{ "resourceType": "StructureDefinition", "id": "c7a6e6f2-4e97-48b9-9ec2-bd4f220e8a5d", "url": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim", "name": "NHSDigitalClaim", "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.extension", "path": "Claim.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "Claim.extension:replacementOf", "path": "Claim.extension", "sliceName": "replacementOf", "short": "Used to reference a previous Claim", "definition": "Used for replacement Claims, this should reference the Claim.identifier of the Claim being replaced.\r\n\r\n```json\r\n\r\n \"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf\",\r\n \"valueIdentifier\": {\r\n \"value\": \"46055273-3001-41bd-86a0-f8dba7f2161a\"\r\n }\r\n }\r\n ],\r\n\r\n```", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf" ] } ], "mustSupport": true }, { "id": "Claim.extension:agent", "path": "Claim.extension", "sliceName": "agent", "short": "Provenance of the resource", "definition": "The person submitting/authoring the Claim\r\n\r\n```json\r\n\r\n \"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent\",\r\n \"valueReference\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/sds-role-profile-id\",\r\n \"value\": \"884562163557\"\r\n },\r\n \"display\": \"dummy full name\"\r\n }\r\n }\r\n ],\r\n```", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent" ] } ], "mustSupport": true }, { "id": "Claim.identifier", "path": "Claim.identifier", "definition": "**MUST** be unique for each Claim. In EPS this must be a UUID with a system of `https://fhir.nhs.uk/Id/prescription-dispense-item-number`\r\n\r\n```json\r\n\r\n \"identifier\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/Id/prescription-dispense-item-number\",\r\n \"value\": \"4509B70D-D8B8-EA03-1105-64557CB54A29\"\r\n }\r\n ],\r\n\r\n```", "min": 1, "mustSupport": true }, { "id": "Claim.identifier.system", "path": "Claim.identifier.system", "min": 1 }, { "id": "Claim.identifier.value", "path": "Claim.identifier.value", "min": 1 }, { "id": "Claim.status", "path": "Claim.status", "definition": "For EPS the following **MUST** be used.\r\n\r\n```json\r\n\r\n \"status\": \"active\",\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\r\n \"code\": \"pharmacy\",\r\n \"display\": \"Pharmacy\"\r\n } \r\n ]\r\n },\r\n \"use\": \"claim\",\r\n\r\n```", "mustSupport": true }, { "id": "Claim.type", "path": "Claim.type", "mustSupport": true }, { "id": "Claim.type.coding", "path": "Claim.type.coding", "min": 1 }, { "id": "Claim.type.coding.system", "path": "Claim.type.coding.system", "min": 1, "fixedUri": "http://terminology.hl7.org/CodeSystem/claim-type" }, { "id": "Claim.type.coding.code", "path": "Claim.type.coding.code", "min": 1, "fixedCode": "pharmacy" }, { "id": "Claim.use", "path": "Claim.use", "fixedCode": "claim" }, { "id": "Claim.patient", "path": "Claim.patient", "definition": "**MUST** be an identifier reference using the Patients NHS Number.\r\n\r\n```json\r\n\r\n \"patient\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/nhs-number\",\r\n \"value\": \"2300992742\"\r\n }\r\n },\r\n\r\n```", "constraint": [ { "key": "patient-reference", "severity": "error", "human": "An identifier reference or resource reference must be provided", "expression": "(reference.exists() or identifier.exists())", "source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim" }, { "key": "patient-nhs", "severity": "error", "human": "Supplied NHS Number is outside the English and Welsh NHS Number range or length of the number is wrong.", "expression": "identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists().not() or (identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists() and identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').value.matches('^([456789]{1}[0-9]{9})$'))", "source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim" } ], "mustSupport": true }, { "id": "Claim.patient.identifier", "path": "Claim.patient.identifier", "min": 1 }, { "id": "Claim.patient.identifier.system", "path": "Claim.patient.identifier.system", "min": 1, "fixedUri": "https://fhir.nhs.uk/Id/nhs-number" }, { "id": "Claim.patient.identifier.value", "path": "Claim.patient.identifier.value", "min": 1 }, { "id": "Claim.created", "path": "Claim.created", "definition": "The date of the Claim\r\n\r\n```json\r\n\r\n \"created\": \"2004-09-16T16:30:00+00:00\",\r\n\r\n```", "mustSupport": true }, { "id": "Claim.provider", "path": "Claim.provider", "definition": "The organisation responsible for the claim, this must be a reference to a contained PractitoinerRole\r\n\r\n```json\r\n \"provider\": {\r\n \"reference\" : \"#provider\"\r\n },\r\n```\r\n\r\nThe contained PractitionerRole\r\n\r\n```json\r\n{\r\n \"resourceType\": \"Claim\",\r\n \"id\": \"258E153F-567B-4D60-B045-BA315A6B8DB0\",\r\n \"contained\": [\r\n {\r\n \"resourceType\": \"PractitionerRole\",\r\n \"id\": \"provider\",\r\n \"identifier\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/Id/sds-role-profile-id\",\r\n \"value\": \"454567759542\"\r\n }\r\n ],\r\n \"code\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/NHSDigital-SDS-JobRoleCode\",\r\n \"code\": \"S0030:G0100:R0620\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"practitioner\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/sds-user-id\",\r\n \"value\": \"7654321\"\r\n },\r\n \"display\": \"Mr Peter Potion\"\r\n },\r\n \"organization\": {\r\n \"reference\": \"#organisation\"\r\n },\r\n \"telecom\": [\r\n {\r\n \"system\": \"phone\",\r\n \"use\": \"work\",\r\n \"value\": \"01234567890\"\r\n }\r\n ]\r\n },\r\n {\r\n \"resourceType\": \"Organization\",\r\n \"id\": \"organisation\",\r\n \"identifier\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/Id/ods-organization-code\",\r\n \"value\": \"VNE51\"\r\n }\r\n ],\r\n \"address\": [\r\n {\r\n \"city\": \"West Yorkshire\",\r\n \"use\": \"work\",\r\n \"line\": [\r\n \"17 Austhorpe Road\",\r\n \"Crossgates\",\r\n \"Leeds\"\r\n ],\r\n \"postalCode\": \"LS15 8BA\"\r\n }\r\n ],\r\n \"active\": true,\r\n \"type\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/organisation-role\",\r\n \"code\": \"182\",\r\n \"display\": \"PHARMACY\"\r\n }\r\n ]\r\n }\r\n ],\r\n \"name\": \"The Simple Pharmacy\",\r\n \"telecom\": [\r\n {\r\n \"system\": \"phone\",\r\n \"use\": \"work\",\r\n \"value\": \"0113 3180277\"\r\n }\r\n ]\r\n } \r\n ],\r\n```", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.nhs.uk/StructureDefinition/NHSDigital-PractitionerRole-SDS" ], "aggregation": [ "contained" ] } ], "mustSupport": true }, { "id": "Claim.provider.reference", "path": "Claim.provider.reference", "min": 1 }, { "id": "Claim.provider.identifier.system", "path": "Claim.provider.identifier.system", "min": 1 }, { "id": "Claim.provider.identifier.value", "path": "Claim.provider.identifier.value", "min": 1 }, { "id": "Claim.priority", "path": "Claim.priority", "definition": "Desired processing ugency. Fixed value.\r\n\r\n```json\r\n\"priority\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\r\n \"code\": \"normal\"\r\n }\r\n ]\r\n }\r\n```", "mustSupport": true }, { "id": "Claim.priority.coding", "path": "Claim.priority.coding", "min": 1, "max": "1" }, { "id": "Claim.priority.coding.system", "path": "Claim.priority.coding.system", "min": 1, "fixedUri": "http://terminology.hl7.org/CodeSystem/processpriority" }, { "id": "Claim.priority.coding.code", "path": "Claim.priority.coding.code", "min": 1, "fixedCode": "normal" }, { "id": "Claim.prescription", "path": "Claim.prescription", "definition": "References to the original prescription, the `groupIdentifier` contains both the ShortForm prescription id and long form UUID variant. See [NHSDigital-MedicationRequest](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest) for more details.\r\n\r\nThis MUST not be used to reference the MedicationRequest.\r\n\r\n```json\r\n\r\n\"prescription\": {\r\n \"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier\",\r\n \"extension\": [\r\n {\r\n \"url\": \"shortForm\",\r\n \"valueIdentifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/prescription-order-number\",\r\n \"value\": \"82D996-C81010-11DB12\"\r\n }\r\n },\r\n {\r\n \"url\": \"UUID\",\r\n \"valueIdentifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/prescription\",\r\n \"value\": \"b2fc79f0-2793-4736-9b2d-0976c21e73a5\"\r\n }\r\n }\r\n ]\r\n }\r\n ]\r\n},\r\n\r\n```", "min": 1, "mustSupport": true }, { "id": "Claim.prescription.extension", "path": "Claim.prescription.