Hướng dẫn triển khai FHIR cốt lõi Việt Nam — VN Core FHIR Implementation Guide - Draft for Community Review (v0.9.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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: Ví dụ: Giải trình bảng kê chi phí KCB đổi mức hưởng — Example: Itemized healthcare cost EOB with a mid-encounter benefit change

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/ExplanationOfBenefit/ExampleExplanationOfBenefitItemizedMultiStage> a fhir:ExplanationOfBenefit ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "ExampleExplanationOfBenefitItemizedMultiStage"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-itemized-healthcare-cost-explanation-of-benefit" ;
       fhir:index -1 ;
       fhir:link <http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-itemized-healthcare-cost-explanation-of-benefit>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "vi"] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ExplanationOfBenefit ExampleExplanationOfBenefitItemizedMultiStage</b></p><a name=\"ExampleExplanationOfBenefitItemizedMultiStage\"> </a><a name=\"hcExampleExplanationOfBenefitItemizedMultiStage\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-vn-core-itemized-healthcare-cost-explanation-of-benefit.html\">Giải trình bảng kê chi phí KCB chi tiết — VN Core Itemized Healthcare Cost Explanation of Benefit</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-ExamplePatientNguyenVanAn.html\">Nguyễn Văn An</a></p><p><b>billablePeriod</b>: 2026-03-01 --&gt; 2026-03-07</p><p><b>created</b>: 2026-03-12</p><p><b>insurer</b>: <a href=\"Organization-ExampleOrganizationBHXH.html\">Bảo hiểm xã hội Việt Nam</a></p><p><b>provider</b>: <a href=\"Organization-ExampleOrganizationChoRay.html\">Bệnh viện Chợ Rẫy</a></p><p><b>claim</b>: <a href=\"Claim-ExampleClaimItemizedMultiStage.html\">Bảng kê chi phí KCB chi tiết LK-ITEMIZED-2026-0001</a></p><p><b>claimResponse</b>: <a href=\"ClaimResponse-ExampleClaimResponseItemizedMultiStage.html\">Kết quả giám định đầy đủ cho bảng kê LK-ITEMIZED-2026-0001</a></p><p><b>outcome</b>: Processing Complete</p><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 K35.8}\">Acute appendicitis, other and unspecified</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-diagnosistype principal}\">Principal Diagnosis</span></td></tr></table><blockquote><p><b>insurance</b></p><blockquote><p><b>Giai đoạn hưởng bảo hiểm — Coverage Benefit Stage</b></p><ul><li>sequence: 1</li><li>period: 2026-03-01 --&gt; 2026-03-04</li><li>benefitLevel: 80</li></ul></blockquote><blockquote><p><b>Giai đoạn hưởng bảo hiểm — Coverage Benefit Stage</b></p><ul><li>sequence: 2</li><li>period: 2026-03-05 --&gt; 2026-03-07</li><li>benefitLevel: 100</li></ul></blockquote><p><b>focal</b>: true</p><p><b>coverage</b>: <a href=\"Coverage-ExampleCoverageBHYTNew.html\">Thẻ BHYT Nguyễn Văn An được giám định</a></p></blockquote><blockquote><p><b>item</b></p><p><b>Liên kết dòng chi phí với giai đoạn hưởng — Item Benefit Stage Sequence</b>: 1</p><blockquote><p><b>Thông tin chi phí BHYT — Insurance Cost Info Extension</b></p><ul><li>scope: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs 1}\">Trong phạm vi hưởng BHYT</span></li><li>paymentRatio: 100</li><li>benefitLevel: 80</li><li>servicePaymentRatio: 100</li><li>insuranceUnitPrice: <span title=\"Vietnamese Dong\">₫200.000</span> (VND)</li><li>insuranceLineAmount: <span title=\"Vietnamese Dong\">₫200.000</span> (VND)</li></ul></blockquote><p><b>sequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs 1}\">Khám bệnh</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-examination-code-cs 10.22}\">Khám chuyên khoa Ngoại tiêu hóa</span></p><p><b>serviced</b>: 2026-03-02</p><p><b>quantity</b>: 1 lần</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200000</td><td>Vietnamese đồng</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200000</td><td>Vietnamese đồng</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>160000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}\">CoPay</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>40000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs other-fund}\">Nguồn khác</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>0</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs patient-self-pay}\">Người bệnh tự trả</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>0</td><td>Vietnamese đồng</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>Liên kết dòng chi phí với giai đoạn hưởng — Item Benefit Stage Sequence</b>: 1</p><blockquote><p><b>Thông tin chi phí BHYT — Insurance Cost Info Extension</b></p><ul><li>scope: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs 1}\">Trong phạm vi hưởng BHYT</span></li><li>paymentRatio: 100</li><li>benefitLevel: 80</li><li>servicePaymentRatio: 