{
"description": null,
"_filename": "NHSDigital-Claim.StructureDefinition.json",
"package_name": "uk.nhsdigital.r4.test",
"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": "2.8.6-prerelease",
"status": "draft",
"id": "520ba1c1-d26b-4345-8da9-549fd295a637",
"kind": "resource",
"url": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim",
"version": null,
"differential": {
"element": [ {
"id": "Claim.extension",
"min": 0,
"path": "Claim.extension",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
}
}, {
"path": "Claim.extension",
"min": 0,
"definition": "Used for replacement Claims, this should reference the Claim.identifier of the Claim being replaced.\r\n\r\n```json\r\n\r\n \"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf\",\r\n \"valueIdentifier\": {\r\n \"value\": \"46055273-3001-41bd-86a0-f8dba7f2161a\"\r\n }\r\n }\r\n ],\r\n\r\n```",
"short": "Used to reference a previous Claim",
"type": [ {
"code": "Extension",
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf" ]
} ],
"mustSupport": true,
"sliceName": "replacementOf",
"max": "1",
"id": "Claim.extension:replacementOf"
}, {
"path": "Claim.extension",
"min": 0,
"definition": "The person submitting/authoring the Claim\r\n\r\n```json\r\n\r\n \"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent\",\r\n \"valueReference\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/sds-role-profile-id\",\r\n \"value\": \"884562163557\"\r\n },\r\n \"display\": \"dummy full name\"\r\n }\r\n }\r\n ],\r\n```",
"short": "Provenance of the resource",
"type": [ {
"code": "Extension",
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent" ]
} ],
"mustSupport": true,
"sliceName": "agent",
"max": "1",
"id": "Claim.extension:agent"
}, {
"path": "Claim.extension",
"min": 0,
"definition": "Identifier of the SupplyHeader (v3) object. The prescription in the context of a Dispense Notification or Claim. Mandatory for EPS interactions.",
"short": "Identifier for the SupplyHeader",
"type": [ {
"code": "Extension",
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-SupplyHeaderIdentifier" ]
} ],
"mustSupport": true,
"sliceName": "supplyHeaderIdentifier",
"max": "1",
"id": "Claim.extension:supplyHeaderIdentifier"
}, {
"id": "Claim.identifier",
"min": 1,
"path": "Claim.identifier",
"definition": "**MUST** be unique for each Claim. In EPS this must be a UUID with a system of `https://fhir.nhs.uk/Id/prescription-dispense-item-number`\r\n\r\n```json\r\n\r\n \"identifier\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/Id/prescription-dispense-item-number\",\r\n \"value\": \"4509B70D-D8B8-EA03-1105-64557CB54A29\"\r\n }\r\n ],\r\n\r\n```",
"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",
"definition": "For EPS the following **MUST** be used.\r\n\r\n```json\r\n\r\n \"status\": \"active\",\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\r\n \"code\": \"pharmacy\",\r\n \"display\": \"Pharmacy\"\r\n } \r\n ]\r\n },\r\n \"use\": \"claim\",\r\n\r\n```",
"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",
"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.",
"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})$'))"
} ],
"definition": "**MUST** be an identifier reference using the Patients NHS Number.\r\n\r\n```json\r\n\r\n \"patient\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/nhs-number\",\r\n \"value\": \"2300992742\"\r\n }\r\n },\r\n\r\n```",
"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",
"definition": "The date of the Claim\r\n\r\n```json\r\n\r\n \"created\": \"2004-09-16T16:30:00+00:00\",\r\n\r\n```",
"mustSupport": true
}, {
"id": "Claim.provider",
"path": "Claim.provider",
"type": [ {
"code": "Reference",
"aggregation": [ "contained" ],
"targetProfile": [ "https://fhir.nhs.uk/StructureDefinition/NHSDigital-PractitionerRole-SDS" ]
} ],
"definition" : "The organisation responsible for the claim, this must be a reference to a contained PractitoinerRole\r\n\r\n```json\r\n \"provider\": {\r\n \"reference\": \"#provider\"\r\n },\r\n```\r\n\r\nThe contained PractitionerRole\r\n\r\n```json\r\n{\r\n \"resourceType\": \"Claim\",\r\n \"id\": \"258E153F-567B-4D60-B045-BA315A6B8DB0\",\r\n \"contained\": [\r\n {\r\n \"resourceType\": \"PractitionerRole\",\r\n \"id\": \"provider\",\r\n \"identifier\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/Id/sds-role-profile-id\",\r\n \"value\": \"454567759542\"\r\n }\r\n ],\r\n \"code\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/NHSDigital-SDS-JobRoleCode\",\r\n \"code\": \"S0030:G0100:R0620\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"practitioner\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/sds-user-id\",\r\n \"value\": \"7654321\"\r\n },\r\n \"display\": \"Mr Peter Potion\"\r\n },\r\n \"organization\": {\r\n \"reference\": \"#organisation\"\r\n },\r\n \"telecom\": [\r\n {\r\n \"system\": \"phone\",\r\n \"use\": \"work\",\r\n \"value\": \"01234567890\"\r\n }\r\n ]\r\n },\r\n {\r\n \"resourceType\": \"Organization\",\r\n \"id\": \"organisation\",\r\n \"identifier\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/Id/ods-organization-code\",\r\n \"value\": \"VNE51\"\r\n }\r\n ],\r\n \"address\": [\r\n {\r\n \"city\": \"West Yorkshire\",\r\n \"use\": \"work\",\r\n \"line\": [\r\n \"17 Austhorpe Road\",\r\n \"Crossgates\",\r\n \"Leeds\"\r\n ],\r\n \"postalCode\": \"LS15 8BA\"\r\n }\r\n ],\r\n \"active\": true,\r\n \"type\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/organisation-role\",\r\n \"code\": \"182\",\r\n \"display\": \"PHARMACY\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"name\": \"The Simple Pharmacy\",\r\n \"telecom\": [\r\n {\r\n \"system\": \"phone\",\r\n \"use\": \"work\",\r\n \"value\": \"0113 3180277\"\r\n }\r\n ]\r\n } \r\n ],\r\n```",
"mustSupport": true
}, {
"id": "Claim.provider.reference",
"min": 1,
"path": "Claim.provider.reference"
}, {
"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",
"path": "Claim.priority",
"definition": "Desired processing ugency. Fixed value.\r\n\r\n```json\r\n\"priority\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\r\n \"code\": \"normal\"\r\n }\r\n ]\r\n }\r\n```",
"mustSupport": true
}, {
"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",
"definition": "References to the original prescription, the `groupIdentifier` contains both the ShortForm prescription id and long form UUID variant. See [NHSDigital-MedicationRequest](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest) for more details.\r\n\r\nThis MUST not be used to reference the MedicationRequest.\r\n\r\n```json\r\n\r\n\"prescription\": {\r\n \"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier\",\r\n \"extension\": [\r\n {\r\n \"url\": \"shortForm\",\r\n \"valueIdentifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/prescription-order-number\",\r\n \"value\": \"82D996-C81010-11DB12\"\r\n }\r\n },\r\n {\r\n \"url\": \"UUID\",\r\n \"valueIdentifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/prescription\",\r\n \"value\": \"b2fc79f0-2793-4736-9b2d-0976c21e73a5\"\r\n }\r\n }\r\n ]\r\n }\r\n ]\r\n},\r\n\r\n```",
"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",
"definition": "The recipient of benefits payable. This is the ODS Code of the Pharmacy (provider) making the Claim.\r\n\r\nSee provider for example of a contained Organization.\r\n\r\n```json\r\n\r\n\"payee\": {\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/payeetype\",\r\n \"value\": \"provider\",\r\n \"display\": \"Provider\"\r\n }\r\n ]\r\n },\r\n \"party\": {\r\n \"reference\": \"#organisation\",\r\n \"display\": \"The Simple Pharmacy\"\r\n }\r\n}\r\n```",
"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" ]
} ],
"constraint": [ {
"key": "nhsd-claim-party",
"human": "party - An identifier reference or resource reference must be provided",
"severity": "error",
"expression": "(reference.exists() or (identifier.exists()))"
} ]
}, {
"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",
"max": "1",
"path": "Claim.insurance",
"definition": "For EPS this is the NHS Business Services Authority. The sequence value must always be 1.\r\n\r\n```json\r\n\r\n\"insurance\": [\r\n {\r\n \"sequence\": 1,\r\n \"focal\": true,\r\n \"coverage\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/ods-organization-code\",\r\n \"value\": \"T1450\"\r\n },\r\n \"display\": \"NHS BUSINESS SERVICES AUTHORITY\"\r\n }\r\n }\r\n],\r\n```",
"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",
"definition": "\r\n \r\n \r\n | \r\n item (prescription) | \r\n detail (requested medication) | \r\n subDetail (dispensed medication) | \r\n
\r\n \r\n \r\n \r\n | \r\n productOrService\r\n | \r\n \r\n 16076005 Prescription\r\n | \r\n \r\n dm+d code of requested medication\r\n | \r\n \r\n dm+d code of dispensed medication\r\n | \r\n
\r\n \r\n | \r\n programCode\r\n | \r\n \r\n exemptionEvidence\r\n prescriptionChargeExemption\r\n | \r\n \r\n prescriptionCharge\r\n dispensingEndorsement\r\n additionalInstructions\r\n | \r\n \r\n | \r\n
\r\n \r\n
\r\n | \r\n modifier\r\n | \r\n \r\n | \r\n \r\n MedicationDispenseType\r\n | \r\n \r\n | \r\n
\r\n \r\n
