{
  "resourceType": "StructureDefinition",
  "id": "profile-DwClaim",
  "url": "https://www.telus.com/health/fhir/dwemrextract/StructureDefinition/DwClaim",
  "version": "2.0.0",
  "name": "DwClaim",
  "status": "draft",
  "date": "2026-05-29",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "Claim",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Claim",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Claim.id",
        "path": "Claim.id",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Claim.meta",
        "path": "Claim.meta",
        "mustSupport": false
      },
      {
        "id": "Claim.meta.lastUpdated",
        "path": "Claim.meta.lastUpdated",
        "min": 1
      },
      {
        "id": "Claim.meta.source",
        "path": "Claim.meta.source",
        "min": 1
      },
      {
        "id": "Claim.text",
        "path": "Claim.text",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Claim.identifier",
        "path": "Claim.identifier",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "Claim.identifier.system",
        "path": "Claim.identifier.system",
        "mustSupport": true
      },
      {
        "id": "Claim.identifier.value",
        "path": "Claim.identifier.value",
        "mustSupport": true
      },
      {
        "id": "Claim.status",
        "path": "Claim.status",
        "comment": "Usage note:\nClaim submitted → active\nClaim not submitted → draft\nClaim deleted before submission → entered-in-error",
        "mustSupport": true
      },
      {
        "id": "Claim.type",
        "path": "Claim.type",
        "comment": "Usage note:\nInpatient, hospital bills → Institutional\nOutpatient clinic bills → professional",
        "mustSupport": true
      },
      {
        "id": "Claim.use",
        "path": "Claim.use",
        "comment": "Always 'claim'.",
        "mustSupport": true
      },
      {
        "id": "Claim.patient",
        "path": "Claim.patient",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://www.telus.com/health/fhir/dwemrextract/StructureDefinition/DwPatient"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.created",
        "path": "Claim.created",
        "mustSupport": true
      },
      {
        "id": "Claim.provider",
        "path": "Claim.provider",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://www.telus.com/health/fhir/dwemrextract/StructureDefinition/DwPractitioner",
              "https://www.telus.com/health/fhir/dwemrextract/StructureDefinition/DwPractitionerRole",
              "https://www.telus.com/health/fhir/dwemrextract/StructureDefinition/DwOrganization"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.priority",
        "path": "Claim.priority",
        "comment": "Usage note: Default to 'Normal'",
        "mustSupport": true
      },
      {
        "id": "Claim.diagnosis",
        "path": "Claim.diagnosis",
        "comment": "Usage note: Diagnosis code for the whole bill",
        "mustSupport": true
      },
      {
        "id": "Claim.insurance",
        "path": "Claim.insurance",
        "mustSupport": true
      },
      {
        "id": "Claim.insurance.sequence",
        "path": "Claim.insurance.sequence",
        "comment": "Usage note: Sequence is always 1"
      },
      {
        "id": "Claim.insurance.focal",
        "path": "Claim.insurance.focal",
        "comment": "Always true."
      },
      {
        "id": "Claim.insurance.coverage.display",
        "path": "Claim.insurance.coverage.display",
        "comment": "Usage note: Province — Ministry Billing",
        "mustSupport": true
      },
      {
        "id": "Claim.item.sequence",
        "path": "Claim.item.sequence",
        "mustSupport": true
      },
      {
        "id": "Claim.item.diagnosisSequence",
        "path": "Claim.item.diagnosisSequence",
        "mustSupport": true
      },
      {
        "id": "Claim.item.productOrService",
        "path": "Claim.item.productOrService",
        "mustSupport": true
      },
      {
        "id": "Claim.item.productOrService.text",
        "path": "Claim.item.productOrService.text",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Claim.item.modifier",
        "path": "Claim.item.modifier",
        "mustSupport": true
      },
      {
        "id": "Claim.item.modifier.text",
        "path": "Claim.item.modifier.text",
        "mustSupport": true
      },
      {
        "id": "Claim.item.serviced[x]",
        "path": "Claim.item.serviced[x]",
        "mustSupport": true
      },
      {
        "id": "Claim.item.quantity",
        "path": "Claim.item.quantity",
        "comment": "Usage note: Typically documented as unit or calls in EMR",
        "mustSupport": true
      },
      {
        "id": "Claim.item.net",
        "path": "Claim.item.net",
        "mustSupport": true
      },
      {
        "id": "Claim.item.encounter",
        "path": "Claim.item.encounter",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://www.telus.com/health/fhir/dwemrextract/StructureDefinition/DwEncounter"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Claim.total",
        "path": "Claim.total",
        "mustSupport": true
      }
    ]
  }
}