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 1 }, { "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.reference", "path": "Claim.prescription.reference", "max": "0" }, { "id": "Claim.prescription.identifier", "path": "Claim.prescription.identifier", "max": "0" }, { "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" }, "min": 1 }, { "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", "definition": "The recipient of benefits payable. This is the ODS Code of the Pharmacy (provider) making the Claim.\r\n\r\nSee provider for example of a contained Organization.\r\n\r\n```json\r\n\r\n\"payee\": {\r\n \"type\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/payeetype\",\r\n \"value\": \"provider\",\r\n \"display\": \"Provider\"\r\n }\r\n ]\r\n },\r\n \"party\": {\r\n \"reference\": \"#organisation\",\r\n \"display\": \"The Simple Pharmacy\"\r\n }\r\n}\r\n```", "min": 1, "mustSupport": true }, { "id": "Claim.payee.type.coding", "path": "Claim.payee.type.coding", "min": 1 }, { "id": "Claim.payee.type.coding.system", "path": "Claim.payee.type.coding.system", "min": 1, "fixedUri": "http://terminology.hl7.org/CodeSystem/payeetype" }, { "id": "Claim.payee.type.coding.code", "path": "Claim.payee.type.coding.code", "min": 1, "fixedCode": "provider" }, { "id": "Claim.payee.type.coding.display", "path": "Claim.payee.type.coding.display", "min": 1, "fixedString": "Provider" }, { "id": "Claim.payee.party", "path": "Claim.payee.party", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Organization" ] } ], "constraint": [ { "key": "nhsd-claim-party", "severity": "error", "human": "party - An identifier reference or resource reference must be provided", "expression": "(reference.exists() or (identifier.exists()))", "source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim" } ] }, { "id": "Claim.payee.party.identifier.system", "path": "Claim.payee.party.identifier.system", "min": 1, "fixedUri": "https://fhir.nhs.uk/Id/ods-organization-code" }, { "id": "Claim.payee.party.identifier.value", "path": "Claim.payee.party.identifier.value", "min": 1 }, { "id": "Claim.insurance", "path": "Claim.insurance", "definition": "For EPS this is the NHS Business Services Authority. The sequence value must always be 1.\r\n\r\n```json\r\n\r\n\"insurance\": [\r\n {\r\n \"sequence\": 1,\r\n \"focal\": true,\r\n \"coverage\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/ods-organization-code\",\r\n \"value\": \"T1450\"\r\n },\r\n \"display\": \"NHS BUSINESS SERVICES AUTHORITY\"\r\n }\r\n }\r\n],\r\n```", "max": "1", "mustSupport": true }, { "id": "Claim.insurance.coverage.identifier", "path": "Claim.insurance.coverage.identifier", "min": 1 }, { "id": "Claim.insurance.coverage.identifier.system", "path": "Claim.insurance.coverage.identifier.system", "min": 1, "fixedUri": "https://fhir.nhs.uk/Id/ods-organization-code" }, { "id": "Claim.insurance.coverage.identifier.value", "path": "Claim.insurance.coverage.identifier.value", "min": 1, "fixedString": "T1450" }, { "id": "Claim.item", "path": "Claim.item", "definition": "\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n
item (prescription)detail (requested medication)subDetail (dispensed medication)
\r\n productOrService\r\n \r\n 16076005 Prescription\r\n \r\n dm+d code of requested medication\r\n \r\n dm+d code of dispensed medication\r\n
\r\n programCode\r\n \r\n exemptionEvidence\r\n prescriptionChargeExemption\r\n \r\n prescriptionCharge\r\n dispensingEndorsement\r\n additionalInstructions\r\n \r\n
\r\n modifier\r\n \r\n \r\n MedicationDispenseType\r\n \r\n
\r\n quantity\r\n \r\n \r\n MedicationRequest.quantity\r\n \r\n MedicationDispense.quantity\r\n