\r\n | \r\n quantity\r\n | \r\n \r\n | \r\n \r\n MedicationRequest.quantity\r\n | \r\n \r\n MedicationDispense.quantity\r\n | \r\n
\r\n \r\n
\r\n
"
,
"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"
,
"definition": "This will generally match the value of the last `dispense-notification` message.\r\n\r\nThis should match the `status` of the associated [NHSDigital-Task](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-Task)\r\n\r\n```json\r\n\r\n\"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus\"
,\r\n \"valueCoding\": {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/EPS-task-business-status\"
,\r\n \"code\": \"0006\"
,\r\n \"display\": \"Dispensed\"\r\n }\r\n }\r\n] \r\n ```"
,
"mustSupport": true
}
, {
"path": "Claim.item.extension"
,
"min": 0
,
"definition": "Mandatory if the medication was not dispensed. \r\nThis should match the `statusReason` of the associated [NHSDigital-Task](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-Task)\r\n\r\n```json\r\n\r\n\"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason\"
,\r\n \"valueCoding\": {\r\n \"system\": \"https://fhir.nhs.uk/ValueSet/DM-medicationdispense-status-reason\"
,\r\n \"code\": \"0001\"
,\r\n \"display\": \"Not required as instructed by the patient\"\r\n }\r\n }\r\n]
,\r\n\r\n```"
,
"short": "Prescription Status Reason"
,
"type": [ {
"code": "Extension"
,
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason" ]
} ]
,
"mustSupport": true
,
"sliceName": "prescriptionStatusReason"
,
"max": "1"
,
"id": "Claim.item.extension:prescriptionStatusReason"
}
, {
"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"
,
"definition": "Mandatory fixed value.\r\n\r\n```json\r\n\r\n\"productOrService\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://snomed.info/sct\"
,\r\n \"code\": \"16076005\"
,\r\n \"display\": \"Prescription\"\r\n }\r\n ]\r\n}
,\r\n\r\n```"
}
, {
"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": "Exemption evidence - code to denote which evidence for exemption has been seen.\r\n\r\nPrescription Charge Exemption - code to denote the exemption reason \r\n```json \r\n\r\n\"programCode\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"code\": \"0001\"
,\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption\"
,\r\n \"display\": \"Patient has paid appropriate charges\"\r\n }\r\n ]\r\n }
,\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence\"
,\r\n \"code\": \"no-evidence-seen\"
,\r\n \"display\": \"No Evidence Seen\"\r\n }\r\n ]\r\n }\r\n ]\r\n\r\n```"
,
"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"
,
"mustSupport": true
}
, {
"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"
,
"mustSupport": true
}
, {
"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"
,
"definition": "A claim detail line. Relates to MedicationRequest"
,
"mustSupport": true
}
, {
"id": "Claim.item.detail.extension"
,
"min": 2
,
"path": "Claim.item.detail.extension"
,
"slicing": {
"rules": "open"
,
"discriminator": [ {
"path": "url"
,
"type": "value"
} ]
}
}
, {
"path": "Claim.item.detail.extension"
,
"min": 1
,
"definition": "This should match the `identifier` of the associated [NHSDigital-MedicationRequest](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest)\r\n\r\n```json\r\n\r\n\"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference\"
,\r\n \"valueReference\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/prescription-order-item-number\"
,\r\n \"value\": \"33560bee-bc0c-4e3b-a155-71591eee9ca5\"\r\n }\r\n }\r\n }\r\n]
,\r\n\r\n```"
,
"short": "MedicationRequest reference"
,
"type": [ {
"code": "Extension"
,
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference" ]
} ]
,
"mustSupport": true
,
"sliceName": "medicationRequest"
,
"max": "1"
,
"id": "Claim.item.detail.extension:medicationRequest"
}
, {
"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.extension:taskBusinessStatusReason"
,
"max": "1"
,
"min": 0
,
"path": "Claim.item.detail.extension"
,
"type": [ {
"code": "Extension"
,
"profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason" ]
} ]
,
"sliceName": "taskBusinessStatusReason"
,
"definition": "To capture non-dispensing reason within a Claim at the line-item level"
,
"isModifier": false
}
, {
"id": "Claim.item.detail.sequence"
,
"path": "Claim.item.detail.sequence"
,
"definition": "An integer to identify the item within the resource. Fixed value.\r\n\r\n```json\r\n\r\n\"sequence\": 1
,\r\n\r\n```"
,
"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"
}
,
