{ "resourceType" : "Claim", "id" : "ExampleClaimItemizedMultiStage", "meta" : { "profile" : ["http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-itemized-healthcare-cost-claim"] }, "language" : "vi", "text" : { "status" : "extensions", "div" : "

Generated Narrative: Claim ExampleClaimItemizedMultiStage

Profile: Yêu cầu bảng kê chi phí KCB chi tiết — VN Core Itemized Healthcare Cost Claim

identifier: Mã liên kết hồ sơ BHYT/LK-ITEMIZED-2026-0001

status: Active

type: Institutional

use: Claim

patient: Nguyễn Văn An

billablePeriod: 2026-03-01 --> 2026-03-07

created: 2026-03-10

insurer: Bảo hiểm xã hội Việt Nam

provider: Bệnh viện Chợ Rẫy

priority: Normal

Diagnoses

-SequenceDiagnosis[x]Type
*1Acute appendicitis, other and unspecifiedPrincipal Diagnosis

insurance

Giai đoạn hưởng bảo hiểm — Coverage Benefit Stage

  • sequence: 1
  • period: 2026-03-01 --> 2026-03-04
  • benefitLevel: 80

Giai đoạn hưởng bảo hiểm — Coverage Benefit Stage

  • sequence: 2
  • period: 2026-03-05 --> 2026-03-07
  • benefitLevel: 100

sequence: 1

focal: true

coverage: Thẻ BHYT Nguyễn Văn An được giám định

item

Thông tin chi phí BHYT — Insurance Cost Info Extension

  • scope: Trong phạm vi hưởng BHYT
  • paymentRatio: 100
  • benefitLevel: 80
  • servicePaymentRatio: 100
  • insuranceUnitPrice: ₫200.000 (VND)
  • insuranceLineAmount: ₫200.000 (VND)

Liên kết dòng chi phí với giai đoạn hưởng — Item Benefit Stage Sequence: 1

Phân bổ nguồn thanh toán theo dòng — Line Payment Allocation

  • insuranceFund: ₫160.000 (VND)
  • patientCopay: ₫40.000 (VND)
  • otherSource: ₫0 (VND)
  • patientSelfPay: ₫0 (VND)

sequence: 1

category: Khám bệnh

productOrService: Khám chuyên khoa Ngoại tiêu hóa

serviced: 2026-03-02

quantity: 1 lần

UnitPrices

-ValueCurrency
*200000Vietnamese đồng

Nets

-ValueCurrency
*200000Vietnamese đồng

item

Thông tin chi phí BHYT — Insurance Cost Info Extension

  • scope: Trong phạm vi hưởng BHYT
  • paymentRatio: 100
  • benefitLevel: 80
  • servicePaymentRatio: 100
  • insuranceUnitPrice: ₫300.000 (VND)
  • insuranceLineAmount: ₫300.000 (VND)

Liên kết dòng chi phí với giai đoạn hưởng — Item Benefit Stage Sequence: 1

Phân bổ nguồn thanh toán theo dòng — Line Payment Allocation

  • insuranceFund: ₫240.000 (VND)
  • patientCopay: ₫60.000 (VND)
  • otherSource: ₫0 (VND)
  • patientSelfPay: ₫0 (VND)

sequence: 2

category: Xét nghiệm

productOrService: Xét nghiệm công thức máu toàn phần

serviced: 2026-03-04

quantity: 1 lần

UnitPrices

-ValueCurrency
*300000Vietnamese đồng

Nets

-ValueCurrency
*300000Vietnamese đồng

item

Thông tin chi phí BHYT — Insurance Cost Info Extension

  • scope: Trong phạm vi hưởng BHYT
  • paymentRatio: 100
  • benefitLevel: 100
  • servicePaymentRatio: 100
  • insuranceUnitPrice: ₫1.000.000 (VND)
  • insuranceLineAmount: ₫1.000.000 (VND)

