{
  "description": null,
  "_filename": "NHSDigital-Claim.StructureDefinition.json",
  "package_name": "uk.nhsdigital.medicines.r4",
  "date": null,
  "derivation": "constraint",
  "publisher": null,
  "fhirVersion": "4.0.1",
  "name": "NHSDigitalClaim",
  "mapping": [ {
    "uri": "http://hl7.org/fhir/workflow",
    "name": "Workflow Pattern",
    "identity": "workflow"
  }, {
    "uri": "http://hl7.org/fhir/fivews",
    "name": "FiveWs Pattern Mapping",
    "identity": "w5"
  }, {
    "uri": "http://hl7.org/v3",
    "name": "RIM Mapping",
    "identity": "rim"
  } ],
  "abstract": false,
  "type": "Claim",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": null,
  "package_version": "2.3.0",
  "status": "draft",
  "id": "50e3e312-9aca-4640-ab5e-c1b2a7926b7f",
  "kind": "resource",
  "url": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim",
  "version": null,
  "differential": {
    "element": [ {
      "id": "Claim.extension",
      "min": 1,
      "path": "Claim.extension",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Claim.extension:replacementOf",
      "max": "1",
      "min": 0,
      "path": "Claim.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf" ]
      } ],
      "sliceName": "replacementOf"
    }, {
      "id": "Claim.extension:agent",
      "max": "1",
      "min": 1,
      "path": "Claim.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent" ]
      } ],
      "short": "Provenance of the resource",
      "sliceName": "agent",
      "definition": "Is used as the author on request resources."
    }, {
      "id": "Claim.identifier",
      "min": 1,
      "path": "Claim.identifier",
      "mustSupport": true
    }, {
      "id": "Claim.identifier.system",
      "min": 1,
      "path": "Claim.identifier.system"
    }, {
      "id": "Claim.identifier.value",
      "min": 1,
      "path": "Claim.identifier.value"
    }, {
      "id": "Claim.status",
      "path": "Claim.status",
      "mustSupport": true
    }, {
      "id": "Claim.type",
      "path": "Claim.type",
      "mustSupport": true
    }, {
      "id": "Claim.type.coding",
      "min": 1,
      "path": "Claim.type.coding"
    }, {
      "id": "Claim.type.coding.system",
      "min": 1,
      "path": "Claim.type.coding.system",
      "fixedUri": "http://terminology.hl7.org/CodeSystem/claim-type"
    }, {
      "id": "Claim.type.coding.code",
      "min": 1,
      "path": "Claim.type.coding.code",
      "fixedCode": "pharmacy"
    }, {
      "id": "Claim.use",
      "path": "Claim.use",
      "fixedCode": "claim"
    }, {
      "id": "Claim.patient",
      "path": "Claim.patient",
      "constraint": [ {
        "key": "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())"
      }, {
        "key": "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
    }, {
      "id": "Claim.patient.identifier",
      "min": 1,
      "path": "Claim.patient.identifier"
    }, {
      "id": "Claim.patient.identifier.system",
      "min": 1,
      "path": "Claim.patient.identifier.system",
      "fixedUri": "https://fhir.nhs.uk/Id/nhs-number"
    }, {
      "id": "Claim.patient.identifier.value",
      "min": 1,
      "path": "Claim.patient.identifier.value"
    }, {
      "id": "Claim.created",
      "path": "Claim.created",
      "mustSupport": true
    }, {
      "id": "Claim.provider",
      "path": "Claim.provider",
      "type": [ {
        "code": "Reference",
        "aggregation": [ "referenced" ],
        "targetProfile": [ "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Organization" ]
      } ],
      "mustSupport": true
    }, {
      "id": "Claim.provider.identifier",
      "min": 1,
      "path": "Claim.provider.identifier"
    }, {
      "id": "Claim.provider.identifier.system",
      "min": 1,
      "path": "Claim.provider.identifier.system"
    }, {
      "id": "Claim.provider.identifier.value",
      "min": 1,
      "path": "Claim.provider.identifier.value"
    }, {
      "id": "Claim.priority.coding",
      "max": "1",
      "min": 1,
      "path": "Claim.priority.coding"
    }, {
      "id": "Claim.priority.coding.system",
      "min": 1,
      "path": "Claim.priority.coding.system",
      "fixedUri": "http://terminology.hl7.org/CodeSystem/processpriority"
    }, {
      "id": "Claim.priority.coding.code",
      "min": 1,
      "path": "Claim.priority.coding.code",
      "fixedCode": "normal"
    }, {
      "id": "Claim.prescription",
      "min": 1,
      "path": "Claim.prescription",
      "mustSupport": true
    }, {
      "id": "Claim.prescription.extension",
