminator:
              - {path: coding.system, type: value}
              min: null
              slices:
                prescriptionCharge:
                  match:
                    coding: {system: 'https://fhir.nhs.uk/CodeSystem/DM-prescription-charge'}
                  schema:
                    binding: {strength: required, valueSet: 'https://fhir.nhs.uk/ValueSet/DM-vs-prescription-charge'}
                    mustSupport: true
                    _required: true
                    index: 80
                    elements:
                      coding:
                        elements:
                          system:
                            pattern: {type: Uri, value: 'https://fhir.nhs.uk/CodeSystem/DM-prescription-charge'}
                            index: 81
                dispensingEndorsement:
                  match:
                    coding: {system: 'https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement'}
                  schema:
                    binding: {strength: required, valueSet: 'https://fhir.nhs.uk/ValueSet/DM-dispensing-endorsement'}
                    mustSupport: true
                    index: 82
                    elements:
                      coding:
                        elements:
                          system:
                            pattern: {type: Uri, value: 'https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement'}
                            index: 83
          quantity: {mustSupport: true, index: 84}
          subDetail:
            mustSupport: true
            index: 85
            extensions:
              medicationDispense: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationDispenseReference', min: 0, max: 1, type: Extension, index: 87}
              repeatInformation: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation', min: 0, max: 1, type: Extension, index: 88}
            elements:
              extension:
                index: 86
                slicing:
                  rules: open
                  discriminator:
                  - {path: url, type: value}
                  min: 0
                  slices:
                    medicationDispense:
                      match: {url: null}
                      schema: {type: Extension, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationDispenseReference', index: 87}
                      min: 0
                      max: 1
                    repeatInformation:
                      match: {url: null}
                      schema: {type: Extension, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation', index: 88}
                      min: 0
                      max: 1
              sequence: {mustSupport: true, index: 89}
              productOrService:
                binding: {strength: extensible, valueSet: 'https://fhir.nhs.uk/ValueSet/NHSDigital-MedicationDispense-Code'}
                mustSupport: true
                index: 90
              quantity:
                mustSupport: true
                index: 91
                extensions:
                  runningTotal: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-DM-RunningTotal', min: 0, max: 1, type: Extension, index: 93}
                elements:
                  extension:
                    index: 92
                    slicing:
                      rules: open
                      discriminator:
                      - {path: url, type: value}
                      min: 0
                      slices:
                        runningTotal:
                          match: {url: null}
                          schema: {type: Extension, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-DM-RunningTotal', index: 93}
                          min: 0
                          max: 1
            required: [quantity]
        required: [modifier]
    required: [detail, extension]
  type:
    mustSupport: true
    index: 7
    elements:
      coding:
        index: 8
        elements:
          system:
            pattern: {type: Uri, value: 'http://terminology.hl7.org/CodeSystem/claim-type'}
            index: 9
          code:
            pattern: {type: Code, value: pharmacy}
            index: 10
        required: [system, code]
    required: [coding]
  created: {mustSupport: true, index: 16}
  extension:
    index: 0
    slicing:
      rules: open
      discriminator:
      - {path: url, type: value}
      min: 0
      slices:
        replacementOf:
          match: {url: null}
          schema: {short: Used to reference a previous Claim, type: Extension, mustSupport: true, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf', index: 1}
          min: 0
          max: 1
        agent:
          match: {url: null}
          schema: {short: Provenance of the resource, type: Extension, mustSupport: true, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent', index: 2}
          min: 0
          max: 1
  priority:
    mustSupport: true
    index: 20
    elements:
      coding:
        index: 21
        elements:
          system:
            pattern: {type: Uri, value: 'http://terminology.hl7.org/CodeSystem/processpriority'}
            index: 22
          code:
            pattern: {type: Code, value: normal}
            index: 23
        required: [system, code]
    required: [coding]
  status: {mustSupport: true, index: 6}
  payee:
    mustSupport: true
    index: 35
    elements:
      type:
        elements:
          coding:
            index: 36
            elements:
              system:
                pattern: {type: Uri, value: 'http://terminology.hl7.org/CodeSystem/payeetype'}
                index: 37
              code:
                pattern: {type: Code, value: provider}
                index: 38
              display:
                pattern: {type: String, value: Provider}
                index: 39
            required: [display, system, code]
        required: [coding]
      party:
        type: Reference
        refers: ['https://fhir.nhs.uk/StructureDefinition/NHSDigital-Organization']
        index: 40
        elements:
          identifier:
            index: 41
            elements:
              system:
                pattern: {type: Uri, value: 'https://fhir.nhs.uk/Id/ods-organization-code'}
                index: 42
              value: {index: 43}
            required: [value, system]
        required: [identifier]
    required: [party]
  prescription:
    mustSupport: true
    index: 24
    extensions:
      groupIdentifier: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier', min: 1, max: 1, type: Extension, index: 26}
    elements:
      extension:
        index: 25
        slicing:
          rules: open
          discriminator:
          - {path: url, type: value}
          min: 1
          slices:
            groupIdentifier:
              match: {url: null}
              schema: {type: Extension, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier', index: 26}
              min: 1
              max: 1
      reference: {index: 27}
      identifier:
        index: 28
        elements:
          system:
            pattern: {type: Uri, value: 'https://fhir.nhs.uk/Id/prescription-order-item-number'}
            index: 29
          value: {index: 30}
        required: [value, system]
    required: [extension]
  identifier:
    mustSupport: true
    index: 3
    elements:
      system: {index: 4}
      value: {index: 5}
    required: [value, system]
  provider:
    type: Reference
    mustSupport: true
    refers: ['https://fhir.nhs.uk/StructureDefinition/NHSDigital-PractitionerRole-MinimalPlusTelecom']
    index: 17
    elements:
      identifier:
        elements:
          system: {index: 18}
          value: {index: 19}
        required: [value, system]
  originalPrescription:
    extensions:
      groupIdentifier: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier', min: 1, max: 1, type: Extension, index: 32}
    elements:
      extension:
        index: 31
        slicing:
          rules: open
          discriminator:
          - {path: url, type: value}
          min: 1
          slices:
            groupIdentifier:
              match: {url: null}
              schema: {type: Extension, url: 'https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier', index: 32}
              min: 1
              max: 1
      identifier:
        elements:
          system: {index: 33}
          value: {index: 34}
        required: [value, system]
    required: [extension]
package_version: 2.4.7
extensions:
  replacementOf: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf', min: 0, max: 1, short: Used to reference a previous Claim, type: Extension, mustSupport: true, index: 1}
  agent: {url: 'https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent', min: 0, max: 1, short: Provenance of the resource, type: Extension, mustSupport: true, index: 2}
class: profile
kind: resource
url: https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim
base: http://hl7.org/fhir/StructureDefinition/Claim
version: null
required: [prescription, payee, identifier, item]