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

Generated Narrative: Claim ExampleClaimSelfPay

Profile: Yêu cầu thanh toán KCB VN Core — VN Core Claim Profile

Tổng chi phí theo nhóm — Claim Cost Summary Extension

Kỳ thanh toán — Claim Payment Period Extension

Phương thức thanh toán — Payment Method Extension: Phí dịch vụ (FFS)

identifier: Mã liên kết hồ sơ BHYT/LK-2026-000103

status: Active

type: Professional

subType: Người bệnh không KCB BHYT

use: Claim

patient: John Smith (DOB: 1980-07-15, Passport: A12345678)

created: 2026-04-15

provider: Bệnh viện Chợ Rẫy

priority: Normal

Diagnoses

-SequenceDiagnosis[x]Type
*1Nhiễm trùng đường hô hấp trên cấp tínhPrincipal Diagnosis

Insurances

-SequenceFocalCoverage
*1trueTự chi trả (No Insurance)

item

Khoa thực hiện — Claim Item Department Extension: Khoa Khám bệnh

sequence: 1

category: Khám bệnh

productOrService: Khám bệnh tổng quát (giá dịch vụ — nước ngoài)

Nets

-ValueCurrency
*300000Vietnamese đồng

item

sequence: 2

category: Thuốc, dịch truyền

productOrService: Amoxicillin 500mg x 10 viên, Paracetamol 500mg x 10 viên

Nets

-ValueCurrency
*250000Vietnamese đồng

Totals

-ValueCurrency
*550000Vietnamese đồng
" }, "extension" : [{ "extension" : [{ "url" : "totalPatientSelfPay", "valueMoney" : { "value" : 550000, "currency" : "VND" } }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary" }, { "extension" : [{ "url" : "year", "valueInteger" : 2026 }, { "url" : "month", "valueInteger" : 4 }], "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period" }, { "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method", "valueCodeableConcept" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-payment-method-cs", "code" : "1", "display" : "Phí dịch vụ (FFS)" }] } }], "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-2026-000103" }], "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "professional", "display" : "Professional" }] }, "subType" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-patient-visit-type-cs", "code" : "9", "display" : "Người bệnh không KCB BHYT" }] }, "use" : "claim", "patient" : { "display" : "John Smith (DOB: 1980-07-15, Passport: A12345678)" }, "created" : "2026-04-15", "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" : "J06.9", "display" : "Acute upper respiratory infection, unspecified" }], "text" : "Nhiễm trùng đường hô hấp trên cấp tính" }, "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code" : "principal", "display" : "Principal Diagnosis" }] }] }], "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "display" : "Tự chi trả (No Insurance)" } }], "item" : [{ "extension" : [{ "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-item-department", "valueCodeableConcept" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-department-cs", "code" : "K01", "display" : "Khoa Khám bệnh" }] } }], "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://terminology.hl7.org/CodeSystem/data-absent-reason", "code" : "unknown", "display" : "Unknown" }], "text" : "Khám bệnh tổng quát (giá dịch vụ — nước ngoài)" }, "net" : { "value" : 300000, "currency" : "VND" } }, { "sequence" : 2, "category" : { "coding" : [{ "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs", "code" : "8", "display" : "Thuốc, dịch truyền" }] }, "productOrService" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/data-absent-reason", "code" : "unknown", "display" : "Unknown" }], "text" : "Amoxicillin 500mg x 10 viên, Paracetamol 500mg x 10 viên" }, "net" : { "value" : 250000, "currency" : "VND" } }], "total" : { "value" : 550000, "currency" : "VND" } }