      "min": 1,
      "path": "Claim.prescription.extension",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Claim.prescription.extension:groupIdentifier",
      "max": "1",
      "min": 1,
      "path": "Claim.prescription.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier" ]
      } ],
      "sliceName": "groupIdentifier"
    }, {
      "id": "Claim.prescription.reference",
      "max": "0",
      "path": "Claim.prescription.reference"
    }, {
      "id": "Claim.prescription.identifier",
      "max": "0",
      "path": "Claim.prescription.identifier"
    }, {
      "id": "Claim.prescription.identifier.system",
      "min": 1,
      "path": "Claim.prescription.identifier.system",
      "fixedUri": "https://fhir.nhs.uk/Id/prescription-order-item-number"
    }, {
      "id": "Claim.prescription.identifier.value",
      "min": 1,
      "path": "Claim.prescription.identifier.value"
    }, {
      "id": "Claim.originalPrescription.extension",
      "min": 1,
      "path": "Claim.originalPrescription.extension",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Claim.originalPrescription.extension:groupIdentifier",
      "max": "1",
      "min": 1,
      "path": "Claim.originalPrescription.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier" ]
      } ],
      "sliceName": "groupIdentifier"
    }, {
      "id": "Claim.originalPrescription.identifier.system",
      "min": 1,
      "path": "Claim.originalPrescription.identifier.system"
    }, {
      "id": "Claim.originalPrescription.identifier.value",
      "min": 1,
      "path": "Claim.originalPrescription.identifier.value"
    }, {
      "id": "Claim.payee",
      "min": 1,
      "path": "Claim.payee",
      "mustSupport": true
    }, {
      "id": "Claim.payee.type.coding",
      "min": 1,
      "path": "Claim.payee.type.coding"
    }, {
      "id": "Claim.payee.type.coding.system",
      "min": 1,
      "path": "Claim.payee.type.coding.system",
      "fixedUri": "http://terminology.hl7.org/CodeSystem/payeetype"
    }, {
      "id": "Claim.payee.type.coding.code",
      "min": 1,
      "path": "Claim.payee.type.coding.code",
      "fixedCode": "provider"
    }, {
      "id": "Claim.payee.type.coding.display",
      "min": 1,
      "path": "Claim.payee.type.coding.display",
      "fixedString": "Provider"
    }, {
      "id": "Claim.payee.party",
      "min": 1,
      "path": "Claim.payee.party",
      "type": [ {
        "code": "Reference",
        "targetProfile": [ "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Organization" ]
      } ]
    }, {
      "id": "Claim.payee.party.identifier",
      "min": 1,
      "path": "Claim.payee.party.identifier"
    }, {
      "id": "Claim.payee.party.identifier.system",
      "min": 1,
      "path": "Claim.payee.party.identifier.system",
      "fixedUri": "https://fhir.nhs.uk/Id/ods-organization-code"
    }, {
      "id": "Claim.payee.party.identifier.value",
      "min": 1,
      "path": "Claim.payee.party.identifier.value"
    }, {
      "id": "Claim.insurance",
      "path": "Claim.insurance",
      "mustSupport": true
    }, {
      "id": "Claim.insurance.coverage.identifier",
      "min": 1,
      "path": "Claim.insurance.coverage.identifier"
    }, {
      "id": "Claim.insurance.coverage.identifier.system",
      "min": 1,
      "path": "Claim.insurance.coverage.identifier.system",
      "fixedUri": "https://fhir.nhs.uk/Id/ods-organization-code"
    }, {
      "id": "Claim.insurance.coverage.identifier.value",
      "min": 1,
      "path": "Claim.insurance.coverage.identifier.value",
      "fixedString": "T1450"
    }, {
      "id": "Claim.item",
      "max": "1",
      "min": 1,
      "path": "Claim.item",
      "mustSupport": true
    }, {
      "id": "Claim.item.extension",
      "min": 1,
      "path": "Claim.item.extension",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Claim.item.extension:prescriptionStatus",
      "max": "1",
      "min": 1,
      "path": "Claim.item.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus" ]
      } ],
      "sliceName": "prescriptionStatus"
    }, {
      "id": "Claim.item.extension:prescriptionStatusReason",
      "max": "1",
      "min": 0,
      "path": "Claim.item.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason" ]
      } ],
      "sliceName": "prescriptionStatusReason",
      "mustSupport": true
    }, {
      "id": "Claim.item.sequence",
      "path": "Claim.item.sequence",
      "fixedPositiveInt": 1
    }, {
      "id": "Claim.item.productOrService",