", "min": 1, "max": "1", "mustSupport": true }, { "id": "Claim.item.extension", "path": "Claim.item.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 1 }, { "id": "Claim.item.extension:prescriptionStatus", "path": "Claim.item.extension", "sliceName": "prescriptionStatus", "definition": "This will generally match the value of the last `dispense-notification` message.\r\n\r\nThis should match the `status` of the associated [NHSDigital-Task](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-Task)\r\n\r\n```json\r\n\r\n\"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus\",\r\n \"valueCoding\": {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/EPS-task-business-status\",\r\n \"code\": \"0006\",\r\n \"display\": \"Dispensed\"\r\n }\r\n }\r\n] \r\n ```", "min": 1, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus" ] } ], "mustSupport": true }, { "id": "Claim.item.extension:prescriptionStatusReason", "path": "Claim.item.extension", "sliceName": "prescriptionStatusReason", "short": "Prescription Status Reason", "definition": "Mandatory if the medication was not dispensed. \r\nThis should match the `statusReason` of the associated [NHSDigital-Task](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-Task)\r\n\r\n```json\r\n\r\n\"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason\",\r\n \"valueCoding\": {\r\n \"system\": \"https://fhir.nhs.uk/ValueSet/DM-medicationdispense-status-reason\",\r\n \"code\": \"0001\",\r\n \"display\": \"Not required as instructed by the patient\"\r\n }\r\n }\r\n],\r\n\r\n```", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason" ] } ], "mustSupport": true }, { "id": "Claim.item.sequence", "path": "Claim.item.sequence", "fixedPositiveInt": 1 }, { "id": "Claim.item.productOrService", "path": "Claim.item.productOrService", "definition": "Mandatory fixed value.\r\n\r\n```json\r\n\r\n\"productOrService\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://snomed.info/sct\",\r\n \"code\": \"16076005\",\r\n \"display\": \"Prescription\"\r\n }\r\n ]\r\n},\r\n\r\n```", "comment": "To be expanded. At present a fixed SNOMED CT value" }, { "id": "Claim.item.productOrService.coding", "path": "Claim.item.productOrService.coding", "min": 1, "max": "1" }, { "id": "Claim.item.productOrService.coding.system", "path": "Claim.item.productOrService.coding.system", "min": 1, "fixedUri": "http://snomed.info/sct" }, { "id": "Claim.item.productOrService.coding.code", "path": "Claim.item.productOrService.coding.code", "min": 1, "fixedCode": "16076005" }, { "id": "Claim.item.productOrService.coding.display", "path": "Claim.item.productOrService.coding.display", "min": 1, "fixedString": "Prescription" }, { "id": "Claim.item.programCode", "path": "Claim.item.programCode", "slicing": { "discriminator": [ { "type": "value", "path": "coding.system" } ], "rules": "open" }, "short": "PrescriptionChargeExemption", "definition": "Exemption evidence - code to denote which evidence for exemption has been seen.\r\n\r\nPrescription Charge Exemption - code to denote the exemption reason \r\n```json \r\n\r\n\"programCode\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"code\": \"0001\",\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption\",\r\n \"display\": \"Patient has paid appropriate charges\"\r\n }\r\n ]\r\n },\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence\",\r\n \"code\": \"no-evidence-seen\",\r\n \"display\": \"No Evidence Seen\"\r\n }\r\n ]\r\n }\r\n ]\r\n\r\n```", "mustSupport": true, "binding": { "strength": "example", "description": "Prescription Charge Exemption" } }, { "id": "Claim.item.programCode.coding", "path": "Claim.item.programCode.coding", "min": 1 }, { "id": "Claim.item.programCode.coding.system", "path": "Claim.item.programCode.coding.system", "min": 1 }, { "id": "Claim.item.programCode.coding.code", "path": "Claim.item.programCode.coding.code", "min": 1 }, { "id": "Claim.item.programCode:exemptionEvidence", "path": "Claim.item.programCode", "sliceName": "exemptionEvidence", "max": "1", "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "https://fhir.nhs.uk/ValueSet/DM-vs-exemption-evidence" } }, { "id": "Claim.item.programCode:exemptionEvidence.coding.system", "path": "Claim.item.programCode.coding.system", "min": 1, "fixedUri": "https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence" }, { "id": "Claim.item.programCode:exemptionEvidence.coding.code", "path": "Claim.item.programCode.coding.code", "min": 1 }, { "id": "Claim.item.programCode:prescriptionChargeExemption", "path": "Claim.item.programCode", "sliceName": "prescriptionChargeExemption", "min": 1, "max": "1", "mustSupport": true, "binding": { "strength": "required", "description": "Prescription