100</li><li>insuranceUnitPrice: <span title=\"Vietnamese Dong\">₫300.000</span> (VND)</li><li>insuranceLineAmount: <span title=\"Vietnamese Dong\">₫300.000</span> (VND)</li></ul></blockquote><p><b>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs 3}\">Xét nghiệm</span></p><p><b>productOrService</b>: <span title=\"Codes:\">Xét nghiệm công thức máu toàn phần</span></p><p><b>serviced</b>: 2026-03-04</p><p><b>quantity</b>: 1 lần</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>300000</td><td>Vietnamese đồng</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>300000</td><td>Vietnamese đồng</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>300000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>300000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>240000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}\">CoPay</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>60000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs other-fund}\">Nguồn khác</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>0</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs patient-self-pay}\">Người bệnh tự trả</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>0</td><td>Vietnamese đồng</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>Liên kết dòng chi phí với giai đoạn hưởng — Item Benefit Stage Sequence</b>: 2</p><blockquote><p><b>Thông tin chi phí BHYT — Insurance Cost Info Extension</b></p><ul><li>scope: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs 1}\">Trong phạm vi hưởng BHYT</span></li><li>paymentRatio: 100</li><li>benefitLevel: 100</li><li>servicePaymentRatio: 100</li><li>insuranceUnitPrice: <span title=\"Vietnamese Dong\">₫1.000.000</span> (VND)</li><li>insuranceLineAmount: <span title=\"Vietnamese Dong\">₫1.000.000</span> (VND)</li></ul></blockquote><p><b>sequence</b>: 3</p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs 9}\">Thiết bị y tế</span></p><p><b>productOrService</b>: <span title=\"Codes:\">Gói thiết bị y tế can thiệp mạch</span></p><p><b>serviced</b>: 2026-03-05</p><p><b>quantity</b>: 1 lần</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>1000000</td><td>Vietnamese đồng</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>1000000</td><td>Vietnamese đồng</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>1000000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>1000000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>1000000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}\">CoPay</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>0</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs other-fund}\">Nguồn khác</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>0</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs patient-self-pay}\">Người bệnh tự trả</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>0</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>detail</b></p><blockquote><p><b>Thông tin chi phí BHYT — Insurance Cost Info Extension</b></p><ul><li>scope: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs 1}\">Trong phạm vi hưởng BHYT</span></li><li>paymentRatio: 100</li><li>servicePaymentRatio: 100</li><li>insuranceUnitPrice: <span title=\"Vietnamese Dong\">₫800.000</span> (VND)</li><li>insuranceLineAmount: <span title=\"Vietnamese Dong\">₫800.000</span> (VND)</li></ul></blockquote><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:\">Stent mạch vành</span></p><p><b>quantity</b>: 1 cái</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>800000</td><td>Vietnamese đồng</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>800000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>detail</b></p><blockquote><p><b>Thông tin chi phí BHYT — Insurance Cost Info Extension</b></p><ul><li>scope: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs 1}\">Trong phạm vi hưởng BHYT</span></li><li>paymentRatio: 100</li><li>servicePaymentRatio: 100</li><li>insuranceUnitPrice: <span title=\"Vietnamese Dong\">₫200.000</span> (VND)</li><li>insuranceLineAmount: <span title=\"Vietnamese Dong\">₫200.000</span> (VND)</li></ul></blockquote><p><b>sequence</b>: 2</p><p><b>productOrService</b>: <span title=\"Codes:\">Bóng nong mạch vành</span></p><p><b>quantity</b>: 1 cái</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200000</td><td>Vietnamese đồng</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200000</td><td>Vietnamese đồng</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>Liên kết dòng chi phí với giai đoạn hưởng — Item Benefit Stage Sequence</b>: 2</p><blockquote><p><b>Thông tin chi phí BHYT — Insurance Cost Info Extension</b></p><ul><li>scope: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs 1}\">Trong phạm vi hưởng BHYT</span></li><li>paymentRatio: 80</li><li>benefitLevel: 100</li><li>servicePaymentRatio: 