Liên kết dòng chi phí với giai đoạn hưởng — Item Benefit Stage Sequence: 2

Phân bổ nguồn thanh toán theo dòng — Line Payment Allocation

  • insuranceFund: ₫1.000.000 (VND)
  • patientCopay: ₫0 (VND)
  • otherSource: ₫0 (VND)
  • patientSelfPay: ₫0 (VND)

sequence: 3

category: Thiết bị y tế

productOrService: Gói thiết bị y tế can thiệp mạch

serviced: 2026-03-05

quantity: 1 lần

UnitPrices

-ValueCurrency
*1000000Vietnamese đồng

Nets

-ValueCurrency
*1000000Vietnamese đồng

detail

Thông tin chi phí BHYT — Insurance Cost Info Extension

  • scope: Trong phạm vi hưởng BHYT
  • paymentRatio: 100
  • servicePaymentRatio: 100
  • insuranceUnitPrice: ₫800.000 (VND)
  • insuranceLineAmount: ₫800.000 (VND)

sequence: 1

productOrService: Stent mạch vành

quantity: 1 cái

UnitPrices

-ValueCurrency
*800000Vietnamese đồng

Nets

-ValueCurrency
*800000Vietnamese đồng

detail

Thông tin chi phí BHYT — Insurance Cost Info Extension

  • scope: Trong phạm vi hưởng BHYT
  • paymentRatio: 100
  • servicePaymentRatio: 100
  • insuranceUnitPrice: ₫200.000 (VND)
  • insuranceLineAmount: ₫200.000 (VND)

sequence: 2

productOrService: Bóng nong mạch vành

quantity: 1 cái

UnitPrices

-ValueCurrency
*200000Vietnamese đồng

Nets

-ValueCurrency
*200000Vietnamese đồng

item

Thông tin chi phí BHYT — Insurance Cost Info Extension

  • scope: Trong phạm vi hưởng BHYT
  • paymentRatio: 80
  • benefitLevel: 100
  • servicePaymentRatio: 100
  • insuranceUnitPrice: ₫50.000 (VND)
  • insuranceLineAmount: ₫400.000 (VND)

Liên kết dòng chi phí với giai đoạn hưởng — Item Benefit Stage Sequence: 2

Phân bổ nguồn thanh toán theo dòng — Line Payment Allocation

  • insuranceFund: ₫400.000 (VND)
  • patientCopay: ₫0 (VND)
  • otherSource: ₫50.000 (VND)
  • patientSelfPay: ₫50.000 (VND)

Chi tiết nguồn khác chi trả theo dòng — Other Fund Breakdown Extension

  • stateBudget: ₫50.000 (VND)