      "path": "Claim.item.productOrService",
      "comment": "To be expanded. At present a fixed SNOMED CT value"
    }, {
      "id": "Claim.item.productOrService.coding",
      "max": "1",
      "min": 1,
      "path": "Claim.item.productOrService.coding"
    }, {
      "id": "Claim.item.productOrService.coding.system",
      "min": 1,
      "path": "Claim.item.productOrService.coding.system",
      "fixedUri": "http://snomed.info/sct"
    }, {
      "id": "Claim.item.productOrService.coding.code",
      "min": 1,
      "path": "Claim.item.productOrService.coding.code",
      "fixedCode": "16076005"
    }, {
      "id": "Claim.item.productOrService.coding.display",
      "min": 1,
      "path": "Claim.item.productOrService.coding.display",
      "fixedString": "Prescription"
    }, {
      "id": "Claim.item.programCode",
      "path": "Claim.item.programCode",
      "short": "PrescriptionChargeExemption",
      "binding": {
        "strength": "example",
        "description": "Prescription Charge Exemption"
      },
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "coding.system",
          "type": "value"
        } ]
      },
      "definition": "Describes possible reasons for someone not having to pay prescription charges.",
      "mustSupport": true
    }, {
      "id": "Claim.item.programCode.coding",
      "min": 1,
      "path": "Claim.item.programCode.coding"
    }, {
      "id": "Claim.item.programCode.coding.system",
      "min": 1,
      "path": "Claim.item.programCode.coding.system"
    }, {
      "id": "Claim.item.programCode.coding.code",
      "min": 1,
      "path": "Claim.item.programCode.coding.code"
    }, {
      "id": "Claim.item.programCode:exemptionEvidence",
      "max": "1",
      "path": "Claim.item.programCode",
      "binding": {
        "strength": "extensible",
        "valueSet": "https://fhir.nhs.uk/ValueSet/DM-vs-exemption-evidence"
      },
      "sliceName": "exemptionEvidence"
    }, {
      "id": "Claim.item.programCode:exemptionEvidence.coding.system",
      "min": 1,
      "path": "Claim.item.programCode.coding.system",
      "fixedUri": "https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence"
    }, {
      "id": "Claim.item.programCode:exemptionEvidence.coding.code",
      "min": 1,
      "path": "Claim.item.programCode.coding.code"
    }, {
      "id": "Claim.item.programCode:prescriptionChargeExemption",
      "max": "1",
      "min": 1,
      "path": "Claim.item.programCode",
      "binding": {
        "strength": "required",
        "valueSet": "https://fhir.nhs.uk/ValueSet/DM-prescription-charge-exemption",
        "description": "Prescription Charge Exemption"
      },
      "sliceName": "prescriptionChargeExemption"
    }, {
      "id": "Claim.item.programCode:prescriptionChargeExemption.coding.system",
      "min": 1,
      "path": "Claim.item.programCode.coding.system",
      "fixedUri": "https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption"
    }, {
      "id": "Claim.item.programCode:prescriptionChargeExemption.coding.code",
      "min": 1,
      "path": "Claim.item.programCode.coding.code"
    }, {
      "id": "Claim.item.detail",
      "min": 1,
      "path": "Claim.item.detail",
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.extension",
      "min": 2,
      "path": "Claim.item.detail.extension",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Claim.item.detail.extension:medicationRequest",
      "max": "1",
      "min": 1,
      "path": "Claim.item.detail.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference" ]
      } ],
      "sliceName": "medicationRequest",
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.extension:sequenceIdentifier",
      "max": "1",
      "min": 1,
      "path": "Claim.item.detail.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-ClaimSequenceIdentifier" ]
      } ],
      "sliceName": "sequenceIdentifier",
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.extension:repeatInformation",
      "max": "1",
      "min": 0,
      "path": "Claim.item.detail.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation" ]
      } ],
      "sliceName": "repeatInformation"
    }, {
      "id": "Claim.item.detail.sequence",
      "path": "Claim.item.detail.sequence",
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.productOrService",
      "path": "Claim.item.detail.productOrService",
      "binding": {
        "strength": "required",
        "valueSet": "https://fhir.nhs.uk/ValueSet/NHSDigital-MedicationRequest-Code",
        "description": "DMD Medication Code"