"definition": "This should match the `medicationCodeableConcept` of the associated [NHSDigital-MedicationRequest](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest)\r\n\r\n```json\r\n\r\n\"productOrService\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://snomed.info/sct\"
,\r\n \"code\": \"322237000\"
,\r\n \"display\": \"Paracetamol 500mg soluble tablets\"\r\n }\r\n ]\r\n}
,\r\n\r\n```"
,
"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"
}
,
"definition": "If the code is `0002 - Item not dispensed` then the extension `prescriptionStatusReason` is required.\r\n\r\nThis should match the `type` of the last associated [NHSDigital-MedicationDispense](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense)\r\n\r\n```json\r\n\r\n\"modifier\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationdispense-type\"
,\r\n \"code\": \"0001\"
,\r\n \"display\": \"Item fully dispensed\"\r\n }\r\n ]\r\n }\r\n]
,\r\n\r\n```"
,
"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.\r\n\r\n```json\r\n\r\n\"programCode\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/DM-prescription-charge\"
,\r\n \"code\": \"paid-once\"
,\r\n \"display\": \"Paid Once\"\r\n }\r\n ]\r\n }
,\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement\"
,\r\n \"code\": \"IP\"
,\r\n \"display\": \"Invoice Price\"\r\n }\r\n ]\r\n }\r\n]
,\r\n\r\n``` \r\nIf an endorsement code of PD is used
, the number of packaged doses dispensed minus the number of dispenses must be entered in the programCode.text field e.g. PD4 for five doses packaged separately and dispensed on one occasion"
,
"mustSupport": true
}
, {
"id": "Claim.item.detail.programCode.coding"
,
"min": 1
,
"path": "Claim.item.detail.programCode.coding"
,
"mustSupport": true
}
, {
"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"
,
"mustSupport": true
}
, {
"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"
,
"mustSupport": true
}
, {
"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.programCode:dispensingEndorsement.text"
,
"path": "Claim.item.detail.programCode.text"
,
"short": "Additional Information for Dispensing Endorsements"
,
"definition" : "Additional Information for Dispensing Endorsements should be entered in this field. Details on the format of this text field can be found in `Requirements and Electronic Prescription Service Guidance for Endorsement (EPS)`\r\n\r\n```json\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement\",\r\n \"code\": \"IP\",\r\n \"display\": \"Invoice Price for less common products or special items\"\r\n }\r\n ],\r\n \"text\" : \"15gram,£12.34,EFGH Ltd\"\r\n },\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement\",\r\n \"code\": \"PD\",\r\n \"display\": \"Packaged Doses\"\r\n }\r\n ],\r\n \"text\": \"PD4\"\r\n }\r\n```"
}
, {
"id": "Claim.item.detail.quantity"
,
"path": "Claim.item.detail.quantity"
,
"definition": "This should match the `quantity` of the associated [NHSDigital-MedicationRequest](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest)\r\n\r\n```json\r\n\r\n\"quantity\": {\r\n \"value\": 200
,\r\n \"unit\": \"unit dose\"
,\r\n \"system\": \"http://snomed.info/sct\"
,\r\n \"code\": \"408102007\"\r\n}
,\r\n\r\n```"
,
"mustSupport": true
}
, {
"id": "Claim.item.detail.subDetail"
,
"path": "Claim.item.detail.subDetail"
,
"definition": "subDetail is only present if the medication has been dispensed."
,
"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"
,
"definition": "An integer id for each medication dispense.\r\n\r\n```json\r\n\r\n\"sequence\": 1
,\r\n\r\n\r\n```"
,
"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"
}
,
"definition": "This should match the `medicationCodeableConcept` of the associated [NHSDigital-MedicationDispense](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense)\r\n\r\n```json\r\n\r\n\"productOrService\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://snomed.info/sct\"
,\r\n \"code\": \"3416211000001106\"
,\r\n \"display\": \"Salbutamol 100micrograms/dose inhaler (Sandoz Ltd) 200 dose\"\r\n }\r\n ]\r\n}
,\r\n\r\n```"
,
"mustSupport": true
}
, {
"id": "Claim.item.detail.subDetail.quantity"
,
"min": 1
,
"path": "Claim.item.detail.subDetail.quantity"
,
"definition": "This should match the `quantity` of the associated [NHSDigital-MedicationDispense](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense)\r\n\r\n```json\r\n\r\n\"quantity\": {\r\n \"value\": 200
,\r\n \"unit\": \"unit dose\"
,\r\n \"system\": \"http://snomed.info/sct\"
,\r\n \"code\": \"408102007\"\r\n}\r\n\r\n```"
,
"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"
}