sequence: 4

category: Thuốc, dịch truyền

productOrService: Ceftriaxone 2 g bột pha tiêm

serviced: 2026-03-06

quantity: 10 lọ

UnitPrices

-ValueCurrency
*50000Vietnamese đồng

Nets

-ValueCurrency
*500000Vietnamese đồng

Totals

-ValueCurrency
*2000000Vietnamese đồng
" }, "identifier" : [{ "type" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-identifier-type-cs", "code" : "MA_LK", "display" : "Mã liên kết hồ sơ BHYT" }] }, "system" : "http://fhir.hl7.org.vn/core/sid/ma-lk", "value" : "LK-ITEMIZED-2026-0001" }], "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "institutional", "display" : "Institutional" }] }, "use" : "claim", "patient" : { "reference" : "Patient/ExamplePatientNguyenVanAn", "display" : "Nguyễn Văn An" }, "billablePeriod" : { "start" : "2026-03-01", "end" : "2026-03-07" }, "created" : "2026-03-10", "insurer" : { "reference" : "Organization/ExampleOrganizationBHXH", "display" : "Bảo hiểm xã hội Việt Nam" }, "provider" : { "reference" : "Organization/ExampleOrganizationChoRay", "display" : "Bệnh viện Chợ Rẫy" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal", "display" : "Normal" }] }, "diagnosis" : [{ "sequence" : 1, "diagnosisCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/sid/icd-10", "code" : "K35.8", "display" : "Acute appendicitis, other and unspecified" }] }, "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code" : "principal", "display" : "Principal Diagnosis" }] }] }], "insurance" : [{ "extension" : [{ "extension" : [{ "url" : "sequence", "valuePositiveInt" : 1 }, { "url" : "period", "valuePeriod" : { "start" : "2026-03-01", "end" : "2026-03-04" } }, { "url" : "benefitLevel", "valueDecimal" : 80 }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-coverage-benefit-stage" }, { "extension" : [{ "url" : "sequence", "valuePositiveInt" : 2 }, { "url" : "period", "valuePeriod" : { "start" : "2026-03-05", "end" : "2026-03-07" } }, { "url" : "benefitLevel", "valueDecimal" : 100 }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-coverage-benefit-stage" }], "sequence" : 1, "focal" : true, "coverage" : { "reference" : "Coverage/ExampleCoverageBHYTNew", "display" : "Thẻ BHYT Nguyễn Văn An được giám định" } }], "item" : [{ "extension" : [{ "extension" : [{ "url" : "scope", "valueCodeableConcept" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs", "code" : "1", "display" : "Trong phạm vi hưởng BHYT" }] } }, { "url" : "paymentRatio", "valueDecimal" : 100 }, { "url" : "benefitLevel", "valueDecimal" : 80 }, { "url" : "servicePaymentRatio", "valueDecimal" : 100 }, { "url" : "insuranceUnitPrice", "valueMoney" : { "value" : 200000, "currency" : "VND" } }, { "url" : "insuranceLineAmount", "valueMoney" : { "value" : 200000, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" }, { "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-item-benefit-stage-sequence", "valuePositiveInt" : 1 }, { "extension" : [{ "url" : "insuranceFund", "valueMoney" : { "value" : 160000, "currency" : "VND" } }, { "url" : "patientCopay", "valueMoney" : { "value" : 40000, "currency" : "VND" } }, { "url" : "otherSource", "valueMoney" : { "value" : 0, "currency" : "VND" } }, { "url" : "patientSelfPay", "valueMoney" : { "value" : 0, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation" }], "sequence" : 1, "category" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs", "code" : "1", "display" : "Khám bệnh" }] }, "productOrService" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-examination-code-cs", "code" : "10.22", "display" : "Ngoại tiêu hóa" }], "text" : "Khám chuyên khoa Ngoại tiêu hóa" }, "servicedDate" : "2026-03-02", "quantity" : { "value" : 1, "unit" : "lần" }, "unitPrice" : { "value" : 200000, "currency" : "VND" }, "net" : { "value" : 200000, "currency" : "VND" } }, { "extension" : [{ "extension" : [{ "url" : "scope", "valueCodeableConcept" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs", "code" : "1", "display" : "Trong phạm vi hưởng BHYT" }] } }, { "url" : "paymentRatio", "valueDecimal" : 100 }, { "url" : "benefitLevel", "valueDecimal" : 80 }, { "url" : "servicePaymentRatio", "valueDecimal" : 100 }, { "url" : "insuranceUnitPrice", "valueMoney" : { "value" : 300000, "currency" : "VND" } }, { "url" : "insuranceLineAmount", "valueMoney" : { "value" : 300000, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" }, { "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-item-benefit-stage-sequence", "valuePositiveInt" : 1 }, { "extension" : [{ "url" : "insuranceFund", "valueMoney" : { "value" : 240000, "currency" : "VND" } }, { "url" : "patientCopay", "valueMoney" : { "value" : 60000, "currency" : "VND" } }, { "url" : "otherSource", "valueMoney" : { "value" : 0, "currency" : "VND" } }, { "url" : "patientSelfPay", "valueMoney" : { "value" : 0, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation" }], "sequence" : 2, "category" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs", "code" : "3", "display" : "Xét