{
  "resourceType": "StructureDefinition",
  "id": "c7a6e6f2-4e97-48b9-9ec2-bd4f220e8a5d",
  "url": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim",
  "name": "NHSDigital-Claim",
  "status": "draft",
  "fhirVersion": "4.0.1",
  "mapping": [
    {
      "identity": "workflow",
      "uri": "http://hl7.org/fhir/workflow",
      "name": "Workflow Pattern"
    },
    {
      "identity": "w5",
      "uri": "http://hl7.org/fhir/fivews",
      "name": "FiveWs Pattern Mapping"
    },
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Claim",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Claim",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Claim.identifier",
        "path": "Claim.identifier",
        "mustSupport": true
      },
      {
        "id": "Claim.status",
        "path": "Claim.status",
        "mustSupport": true
      },
      {
        "id": "Claim.type",
        "path": "Claim.type",
        "mustSupport": true
      },
      {
        "id": "Claim.patient",
        "path": "Claim.patient",
        "mustSupport": true
      },
      {
        "id": "Claim.created",
        "path": "Claim.created",
        "mustSupport": true
      },
      {
        "id": "Claim.provider",
        "path": "Claim.provider",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-PractitionerRole",
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Practitioner"
            ],
            "aggregation": [
              "referenced",
              "bundled"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.prescription",
        "path": "Claim.prescription",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Claim.prescription.extension",
        "path": "Claim.prescription.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Claim.prescription.extension:groupIdentifier",
        "path": "Claim.prescription.extension",
        "sliceName": "groupIdentifier",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier"
            ]
          }
        ]
      },
      {
        "id": "Claim.prescription.identifier.system",
        "path": "Claim.prescription.identifier.system",
        "min": 1,
        "fixedUri": "https://fhir.nhs.uk/Id/prescription-order-item-number"
      },
      {
        "id": "Claim.prescription.identifier.value",
        "path": "Claim.prescription.identifier.value",
        "min": 1
      },
      {
        "id": "Claim.originalPrescription.extension",
        "path": "Claim.originalPrescription.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Claim.originalPrescription.extension:groupIdentifier",
        "path": "Claim.originalPrescription.extension",
        "sliceName": "groupIdentifier",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier"
            ]
          }
        ]
      },
      {
        "id": "Claim.originalPrescription.identifier.system",
        "path": "Claim.originalPrescription.identifier.system",
        "min": 1
      },
      {
        "id": "Claim.originalPrescription.identifier.value",
        "path": "Claim.originalPrescription.identifier.value",
        "min": 1
      },
      {
        "id": "Claim.payee",
        "path": "Claim.payee",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Claim.payee.party",
        "path": "Claim.payee.party",
        "min": 1
      },
      {
        "id": "Claim.payee.party.identifier",
        "path": "Claim.payee.party.identifier",
        "min": 1
      },
      {
        "id": "Claim.payee.party.identifier.system",
        "path": "Claim.payee.party.identifier.system",
        "min": 1
      },
      {
        "id": "Claim.payee.party.identifier.value",
        "path": "Claim.payee.party.identifier.value",
        "min": 1
      },
      {
        "id": "Claim.insurance",
        "path": "Claim.insurance",
        "mustSupport": true
      },
      {
        "id": "Claim.item",
        "path": "Claim.item",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Claim.item.extension",
        "path": "Claim.item.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Claim.item.extension:lineItemIdentifier",
        "path": "Claim.item.extension",
        "sliceName": "lineItemIdentifier",
        "short": "UUID for HL7v3 Message",
        "definition": "SuppliedLineItem.id",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/Extension-DM-SuppliedItemIdentifier"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.item.extension:prescriptionStatus",
        "path": "Claim.item.extension",
        "sliceName": "prescriptionStatus",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus"
            ]
          }
        ]
      },
      {
        "id": "Claim.item.extension:prescriptionStatusReasson",
        "path": "Claim.item.extension",
        "sliceName": "prescriptionStatusReasson",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.item.sequence",
        "path": "Claim.item.sequence",
        "mustSupport": true
      },
      {
        "id": "Claim.item.productOrService",
        "path": "Claim.item.productOrService",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "description": "DMD Medication Code",
          "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode"
        }
      },
      {
        "id": "Claim.item.modifier",
        "path": "Claim.item.modifier",
        "min": 1,
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "description": "Prescription status",
          "valueSet": "https://fhir.nhs.uk/ValueSet/DM-medicationdispense-type"
        }
      },
      {
        "id": "Claim.item.programCode",
        "path": "Claim.item.programCode",
        "short": "PrescriptionChargeExemption",
        "definition": "Describes possible reasons for someone not having to pay prescription charges.",
        "min": 1,
        "max": "1",
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "description": "Prescription Charge Exemption",
          "valueSet": "https://fhir.nhs.uk/ValueSet/DM-prescription-charge-exemption"
        }
      },
      {
        "id": "Claim.item.quantity",
        "path": "Claim.item.quantity",
        "mustSupport": true
      },
      {
        "id": "Claim.item.detail",
        "path": "Claim.item.detail",
        "mustSupport": true
      },
      {
        "id": "Claim.item.detail.sequence",
        "path": "Claim.item.detail.sequence",
        "mustSupport": true
      },
      {
        "id": "Claim.item.detail.productOrService",
        "path": "Claim.item.detail.productOrService",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "description": "DMD Medication Code",
          "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode"
        }
      },
      {
        "id": "Claim.item.detail.programCode",
        "path": "Claim.item.detail.programCode",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "coding.system"
            }
          ],
          "rules": "open"
        },
        "short": "Dispensing Endorsement and Charge Payment",
        "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.",
        "mustSupport": true
      },
      {
        "id": "Claim.item.detail.programCode:exemptionEvidence",
        "path": "Claim.item.detail.programCode",
        "sliceName": "exemptionEvidence",
        "max": "1",
        "binding": {
          "strength": "extensible",
          "valueSet": "https://fhir.nhs.uk/ValueSet/DM-vs-exemption-evidence"
        }
      },
      {
        "id": "Claim.item.detail.programCode:exemptionEvidence.coding.system",
        "path": "Claim.item.detail.programCode.coding.system",
        "fixedUri": "https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence"
      },
      {
        "id": "Claim.item.detail.programCode:prescriptionCharge",
        "path": "Claim.item.detail.programCode",
        "sliceName": "prescriptionCharge",
        "max": "1",
        "binding": {
          "strength": "extensible",
          "valueSet": "https://fhir.nhs.uk/ValueSet/DM-vs-prescription-charge"
        }
      },
      {
        "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",
        "sliceName": "dispensingEndorsement",
        "max": "1",
        "binding": {
          "strength": "extensible",
          "description": "Program specific reason codes",
          "valueSet": "https://fhir.nhs.uk/ValueSet/DM-dispensing-endorsement"
        }
      },
      {
        "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.quantity",
        "path": "Claim.item.detail.quantity",
        "mustSupport": true
      },
      {
        "id": "Claim.item.detail.quantity.extension",
        "path": "Claim.item.detail.quantity.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Claim.item.detail.quantity.extension:runningTotal",
        "path": "Claim.item.detail.quantity.extension",
        "sliceName": "runningTotal",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/Extension-DM-RunningTotal"
            ]
          }
        ]
      }
    ]
  }
}