100</li><li>insuranceUnitPrice: <span title=\"Vietnamese Dong\">₫50.000</span> (VND)</li><li>insuranceLineAmount: <span title=\"Vietnamese Dong\">₫400.000</span> (VND)</li></ul></blockquote><blockquote><p><b>Chi tiết nguồn khác chi trả theo dòng — Other Fund Breakdown Extension</b></p><ul><li>stateBudget: <span title=\"Vietnamese Dong\">₫50.000</span> (VND)</li></ul></blockquote><p><b>sequence</b>: 4</p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs 8}\">Thuốc, dịch truyền</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.whocc.no/atc J01DD04}\">Ceftriaxone 2 g bột pha tiêm</span></p><p><b>serviced</b>: 2026-03-06</p><p><b>quantity</b>: 10 lọ</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50000</td><td>Vietnamese đồng</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>500000</td><td>Vietnamese đồng</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>500000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>400000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>400000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}\">CoPay</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>0</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs other-fund}\">Nguồn khác</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs patient-self-pay}\">Người bệnh tự trả</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50000</td><td>Vietnamese đồng</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>2000000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>1900000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>1800000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}\">CoPay</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>100000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs other-fund}\">Nguồn khác</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs patient-self-pay}\">Người bệnh tự trả</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50000</td><td>Vietnamese đồng</td></tr></table></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-paymenttype complete}\">Complete</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>1800000</td><td>Vietnamese đồng</td></tr></table></blockquote><p><b>benefitPeriod</b>: 2026-01-01 --&gt; 2026-12-31</p></div>"
  ] ;
  fhir:ExplanationOfBenefit.status [ fhir:value "active"] ;
  fhir:ExplanationOfBenefit.type [
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ] ;
       fhir:Coding.code [ fhir:value "institutional" ] ;
       fhir:Coding.display [ fhir:value "Institutional" ]
     ]
  ] ;
  fhir:ExplanationOfBenefit.use [ fhir:value "claim"] ;
  fhir:ExplanationOfBenefit.patient [
     fhir:link <http://hl7.org/fhir/Patient/ExamplePatientNguyenVanAn> ;
     fhir:Reference.reference [ fhir:value "Patient/ExamplePatientNguyenVanAn" ] ;
     fhir:Reference.display [ fhir:value "Nguyễn Văn An" ]
  ] ;
  fhir:ExplanationOfBenefit.billablePeriod [
     fhir:Period.start [ fhir:value "2026-03-01"^^xsd:date ] ;
     fhir:Period.end [ fhir:value "2026-03-07"^^xsd:date ]
  ] ;
  fhir:ExplanationOfBenefit.created [ fhir:value "2026-03-12"^^xsd:date] ;
  fhir:ExplanationOfBenefit.insurer [
     fhir:link <http://hl7.org/fhir/Organization/ExampleOrganizationBHXH> ;
     fhir:Reference.reference [ fhir:value "Organization/ExampleOrganizationBHXH" ] ;
     fhir:Reference.display [ fhir:value "Bảo hiểm xã hội Việt Nam" ]
  ] ;
  fhir:ExplanationOfBenefit.provider [
     fhir:link <http://hl7.org/fhir/Organization/ExampleOrganizationChoRay> ;
     fhir:Reference.reference [ fhir:value "Organization/ExampleOrganizationChoRay" ] ;
     fhir:Reference.display [ fhir:value "Bệnh viện Chợ Rẫy" ]
  ] ;
  fhir:ExplanationOfBenefit.claim [
     fhir:link <http://hl7.org/fhir/Claim/ExampleClaimItemizedMultiStage> ;
     fhir:Reference.reference [ fhir:value "Claim/ExampleClaimItemizedMultiStage" ] ;
     fhir:Reference.display [ fhir:value "Bảng kê chi phí KCB chi tiết LK-ITEMIZED-2026-0001" ]
  ] ;
  fhir:ExplanationOfBenefit.claimResponse [
     fhir:link <http://hl7.org/fhir/ClaimResponse/ExampleClaimResponseItemizedMultiStage> ;
     fhir:Reference.reference [ fhir:value "ClaimResponse/ExampleClaimResponseItemizedMultiStage" ] ;
     fhir:Reference.display [ fhir:value "Kết quả giám định đầy đủ cho bảng kê LK-ITEMIZED-2026-0001" ]
  ] ;
  fhir:ExplanationOfBenefit.outcome [ fhir:value "complete"] ;
  fhir:ExplanationOfBenefit.diagnosis [
     fhir:index -1 ;
     fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10" ] ;
         fhir:Coding.code [ fhir:value "K35.8" ] ;
         fhir:Coding.display [ fhir:value "Acute appendicitis, other and unspecified" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.diagnosis.type [
       fhir:index -1 ;
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ] ;