nghiệm" }] }, "productOrService" : { "text" : "Xét nghiệm công thức máu toàn phần" }, "servicedDate" : "2026-03-04", "quantity" : { "value" : 1, "unit" : "lần" }, "unitPrice" : { "value" : 300000, "currency" : "VND" }, "net" : { "value" : 300000, "currency" : "VND" } }, { "extension" : [{ "extension" : [{ "url" : "scope", "valueCodeableConcept" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs", "code" : "1", "display" : "Trong phạm vi hưởng BHYT" }] } }, { "url" : "paymentRatio", "valueDecimal" : 100 }, { "url" : "benefitLevel", "valueDecimal" : 100 }, { "url" : "servicePaymentRatio", "valueDecimal" : 100 }, { "url" : "insuranceUnitPrice", "valueMoney" : { "value" : 1000000, "currency" : "VND" } }, { "url" : "insuranceLineAmount", "valueMoney" : { "value" : 1000000, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" }, { "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-item-benefit-stage-sequence", "valuePositiveInt" : 2 }, { "extension" : [{ "url" : "insuranceFund", "valueMoney" : { "value" : 1000000, "currency" : "VND" } }, { "url" : "patientCopay", "valueMoney" : { "value" : 0, "currency" : "VND" } }, { "url" : "otherSource", "valueMoney" : { "value" : 0, "currency" : "VND" } }, { "url" : "patientSelfPay", "valueMoney" : { "value" : 0, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation" }], "sequence" : 3, "category" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs", "code" : "9", "display" : "Thiết bị y tế" }] }, "productOrService" : { "text" : "Gói thiết bị y tế can thiệp mạch" }, "servicedDate" : "2026-03-05", "quantity" : { "value" : 1, "unit" : "lần" }, "unitPrice" : { "value" : 1000000, "currency" : "VND" }, "net" : { "value" : 1000000, "currency" : "VND" }, "detail" : [{ "extension" : [{ "extension" : [{ "url" : "scope", "valueCodeableConcept" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs", "code" : "1", "display" : "Trong phạm vi hưởng BHYT" }] } }, { "url" : "paymentRatio", "valueDecimal" : 100 }, { "url" : "servicePaymentRatio", "valueDecimal" : 100 }, { "url" : "insuranceUnitPrice", "valueMoney" : { "value" : 800000, "currency" : "VND" } }, { "url" : "insuranceLineAmount", "valueMoney" : { "value" : 800000, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" }], "sequence" : 1, "productOrService" : { "text" : "Stent mạch vành" }, "quantity" : { "value" : 1, "unit" : "cái" }, "unitPrice" : { "value" : 800000, "currency" : "VND" }, "net" : { "value" : 800000, "currency" : "VND" } }, { "extension" : [{ "extension" : [{ "url" : "scope", "valueCodeableConcept" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs", "code" : "1", "display" : "Trong phạm vi hưởng BHYT" }] } }, { "url" : "paymentRatio", "valueDecimal" : 100 }, { "url" : "servicePaymentRatio", "valueDecimal" : 100 }, { "url" : "insuranceUnitPrice", "valueMoney" : { "value" : 200000, "currency" : "VND" } }, { "url" : "insuranceLineAmount", "valueMoney" : { "value" : 200000, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" }], "sequence" : 2, "productOrService" : { "text" : "Bóng nong mạch vành" }, "quantity" : { "value" : 1, "unit" : "cái" }, "unitPrice" : { "value" : 200000, "currency" : "VND" }, "net" : { "value" : 200000, "currency" : "VND" } }] }, { "extension" : [{ "extension" : [{ "url" : "scope", "valueCodeableConcept" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs", "code" : "1", "display" : "Trong phạm vi hưởng BHYT" }] } }, { "url" : "paymentRatio", "valueDecimal" : 80 }, { "url" : "benefitLevel", "valueDecimal" : 100 }, { "url" : "servicePaymentRatio", "valueDecimal" : 100 }, { "url" : "insuranceUnitPrice", "valueMoney" : { "value" : 50000, "currency" : "VND" } }, { "url" : "insuranceLineAmount", "valueMoney" : { "value" : 400000, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" }, { "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-item-benefit-stage-sequence", "valuePositiveInt" : 2 }, { "extension" : [{ "url" : "insuranceFund", "valueMoney" : { "value" : 400000, "currency" : "VND" } }, { "url" : "patientCopay", "valueMoney" : { "value" : 0, "currency" : "VND" } }, { "url" : "otherSource", "valueMoney" : { "value" : 50000, "currency" : "VND" } }, { "url" : "patientSelfPay", "valueMoney" : { "value" : 50000, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-line-payment-allocation" }, { "extension" : [{ "url" : "stateBudget", "valueMoney" : { "value" : 50000, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-other-fund-breakdown" }], "sequence" : 4, "category" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs", "code" : "8", "display" : "Thuốc, dịch truyền" }] }, "productOrService" : { "coding" : [{ "system" : "http://www.whocc.no/atc", "code" : "J01DD04", "display" : "Ceftriaxone" }], "text" : "Ceftriaxone 2 g bột pha tiêm" }, "servicedDate" : "2026-03-06", "quantity" : { "value" : 10, "unit" : "lọ" }, "unitPrice" : { "value" : 50000, "currency" : "VND" }, "net" : { "value" : 500000, "currency" : "VND" } }], "total" : { "value" : 2000000, "currency" : "VND" } }