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

<ClaimResponse xmlns="http://hl7.org/fhir">
  <meta>
    <profile value="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyClaimResponse"/>
  </meta>
  <text>
    <status value="extensions"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ClaimResponse NzPharmacyClaimResponseExample</b></p><a name="NzPharmacyClaimResponseExample"> </a><a name="hcNzPharmacyClaimResponseExample"> </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-NzPharmacyClaimResponse.html">New Zealand Pharmacy Claim Response</a></p></div><p><b>Shared Care Claim Trace Number</b>: <code>https://example.com/system</code>/TRN-123456789</p><p><b>identifier</b>: 123456789123456789</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}">Pharmacy</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href="Patient/example">Patient/example</a></p><p><b>created</b>: 2025-01-01 00:00:00+0000</p><p><b>insurer</b>: <a href="Organization/pharmac">Organization/pharmac</a></p><p><b>requestor</b>: <a href="Organization/pharmacy">Organization/pharmacy</a></p><p><b>request</b>: <a href="Claim/123456789123456789">Claim/123456789123456789</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>item</b></p><p><b>Shared Care Product Or Service</b>: <span title="Codes:{https://standards.digital.health.nz/ns/purchase-unit PU1234}">PU1234</span></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category amountpaid}">Amount Paid</span></p><h3>Amounts</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>100</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>detailSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category drugcost}">Drug Cost</span></p><h3>Amounts</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>50</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category pharmaceuticalsubsidy}">Pharmaceutical Subsidy</span></p><h3>Amounts</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>30</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category amountpaid}">Amount Paid</span></p><h3>Amounts</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>100</td><td>New Zealand dollar</td></tr></table></blockquote></blockquote></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/ex-paymenttype complete}">Complete</span></p><p><b>date</b>: 2025-01-01</p><h3>Amounts</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>100</td><td>New Zealand dollar</td></tr></table></blockquote><h3>Errors</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ItemSequence</b></td><td><b>DetailSequence</b></td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>1</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication-error a002}">Missing Creation Date</span></td></tr></table></div>
  </text>
  <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number">
    <valueIdentifier>
      <system value="https://example.com/system"/>
      <value value="TRN-123456789"/>
    </valueIdentifier>
  </extension>
  <identifier>
    <value value="123456789123456789"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="pharmacy"/>
    </coding>
  </type>
  <use value="claim"/>
  <patient>
    <reference value="Patient/example"/>
  </patient>
  <created value="2025-01-01T00:00:00-00:00"/>
  <insurer>
    <reference value="Organization/pharmac"/>
  </insurer>
  <requestor>
    <reference value="Organization/pharmacy"/>
  </requestor>
  <request>
    <reference value="Claim/123456789123456789"/>
  </request>
  <outcome value="complete"/>
  <item>
    <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service">
      <valueCodeableConcept>
        <coding>
          <system value="https://standards.digital.health.nz/ns/purchase-unit"/>
          <code value="PU1234"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <itemSequence value="1"/>
    <adjudication>
      <category>
        <coding>
          <system value="https://standards.digital.health.nz/ns/pharmacy-adjudication-category"/>
          <code value="amountpaid"/>
        </coding>
      </category>
      <amount>
        <value value="100"/>
        <currency value="NZD"/>
      </amount>
    </adjudication>
    <detail>
      <detailSequence value="1"/>
      <adjudication>
        <category>
          <coding>
            <system value="https://standards.digital.health.nz/ns/pharmacy-adjudication-category"/>
            <code value="drugcost"/>
          </coding>
        </category>
        <amount>
          <value value="50"/>
          <currency value="NZD"/>
        </amount>
      </adjudication>
      <adjudication>
        <category>
          <coding>
            <system value="https://standards.digital.health.nz/ns/pharmacy-adjudication-category"/>
            <code value="pharmaceuticalsubsidy"/>
          </coding>
        </category>
        <amount>
          <value value="30"/>
          <currency value="NZD"/>
        </amount>
      </adjudication>
      <adjudication>
        <category>
          <coding>
            <system value="https://standards.digital.health.nz/ns/pharmacy-adjudication-category"/>
            <code value="amountpaid"/>
          </coding>
        </category>
        <amount>
          <value value="100"/>
          <currency value="NZD"/>
        </amount>
      </adjudication>
    </detail>
  </item>
  <payment>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/ex-paymenttype"/>
        <code value="complete"/>
      </coding>
    </type>
    <date value="2025-01-01"/>
    <amount>
      <value value="100"/>
      <currency value="NZD"/>
    </amount>
  </payment>
  <error>
    <itemSequence value="1"/>
    <detailSequence value="1"/>
    <code>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/adjudication-error"/>
        <code value="a002"/>
      </coding>
    </code>
  </error>
</ClaimResponse>