         fhir:Coding.code [ fhir:value "principal" ] ;
         fhir:Coding.display [ fhir:value "Principal Diagnosis" ]
       ]
     ]
  ] ;
  fhir:ExplanationOfBenefit.insurance [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "sequence" ] ;
         fhir:Extension.valuePositiveInt [ fhir:value "1"^^xsd:positiveInteger ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "period" ] ;
         fhir:Extension.valuePeriod [
           fhir:Period.start [ fhir:value "2026-03-01"^^xsd:date ] ;
           fhir:Period.end [ fhir:value "2026-03-04"^^xsd:date ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "benefitLevel" ] ;
         fhir:Extension.valueDecimal [ fhir:value "80"^^xsd:decimal ]
       ] ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-coverage-benefit-stage" ]
     ], [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "sequence" ] ;
         fhir:Extension.valuePositiveInt [ fhir:value "2"^^xsd:positiveInteger ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "period" ] ;
         fhir:Extension.valuePeriod [
           fhir:Period.start [ fhir:value "2026-03-05"^^xsd:date ] ;
           fhir:Period.end [ fhir:value "2026-03-07"^^xsd:date ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "benefitLevel" ] ;
         fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
       ] ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-coverage-benefit-stage" ]
     ] ;
     fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ] ;
     fhir:ExplanationOfBenefit.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/ExampleCoverageBHYTNew> ;
       fhir:Reference.reference [ fhir:value "Coverage/ExampleCoverageBHYTNew" ] ;
       fhir:Reference.display [ fhir:value "Thẻ BHYT Nguyễn Văn An được giám định" ]
     ]
  ] ;
  fhir:ExplanationOfBenefit.item [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-item-benefit-stage-sequence" ] ;
       fhir:Extension.valuePositiveInt [ fhir:value "1"^^xsd:positiveInteger ]
     ], [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "scope" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index -1 ;
             fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs" ] ;
             fhir:Coding.code [ fhir:value "1" ] ;
             fhir:Coding.display [ fhir:value "Trong phạm vi hưởng BHYT" ]
           ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "paymentRatio" ] ;
         fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "benefitLevel" ] ;
         fhir:Extension.valueDecimal [ fhir:value "80"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "servicePaymentRatio" ] ;
         fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "insuranceUnitPrice" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "200000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "VND" ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "insuranceLineAmount" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "200000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "VND" ]
         ]
       ] ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" ]
     ] ;
     fhir:ExplanationOfBenefit.item.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ExplanationOfBenefit.item.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs" ] ;
         fhir:Coding.code [ fhir:value "1" ] ;
         fhir:Coding.display [ fhir:value "Khám bệnh" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-examination-code-cs" ] ;
         fhir:Coding.code [ fhir:value "10.22" ] ;
         fhir:Coding.display [ fhir:value "Ngoại tiêu hóa" ]
       ] ;
       fhir:CodeableConcept.text [ fhir:value "Khám chuyên khoa Ngoại tiêu hóa" ]
     ] ;
     fhir:ExplanationOfBenefit.item.servicedDate [ fhir:value "2026-03-02"^^xsd:date ] ;
     fhir:ExplanationOfBenefit.item.quantity [
       fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ] ;
       fhir:Quantity.unit [ fhir:value "lần" ]
     ] ;
     fhir:ExplanationOfBenefit.item.unitPrice [
       fhir:Money.value [ fhir:value "200000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ] ;
     fhir:ExplanationOfBenefit.item.net [
       fhir:Money.value [ fhir:value "200000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ] ;
     fhir:ExplanationOfBenefit.item.adjudication [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "submitted" ] ;
           fhir:Coding.display [ fhir:value "Submitted Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "200000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "eligible" ] ;
           fhir:Coding.display [ fhir:value "Eligible Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "200000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "benefit" ] ;
           fhir:Coding.display [ fhir:value "Benefit Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "160000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "copay" ] ;