Charge Exemption", "valueSet": "https://fhir.nhs.uk/ValueSet/DM-prescription-charge-exemption" } }, { "id": "Claim.item.programCode:prescriptionChargeExemption.coding.system", "path": "Claim.item.programCode.coding.system", "min": 1, "fixedUri": "https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption" }, { "id": "Claim.item.programCode:prescriptionChargeExemption.coding.code", "path": "Claim.item.programCode.coding.code", "min": 1 }, { "id": "Claim.item.detail", "path": "Claim.item.detail", "definition": "A claim detail line. Relates to MedicationRequest", "min": 1, "mustSupport": true }, { "id": "Claim.item.detail.extension", "path": "Claim.item.detail.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 2 }, { "id": "Claim.item.detail.extension:medicationRequest", "path": "Claim.item.detail.extension", "sliceName": "medicationRequest", "short": "MedicationRequest reference", "definition": "This should match the `identifier` of the associated [NHSDigital-MedicationRequest](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest)\r\n\r\n```json\r\n\r\n\"extension\": [\r\n {\r\n \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference\",\r\n \"valueReference\": {\r\n \"identifier\": {\r\n \"system\": \"https://fhir.nhs.uk/Id/prescription-order-item-number\",\r\n \"value\": \"33560bee-bc0c-4e3b-a155-71591eee9ca5\"\r\n }\r\n }\r\n }\r\n],\r\n\r\n```", "min": 1, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference" ] } ], "mustSupport": true }, { "id": "Claim.item.detail.extension:sequenceIdentifier", "path": "Claim.item.detail.extension", "sliceName": "sequenceIdentifier", "min": 1, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-ClaimSequenceIdentifier" ] } ], "mustSupport": true }, { "id": "Claim.item.detail.extension:repeatInformation", "path": "Claim.item.detail.extension", "sliceName": "repeatInformation", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation" ] } ] }, { "id": "Claim.item.detail.sequence", "path": "Claim.item.detail.sequence", "definition": "An integer to identify the item within the resource. Fixed value.\r\n\r\n```json\r\n\r\n\"sequence\": 1,\r\n\r\n```", "mustSupport": true }, { "id": "Claim.item.detail.productOrService", "path": "Claim.item.detail.productOrService", "definition": "This should match the `medicationCodeableConcept` of the associated [NHSDigital-MedicationRequest](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest)\r\n\r\n```json\r\n\r\n\"productOrService\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://snomed.info/sct\",\r\n \"code\": \"322237000\",\r\n \"display\": \"Paracetamol 500mg soluble tablets\"\r\n }\r\n ]\r\n},\r\n\r\n```", "mustSupport": true, "binding": { "strength": "required", "description": "DMD Medication Code", "valueSet": "https://fhir.nhs.uk/ValueSet/NHSDigital-MedicationRequest-Code" } }, { "id": "Claim.item.detail.modifier", "path": "Claim.item.detail.modifier", "definition": "If the code is `0002 - Item not dispensed` then the extension `prescriptionStatusReason` is required.\r\n\r\nThis should match the `type` of the last associated [NHSDigital-MedicationDispense](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense)\r\n\r\n```json\r\n\r\n\"modifier\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationdispense-type\",\r\n \"code\": \"0001\",\r\n \"display\": \"Item fully dispensed\"\r\n }\r\n ]\r\n }\r\n],\r\n\r\n```", "min": 1, "mustSupport": true, "binding": { "strength": "required", "description": "MedicationDispense Type", "valueSet": "https://fhir.nhs.uk/ValueSet/DM-medicationdispense-type" } }, { "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.