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: hl7.fhir.us.qicore
derivation: constraint
name: QICoreClaim
type: Claim
elements:
  patient:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient']
    index: 0
  facility:
    type: Reference
    mustSupport: false
    refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location']
    index: 8
  diagnosis:
    elements:
      sequence: {type: positiveInt, mustSupport: true, index: 11}
      diagnosis:
        mustSupport: true
        choices: [diagnosisCodeableConcept, diagnosisReference]
        index: 13
      diagnosisCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: diagnosis, index: 14}
      diagnosisReference:
        type: Reference
        mustSupport: true
        choiceOf: diagnosis
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis']
        index: 15
      onAdmission:
        type: CodeableConcept
        binding: {strength: required, valueSet: 'http://terminology.hl7.org/ValueSet/POAIndicators'}
        mustSupport: true
        index: 16
  item:
    elements:
      encounter:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter']
        index: 22
  created: {mustSupport: true, index: 2}
  procedure:
    elements:
      sequence: {type: positiveInt, isSummary: false, isModifier: false, mustSupport: true, index: 17}
      procedure:
        mustSupport: true
        choices: [procedureCodeableConcept, procedureReference]
        index: 19
      procedureCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: procedure, index: 20}
      procedureReference:
        type: Reference
        mustSupport: true
        choiceOf: procedure
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure']
        index: 21
  referral:
    type: Reference
    mustSupport: false
    refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest']
    index: 7
  payee:
    mustSupport: false
    index: 5
    elements:
      party:
        type: Reference
        mustSupport: false
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson']
        index: 6
  prescription:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/StructureDefinition/VisionPrescription', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-devicerequest', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest']
    index: 4
  billablePeriod: {mustSupport: true, index: 1}
  provider:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole']
    index: 3
  careTeam:
    mustSupport: false
    index: 9
    elements:
      provider:
        type: Reference
        mustSupport: false
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole']
        index: 10
package_version: 6.0.0-ballot
class: profile
kind: resource
url: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 6.0.0-ballot