           fhir:Coding.display [ fhir:value "CoPay" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "40000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs" ] ;
           fhir:Coding.code [ fhir:value "other-fund" ] ;
           fhir:Coding.display [ fhir:value "Nguồn khác" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs" ] ;
           fhir:Coding.code [ fhir:value "patient-self-pay" ] ;
           fhir:Coding.display [ fhir:value "Người bệnh tự trả" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ]
  ], [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-item-benefit-stage-sequence" ] ;
       fhir:Extension.valuePositiveInt [ fhir:value "1"^^xsd:positiveInteger ]
     ], [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "scope" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index -1 ;
             fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs" ] ;
             fhir:Coding.code [ fhir:value "1" ] ;
             fhir:Coding.display [ fhir:value "Trong phạm vi hưởng BHYT" ]
           ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "paymentRatio" ] ;
         fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "benefitLevel" ] ;
         fhir:Extension.valueDecimal [ fhir:value "80"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "servicePaymentRatio" ] ;
         fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "insuranceUnitPrice" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "300000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "VND" ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "insuranceLineAmount" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "300000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "VND" ]
         ]
       ] ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" ]
     ] ;
     fhir:ExplanationOfBenefit.item.sequence [ fhir:value "2"^^xsd:positiveInteger ] ;
     fhir:ExplanationOfBenefit.item.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs" ] ;
         fhir:Coding.code [ fhir:value "3" ] ;
         fhir:Coding.display [ fhir:value "Xét nghiệm" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.item.productOrService [
       fhir:CodeableConcept.text [ fhir:value "Xét nghiệm công thức máu toàn phần" ]
     ] ;
     fhir:ExplanationOfBenefit.item.servicedDate [ fhir:value "2026-03-04"^^xsd:date ] ;
     fhir:ExplanationOfBenefit.item.quantity [
       fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ] ;
       fhir:Quantity.unit [ fhir:value "lần" ]
     ] ;
     fhir:ExplanationOfBenefit.item.unitPrice [
       fhir:Money.value [ fhir:value "300000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ] ;
     fhir:ExplanationOfBenefit.item.net [
       fhir:Money.value [ fhir:value "300000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ] ;
     fhir:ExplanationOfBenefit.item.adjudication [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "submitted" ] ;
           fhir:Coding.display [ fhir:value "Submitted Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "300000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "eligible" ] ;
           fhir:Coding.display [ fhir:value "Eligible Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "300000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "benefit" ] ;
           fhir:Coding.display [ fhir:value "Benefit Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "240000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "copay" ] ;
           fhir:Coding.display [ fhir:value "CoPay" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "60000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs" ] ;
           fhir:Coding.code [ fhir:value "other-fund" ] ;
           fhir:Coding.display [ fhir:value "Nguồn khác" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs" ] ;
           fhir:Coding.code [ fhir:value "patient-self-pay" ] ;
           fhir:Coding.display [ fhir:value "Người bệnh tự trả" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ]
  ], [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-item-benefit-stage-sequence" ] ;
       fhir:Extension.valuePositiveInt [ fhir:value "2"^^xsd:positiveInteger ]
     ], [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "scope" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index -1 ;
             fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs" ] ;
             fhir:Coding.code [ fhir:value "1" ] ;
             fhir:Coding.display [ fhir:value "Trong phạm vi hưởng BHYT" ]
           ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "paymentRatio" ] ;
         fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "benefitLevel" ] ;
         fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "servicePaymentRatio" ] ;
         fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "insuranceUnitPrice" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "1000000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "VND" ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "insuranceLineAmount" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "1000000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "VND" ]
         ]
       ] ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" ]
     ] ;
     fhir:ExplanationOfBenefit.item.sequence [ fhir:value "3"^^xsd:positiveInteger ] ;
     fhir:ExplanationOfBenefit.item.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs" ] ;
         fhir:Coding.code [ fhir:value "9" ] ;
         fhir:Coding.display [ fhir:value "Thiết bị y tế" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.item.productOrService [
       fhir:CodeableConcept.text [ fhir:value "Gói thiết bị y tế can thiệp mạch" ]
     ] ;
     fhir:ExplanationOfBenefit.item.servicedDate [ fhir:value "2026-03-05"^^xsd:date ] ;
     fhir:ExplanationOfBenefit.item.quantity [
       fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ] ;
       fhir:Quantity.unit [ fhir:value "lần" ]
     ] ;
     fhir:ExplanationOfBenefit.item.unitPrice [
       fhir:Money.value [ fhir:value "1000000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ] ;
     fhir:ExplanationOfBenefit.item.net [
       fhir:Money.value [ fhir:value "1000000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ] ;
     fhir:ExplanationOfBenefit.item.adjudication [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "submitted" ] ;
           fhir:Coding.display [ fhir:value "Submitted Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "1000000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "eligible" ] ;
           fhir:Coding.display [ fhir:value "Eligible Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "1000000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "benefit" ] ;
           fhir:Coding.display [ fhir:value "Benefit Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "1000000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "copay" ] ;
           fhir:Coding.display [ fhir:value "CoPay" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs" ] ;
           fhir:Coding.code [ fhir:value "other-fund" ] ;
           fhir:Coding.display [ fhir:value "Nguồn khác" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs" ] ;
           fhir:Coding.code [ fhir:value "patient-self-pay" ] ;
           fhir:Coding.display [ fhir:value "Người bệnh tự trả" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.item.detail [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Element.extension [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "scope" ] ;
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index -1 ;
               fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs" ] ;
               fhir:Coding.code [ fhir:value "1" ] ;
               fhir:Coding.display [ fhir:value "Trong phạm vi hưởng BHYT" ]
             ]
           ]
         ], [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "paymentRatio" ] ;
           fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
         ], [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "servicePaymentRatio" ] ;
           fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
         ], [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "insuranceUnitPrice" ] ;
           fhir:Extension.valueMoney [
             fhir:Money.value [ fhir:value "800000"^^xsd:decimal ] ;
             fhir:Money.currency [ fhir:value "VND" ]
           ]
         ], [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "insuranceLineAmount" ] ;
           fhir:Extension.valueMoney [
             fhir:Money.value [ fhir:value "800000"^^xsd:decimal ] ;
             fhir:Money.currency [ fhir:value "VND" ]
           ]
         ] ;
         fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" ]
       ] ;
       fhir:ExplanationOfBenefit.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
       fhir:ExplanationOfBenefit.item.detail.productOrService [
         fhir:CodeableConcept.text [ fhir:value "Stent mạch vành" ]
       ] ;
       fhir:ExplanationOfBenefit.item.detail.quantity [
         fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ] ;
         fhir:Quantity.unit [ fhir:value "cái" ]
       ] ;
       fhir:ExplanationOfBenefit.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "800000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ] ;
       fhir:ExplanationOfBenefit.item.detail.net [
         fhir:Money.value [ fhir:value "800000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Element.extension [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "scope" ] ;
