description: Profile of Claim for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
package_name: fhir.onc.us-quality-core
derivation: constraint
name: USQualityCoreClaim
type: Claim
elements:
  patient:
    type: Reference
    short: The recipient of the products and services
    refers: ['http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient']
    index: 0
  facility:
    type: Reference
    mustSupport: false
    refers: ['http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-location']
    index: 8
  diagnosis:
    short: Pertinent diagnosis information
    index: 11
    elements:
      sequence: {type: positiveInt, short: Diagnosis instance identifier, index: 12}
      diagnosis:
        short: Nature of illness or problem
        choices: [diagnosisCodeableConcept, diagnosisReference]
        index: 14
      diagnosisCodeableConcept: {type: CodeableConcept, short: Nature of illness or problem, choiceOf: diagnosis, index: 15}
      diagnosisReference:
        type: Reference
        short: Nature of illness or problem
        choiceOf: diagnosis
        refers: ['http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis']
        index: 16
      onAdmission:
        type: CodeableConcept
        short: Present on admission
        binding: {strength: required, valueSet: 'http://terminology.hl7.org/ValueSet/POAIndicators'}
        index: 17
  item:
    elements:
      encounter:
        type: Reference
        short: Encounters related to this billed item
        refers: ['http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-encounter']
        index: 23
  created: {short: Resource creation date, index: 2}
  procedure:
    elements:
      sequence: {type: positiveInt, short: Procedure instance identifier, isSummary: false, isModifier: false, index: 18}
      procedure:
        short: Specific clinical procedure
        choices: [procedureCodeableConcept, procedureReference]
        index: 20
      procedureCodeableConcept: {type: CodeableConcept, short: Specific clinical procedure, choiceOf: procedure, index: 21}
      procedureReference:
        type: Reference
        short: Specific clinical procedure
        choiceOf: procedure
        refers: ['http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-procedure']
        index: 22
  referral:
    type: Reference
    mustSupport: false
    refers: ['http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-servicerequest']
    index: 7
  payee:
    mustSupport: false
    index: 5
    elements:
      party:
        type: Reference
        mustSupport: false
        refers: ['http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization', 'http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient', 'http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner', 'http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitionerrole', 'http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson']
        index: 6
  prescription:
    type: Reference
    short: Prescription authorizing services and products
    refers: ['http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-devicerequest', 'http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationrequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription']
    index: 4
  billablePeriod: {short: Relevant time frame for the claim, index: 1}
  provider:
    type: Reference
    short: Party responsible for the claim
    refers: ['http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization', 'http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner', 'http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitionerrole']
    index: 3
  careTeam:
    mustSupport: false
    index: 9
    elements:
      provider:
        type: Reference
        mustSupport: false
        refers: ['http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization', 'http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner', 'http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitionerrole']
        index: 10
package_version: 0.5.0
class: profile
kind: resource
url: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-claim
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 0.5.0