\r\n\r\n```json\r\n\r\n\"programCode\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/DM-prescription-charge\",\r\n \"code\": \"paid-once\",\r\n \"display\": \"Paid Once\"\r\n }\r\n ]\r\n },\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement\",\r\n \"code\": \"IP\",\r\n \"display\": \"Invoice Price\"\r\n }\r\n ]\r\n }\r\n],\r\n\r\n```", "mustSupport": true }, { "id": "Claim.item.detail.programCode.coding", "path": "Claim.item.detail.programCode.coding", "min": 1, "mustSupport": true }, { "id": "Claim.item.detail.programCode.coding.system", "path": "Claim.item.detail.programCode.coding.system", "min": 1 }, { "id": "Claim.item.detail.programCode.coding.code", "path": "Claim.item.detail.programCode.coding.code", "min": 1 }, { "id": "Claim.item.detail.programCode:prescriptionCharge", "path": "Claim.item.detail.programCode", "sliceName": "prescriptionCharge", "min": 1, "max": "1", "mustSupport": true, "binding": { "strength": "required", "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", "mustSupport": true, "binding": { "strength": "required", "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.programCode:dispensingEndorsement.text", "path": "Claim.item.detail.programCode.text", "short": "Additional Information for Dispensing Endorsements", "definition": "Additional Information for Dispensing Endorsements should be entered in this field. Details on the format of this text field can be found in `Requirements and Electronic Prescription Service Guidance for Endorsement (EPS)`\r\n\r\n```json\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement\",\r\n \"code\": \"IP\",\r\n \"display\": \"Invoice Price for less common products or special items\"\r\n }\r\n ],\r\n \"text\" : \"15gram,£12.34,EFGH Ltd\"\r\n }\r\n```" }, { "id": "Claim.item.detail.quantity", "path": "Claim.item.detail.quantity", "definition": "This should match the `quantity` of the associated [NHSDigital-MedicationRequest](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest)\r\n\r\n```json\r\n\r\n\"quantity\": {\r\n \"value\": 200,\r\n \"unit\": \"unit dose\",\r\n \"system\": \"http://snomed.info/sct\",\r\n \"code\": \"408102007\"\r\n},\r\n\r\n```", "mustSupport": true }, { "id": "Claim.item.detail.subDetail", "path": "Claim.item.detail.subDetail", "definition": "subDetail is only present if the medication has been dispensed.", "mustSupport": true }, { "id": "Claim.item.detail.subDetail.extension", "path": "Claim.item.detail.subDetail.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "Claim.item.detail.subDetail.extension:medicationDispense", "path": "Claim.item.detail.subDetail.extension", "sliceName": "medicationDispense", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationDispenseReference" ] } ] }, { "id": "Claim.item.detail.subDetail.extension:repeatInformation", "path": "Claim.item.detail.subDetail.extension", "sliceName": "repeatInformation", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation" ] } ] }, { "id": "Claim.item.detail.subDetail.sequence", "path": "Claim.item.detail.subDetail.sequence", "definition": "An integer id for each medication dispense.\r\n\r\n```json\r\n\r\n\"sequence\": 1,\r\n\r\n\r\n```", "mustSupport": true }, { "id": "Claim.item.detail.subDetail.productOrService", "path": "Claim.item.detail.subDetail.productOrService", "definition": "This should match the `medicationCodeableConcept` of the associated [NHSDigital-MedicationDispense](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense)\r\n\r\n```json\r\n\r\n\"productOrService\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://snomed.info/sct\",\r\n \"code\": \"3416211000001106\",\r\n \"display\": \"Salbutamol 100micrograms/dose inhaler (Sandoz Ltd) 200 dose\"\r\n }\r\n ]\r\n},\r\n\r\n```", "mustSupport": true, "binding": { "strength": "extensible", "description": "DMD Medication Code", "valueSet": "https://fhir.nhs.uk/ValueSet/NHSDigital-MedicationDispense-Code" } }, { "id": "Claim.item.detail.subDetail.quantity", "path": "Claim.item.detail.subDetail.quantity", "definition": "This should match the `quantity` of the associated [NHSDigital-MedicationDispense](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense)\r\n\r\n```json\r\n\r\n\"quantity\": {\r\n \"value\": 200,\r\n \"unit\": \"unit dose\",\r\n \"system\": \"http://snomed.info/sct\",\r\n \"code\": \"408102007\"\r\n}\r\n\r\n```", "min": 1, "mustSupport": true }, { "id": "Claim.item.detail.subDetail.quantity.extension", "path": "Claim.item.detail.subDetail.quantity.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "Claim.item.detail.subDetail.quantity.extension:runningTotal", "path": "Claim.item.detail.subDetail.quantity.extension", "sliceName": "runningTotal", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-DM-RunningTotal" ] } ] } ] } }