<?xml version="1.0" encoding="UTF-8"?>

<Claim xmlns="http://hl7.org/fhir">
  <meta>
    <profile value="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyClaim"/>
  </meta>
  <text>
    <status value="extensions"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Claim NzPharmacyClaimExample2</b></p><a name="NzPharmacyClaimExample2"> </a><a name="hcNzPharmacyClaimExample2"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-NzPharmacyClaim.html">NZ Pharmacy Claim</a></p></div><p><b>Patient Cohort</b>: CRC</p><p><b>Claimant Number</b>: AG12345</p><p><b>Originating Claimant Number</b>: AG54321</p><p><b>identifier</b>: <code>https://standards.digital.health.nz/ns/nzeps-scid-item-id</code>/123456789123456789</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{https://standards.digital.health.nz/ns/claim-type PHM}">PHM</span></p><p><b>subType</b>: <span title="Codes:{https://standards.digital.health.nz/ns/claim-subtype ICPSA}">ICPSA</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href="Patient/ZZZ0008">Mr Test Patient | Male | 2001-01-01</a></p><p><b>billablePeriod</b>: 2025-01-01 --&gt; 2025-01-01</p><p><b>created</b>: 2025-01-01 00:00:00+0000</p><p><b>enterer</b>: <a href="Practitioner/12345">Practitioner/12345</a></p><p><b>provider</b>: <code>Organisation/12345</code></p><p><b>priority</b>: <span title="Codes:">routine</span></p><h3>SupportingInfos</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Category</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{https://standards.digital.health.nz/ns/transaction-category PHARMACY}">PHARMACY</span></td></tr></table><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td><a href="Coverage/9876B1">Coverage/9876B1</a></td></tr></table><blockquote><p><b>item</b></p><p><b>Patient Flag</b>: true</p><p><b>Prescriber Flag</b>: false</p><p><b>Prescription Flag</b>: true</p><p><b>Dose Flag</b>: false</p><p><b>Group ID</b>: GRP001</p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title="Codes:{https://standards.digital.health.nz/ns/purchase-unit PU1234}">PU1234</span></p><p><b>serviced</b>: 2015-01-01</p><blockquote><p><b>detail</b></p><p><b>Balance Owing</b>: 0</p><p><b>Wastage Quantity</b>: 5 Tablets</p><p><b>CBS Subsidy</b>: <span title="New Zealand Dollar">$10.00</span> (NZD)</p><p><b>CBS Pack Size</b>: 30 Tablets</p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title="Codes:{https://standards.digital.health.nz/ns/pharmac-subsidy-code 123456}">123456</span></p><p><b>quantity</b>: 180 Tablets</p><h3>Nets</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>500</td><td>New Zealand dollar</td></tr></table></blockquote></blockquote><h3>Totals</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>500</td><td>New Zealand dollar</td></tr></table></div>
  </text>
  <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort">
    <valueString value="CRC"/>
  </extension>
  <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number">
    <valueString value="AG12345"/>
  </extension>
  <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number">
    <valueString value="AG54321"/>
  </extension>
  <identifier>
    <system value="https://standards.digital.health.nz/ns/nzeps-scid-item-id"/>
    <value value="123456789123456789"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="https://standards.digital.health.nz/ns/claim-type"/>
      <code value="PHM"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system value="https://standards.digital.health.nz/ns/claim-subtype"/>
      <code value="ICPSA"/>
    </coding>
  </subType>
  <use value="claim"/>
  <patient>
    <reference value="Patient/ZZZ0008"/>
    <type value="Patient"/>
    <identifier>
      <system value="https://standards.digital.health.nz/ns/nhi-id"/>
      <value value="ZZZ0008"/>
    </identifier>
    <display value="Mr Test Patient | Male | 2001-01-01"/>
  </patient>
  <billablePeriod>
    <start value="2025-01-01"/>
    <end value="2025-01-01"/>
  </billablePeriod>
  <created value="2025-01-01T00:00:00-00:00"/>
  <enterer>
    <reference value="Practitioner/12345"/>
    <type value="Practitioner"/>
    <identifier>
      <system value="https://standards.digital.health.nz/ns/hpi-person-id"/>
      <value value="12345"/>
    </identifier>
  </enterer>
  <provider>
    <reference value="Organisation/12345"/>
    <type value="Organisation"/>
    <identifier>
      <system value="https://standards.digital.health.nz/ns/hpi-organisation-id"/>
      <value value="12345"/>
    </identifier>
  </provider>
  <priority>
    <coding>
      <code value="routine"/>
    </coding>
  </priority>
  <supportingInfo>
    <sequence value="1"/>
    <category>
      <coding>
        <system value="https://standards.digital.health.nz/ns/transaction-category"/>
        <code value="PHARMACY"/>
      </coding>
    </category>
  </supportingInfo>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag">
      <valueBoolean value="true"/>
    </extension>
    <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag">
      <valueBoolean value="false"/>
    </extension>
    <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag">
      <valueBoolean value="true"/>
    </extension>
    <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag">
      <valueBoolean value="false"/>
    </extension>
    <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id">
      <valueString value="GRP001"/>
    </extension>
    <sequence value="1"/>
    <productOrService>
      <coding>
        <system value="https://standards.digital.health.nz/ns/purchase-unit"/>
        <code value="PU1234"/>
      </coding>
    </productOrService>
    <servicedDate value="2015-01-01"/>
    <detail>
      <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing">
        <valueString value="0"/>
      </extension>
      <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity">
        <valueQuantity>
          <value value="5"/>
          <unit value="Tablets"/>
        </valueQuantity>
      </extension>
      <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy">
        <valueMoney>
          <value value="10"/>
          <currency value="NZD"/>
        </valueMoney>
      </extension>
      <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize">
        <valueQuantity>
          <value value="30"/>
          <unit value="Tablets"/>
        </valueQuantity>
      </extension>
      <sequence value="1"/>
      <productOrService>
        <coding>
          <system value="https://standards.digital.health.nz/ns/pharmac-subsidy-code"/>
          <code value="123456"/>
        </coding>
      </productOrService>
      <quantity>
        <value value="180"/>
        <unit value="Tablets"/>
      </quantity>
      <net>
        <value value="500"/>
        <currency value="NZD"/>
      </net>
    </detail>
  </item>
  <total>
    <value value="500"/>
    <currency value="NZD"/>
  </total>
</Claim>