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index -1 ;
               fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs" ] ;
               fhir:Coding.code [ fhir:value "1" ] ;
               fhir:Coding.display [ fhir:value "Trong phạm vi hưởng BHYT" ]
             ]
           ]
         ], [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "paymentRatio" ] ;
           fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
         ], [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "servicePaymentRatio" ] ;
           fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
         ], [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "insuranceUnitPrice" ] ;
           fhir:Extension.valueMoney [
             fhir:Money.value [ fhir:value "200000"^^xsd:decimal ] ;
             fhir:Money.currency [ fhir:value "VND" ]
           ]
         ], [
           fhir:index -1 ;
           fhir:Extension.url [ fhir:value "insuranceLineAmount" ] ;
           fhir:Extension.valueMoney [
             fhir:Money.value [ fhir:value "200000"^^xsd:decimal ] ;
             fhir:Money.currency [ fhir:value "VND" ]
           ]
         ] ;
         fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" ]
       ] ;
       fhir:ExplanationOfBenefit.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ] ;
       fhir:ExplanationOfBenefit.item.detail.productOrService [
         fhir:CodeableConcept.text [ fhir:value "Bóng nong mạch vành" ]
       ] ;
       fhir:ExplanationOfBenefit.item.detail.quantity [
         fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ] ;
         fhir:Quantity.unit [ fhir:value "cái" ]
       ] ;
       fhir:ExplanationOfBenefit.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "200000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ] ;
       fhir:ExplanationOfBenefit.item.detail.net [
         fhir:Money.value [ fhir:value "200000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ]
  ], [
     fhir:index -1 ;
     fhir:Element.extension [
       fhir:index -1 ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-item-benefit-stage-sequence" ] ;
       fhir:Extension.valuePositiveInt [ fhir:value "2"^^xsd:positiveInteger ]
     ], [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "scope" ] ;
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index -1 ;
             fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-insurance-scope-cs" ] ;
             fhir:Coding.code [ fhir:value "1" ] ;
             fhir:Coding.display [ fhir:value "Trong phạm vi hưởng BHYT" ]
           ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "paymentRatio" ] ;
         fhir:Extension.valueDecimal [ fhir:value "80"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "benefitLevel" ] ;
         fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "servicePaymentRatio" ] ;
         fhir:Extension.valueDecimal [ fhir:value "100"^^xsd:decimal ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "insuranceUnitPrice" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "50000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "VND" ]
         ]
       ], [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "insuranceLineAmount" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "400000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "VND" ]
         ]
       ] ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-insurance-cost-info" ]
     ], [
       fhir:index -1 ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "stateBudget" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "50000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "VND" ]
         ]
       ] ;
       fhir:Extension.url [ fhir:value "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-other-fund-breakdown" ]
     ] ;
     fhir:ExplanationOfBenefit.item.sequence [ fhir:value "4"^^xsd:positiveInteger ] ;
     fhir:ExplanationOfBenefit.item.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs" ] ;
         fhir:Coding.code [ fhir:value "8" ] ;
         fhir:Coding.display [ fhir:value "Thuốc, dịch truyền" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://www.whocc.no/atc" ] ;
         fhir:Coding.code [ fhir:value "J01DD04" ] ;
         fhir:Coding.display [ fhir:value "Ceftriaxone" ]
       ] ;
       fhir:CodeableConcept.text [ fhir:value "Ceftriaxone 2 g bột pha tiêm" ]
     ] ;
     fhir:ExplanationOfBenefit.item.servicedDate [ fhir:value "2026-03-06"^^xsd:date ] ;
     fhir:ExplanationOfBenefit.item.quantity [
       fhir:Quantity.value [ fhir:value "10"^^xsd:decimal ] ;
       fhir:Quantity.unit [ fhir:value "lọ" ]
     ] ;
     fhir:ExplanationOfBenefit.item.unitPrice [
       fhir:Money.value [ fhir:value "50000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ] ;
     fhir:ExplanationOfBenefit.item.net [