      },
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.modifier",
      "min": 1,
      "path": "Claim.item.detail.modifier",
      "binding": {
        "strength": "required",
        "valueSet": "https://fhir.nhs.uk/ValueSet/DM-medicationdispense-type",
        "description": "MedicationDispense Type"
      },
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.programCode",
      "path": "Claim.item.detail.programCode",
      "short": "Dispensing Endorsement and Charge Payment",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "coding.system",
          "type": "value"
        } ]
      },
      "definition": "Dispensing Endorsement  - Details of the endorsement(s) to support the claim for this medication item. \r\n\r\nCharge Payment - Details on whether a prescription charge was paid for the medication treatment.",
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.programCode.coding",
      "min": 1,
      "path": "Claim.item.detail.programCode.coding"
    }, {
      "id": "Claim.item.detail.programCode.coding.system",
      "min": 1,
      "path": "Claim.item.detail.programCode.coding.system"
    }, {
      "id": "Claim.item.detail.programCode.coding.code",
      "min": 1,
      "path": "Claim.item.detail.programCode.coding.code"
    }, {
      "id": "Claim.item.detail.programCode:prescriptionCharge",
      "max": "1",
      "min": 1,
      "path": "Claim.item.detail.programCode",
      "binding": {
        "strength": "required",
        "valueSet": "https://fhir.nhs.uk/ValueSet/DM-vs-prescription-charge"
      },
      "sliceName": "prescriptionCharge"
    }, {
      "id": "Claim.item.detail.programCode:prescriptionCharge.coding.system",
      "path": "Claim.item.detail.programCode.coding.system",
      "fixedUri": "https://fhir.nhs.uk/CodeSystem/DM-prescription-charge"
    }, {
      "id": "Claim.item.detail.programCode:dispensingEndorsement",
      "path": "Claim.item.detail.programCode",
      "binding": {
        "strength": "required",
        "valueSet": "https://fhir.nhs.uk/ValueSet/DM-dispensing-endorsement",
        "description": "Program specific reason codes"
      },
      "sliceName": "dispensingEndorsement"
    }, {
      "id": "Claim.item.detail.programCode:dispensingEndorsement.coding.system",
      "path": "Claim.item.detail.programCode.coding.system",
      "fixedUri": "https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement"
    }, {
      "id": "Claim.item.detail.quantity",
      "path": "Claim.item.detail.quantity",
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.subDetail",
      "path": "Claim.item.detail.subDetail",
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.subDetail.extension",
      "min": 0,
      "path": "Claim.item.detail.subDetail.extension",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Claim.item.detail.subDetail.extension:medicationDispense",
      "max": "1",
      "min": 0,
      "path": "Claim.item.detail.subDetail.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationDispenseReference" ]
      } ],
      "sliceName": "medicationDispense"
    }, {
      "id": "Claim.item.detail.subDetail.extension:repeatInformation",
      "max": "1",
      "min": 0,
      "path": "Claim.item.detail.subDetail.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation" ]
      } ],
      "sliceName": "repeatInformation"
    }, {
      "id": "Claim.item.detail.subDetail.sequence",
      "path": "Claim.item.detail.subDetail.sequence",
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.subDetail.productOrService",
      "path": "Claim.item.detail.subDetail.productOrService",
      "binding": {
        "strength": "extensible",
        "valueSet": "https://fhir.nhs.uk/ValueSet/NHSDigital-MedicationDispense-Code",
        "description": "DMD Medication Code"
      },
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.subDetail.quantity",
      "min": 1,
      "path": "Claim.item.detail.subDetail.quantity",
      "mustSupport": true
    }, {
      "id": "Claim.item.detail.subDetail.quantity.extension",
      "min": 0,
      "path": "Claim.item.detail.subDetail.quantity.extension",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Claim.item.detail.subDetail.quantity.extension:runningTotal",
      "max": "1",
      "min": 0,
      "path": "Claim.item.detail.subDetail.quantity.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-DM-RunningTotal" ]
      } ],
      "sliceName": "runningTotal"
    } ]
  },
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Claim"
}