       fhir:Money.value [ fhir:value "500000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ] ;
     fhir:ExplanationOfBenefit.item.adjudication [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "submitted" ] ;
           fhir:Coding.display [ fhir:value "Submitted Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "500000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "eligible" ] ;
           fhir:Coding.display [ fhir:value "Eligible Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "400000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "benefit" ] ;
           fhir:Coding.display [ fhir:value "Benefit Amount" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "400000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "copay" ] ;
           fhir:Coding.display [ fhir:value "CoPay" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs" ] ;
           fhir:Coding.code [ fhir:value "other-fund" ] ;
           fhir:Coding.display [ fhir:value "Nguồn khác" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "50000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ], [
       fhir:index -1 ;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs" ] ;
           fhir:Coding.code [ fhir:value "patient-self-pay" ] ;
           fhir:Coding.display [ fhir:value "Người bệnh tự trả" ]
         ]
       ] ;
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "50000"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "VND" ]
       ]
     ]
  ] ;
  fhir:ExplanationOfBenefit.total [
     fhir:index -1 ;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
         fhir:Coding.code [ fhir:value "submitted" ] ;
         fhir:Coding.display [ fhir:value "Submitted Amount" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "2000000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ]
  ], [
     fhir:index -1 ;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
         fhir:Coding.code [ fhir:value "eligible" ] ;
         fhir:Coding.display [ fhir:value "Eligible Amount" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "1900000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ]
  ], [
     fhir:index -1 ;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
         fhir:Coding.code [ fhir:value "benefit" ] ;
         fhir:Coding.display [ fhir:value "Benefit Amount" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "1800000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ]
  ], [
     fhir:index -1 ;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
         fhir:Coding.code [ fhir:value "copay" ] ;
         fhir:Coding.display [ fhir:value "CoPay" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "100000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ]
  ], [
     fhir:index -1 ;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs" ] ;
         fhir:Coding.code [ fhir:value "other-fund" ] ;
         fhir:Coding.display [ fhir:value "Nguồn khác" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "50000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ]
  ], [
     fhir:index -1 ;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://fhir.hl7.org.vn/core/CodeSystem/vn-bhyt-adjudication-category-cs" ] ;
         fhir:Coding.code [ fhir:value "patient-self-pay" ] ;
         fhir:Coding.display [ fhir:value "Người bệnh tự trả" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "50000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ]
  ] ;
  fhir:ExplanationOfBenefit.payment [
     fhir:ExplanationOfBenefit.payment.type [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-paymenttype" ] ;
         fhir:Coding.code [ fhir:value "complete" ] ;
         fhir:Coding.display [ fhir:value "Complete" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.payment.amount [
       fhir:Money.value [ fhir:value "1800000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "VND" ]
     ]
  ] ;
  fhir:ExplanationOfBenefit.benefitPeriod [
     fhir:Period.start [ fhir:value "2026-01-01"^^xsd:date ] ;
     fhir:Period.end [ fhir:value "2026-12-31"^^xsd:date ]
  ] .

<http://hl7.org/fhir/Patient/ExamplePatientNguyenVanAn> a fhir:Patient .

<http://hl7.org/fhir/Organization/ExampleOrganizationBHXH> a fhir:Organization .

<http://hl7.org/fhir/Organization/ExampleOrganizationChoRay> a fhir:Organization .

<http://hl7.org/fhir/Claim/ExampleClaimItemizedMultiStage> a fhir:Claim .

<http://hl7.org/fhir/ClaimResponse/ExampleClaimResponseItemizedMultiStage> a fhir:ClaimResponse .

<http://hl7.org/fhir/Coverage/ExampleCoverageBHYTNew> a fhir:Coverage .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/ExplanationOfBenefit/ExampleExplanationOfBenefitItemizedMultiStage.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/ExplanationOfBenefit/ExampleExplanationOfBenefitItemizedMultiStage.ttl> .