@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/us/davinci-pas/Claim/ReferralAuthorizationExample> a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "ReferralAuthorizationExample"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"^^xsd:anyURI ;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim>
     ] )
  ] ; # 
  fhir:text [
     fhir:status [ fhir:v "extensions" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Claim</b><a name=\"ReferralAuthorizationExample\"> </a></p><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\">Resource Claim &quot;ReferralAuthorizationExample&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-claim.html\">PAS Claim</a></p></div><p><b>LevelOfServiceCode</b>: Urgent <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1338#U)</span></p><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"Patient-SubscriberExample.html\">Patient/SubscriberExample</a> &quot; SMITH&quot;</p><p><b>created</b>: 2005-05-02 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization/InsurerExample</a> &quot;MARYLAND CAPITAL INSURANCE COMPANY&quot;</p><p><b>provider</b>: <a href=\"Organization-UMOExample.html\">Organization/UMOExample</a> &quot;DR. JOE SMITH CORPORATION&quot;</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td><a href=\"PractitionerRole-ReferralPractitionerRoleExample.html\">PractitionerRole/ReferralPractitionerRoleExample</a></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>1</td><td>G89.4 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G89.4)</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-InsuranceExample.html\">Coverage/InsuranceExample</a></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>DiagnosisSequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Location[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>, , , , , , , , , </td><td>1</td><td>1</td><td>1</td><td>Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1365#3)</span></td><td>Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1365#3)</span></td><td>11 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-CMSPlaceofServiceCodes.html\">CMS Place of Service Codes (POS)</a>#11)</span></td></tr></table></div>"
  ] ; # 
  fhir:extension ( [
     fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode"^^xsd:anyURI ] ;
     fhir:value [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [ fhir:v "https://codesystem.x12.org/005010/1338"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "U" ] ;
         fhir:display [ fhir:v "Urgent" ]
       ] )
     ]
  ] ) ; # 
  fhir:identifier ( [
     fhir:extension ( [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction"^^xsd:anyURI ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [ fhir:v "https://www.usps.com/"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "MA" ]
         ] )
       ]
     ] [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "223412" ]
     ] ) ;
     fhir:system [ fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "111099" ] ;
     fhir:assigner [
       fhir:identifier [
         fhir:system [ fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ] ;
         fhir:value [ fhir:v "9012345678" ]
       ]
     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "professional" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "preauthorization"] ; # 
  fhir:patient [
     fhir:link <http://hl7.org/fhir/us/davinci-pas/Patient/SubscriberExample> ;
     fhir:reference [ fhir:v "Patient/SubscriberExample" ]
  ] ; # 
  fhir:created [ fhir:v "2005-05-02T11:01:00+05:00"^^xsd:dateTime] ; # 
  fhir:insurer [
     fhir:link <http://hl7.org/fhir/us/davinci-pas/Organization/InsurerExample> ;
     fhir:reference [ fhir:v "Organization/InsurerExample" ]
  ] ; # 
  fhir:provider [
     fhir:link <http://hl7.org/fhir/us/davinci-pas/Organization/UMOExample> ;
     fhir:reference [ fhir:v "Organization/UMOExample" ]
  ] ; # 
  fhir:priority [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "normal" ]
     ] )
  ] ; # 
  fhir:careTeam ( [
     fhir:extension ( [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "true"^^xsd:boolean ]
     ] ) ;
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:provider [
       fhir:link <http://hl7.org/fhir/us/davinci-pas/PractitionerRole/ReferralPractitionerRoleExample> ;
       fhir:reference [ fhir:v "PractitionerRole/ReferralPractitionerRoleExample" ]
     ]
  ] ) ; # 
  fhir:diagnosis ( [
     fhir:extension ( [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "2021-05-10"^^xsd:date ]
     ] ) ;
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "G89.4" ]
       ] )
     ]
  ] ) ; # 
  fhir:insurance ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
     fhir:coverage [
       fhir:link <http://hl7.org/fhir/us/davinci-pas/Coverage/InsuranceExample> ;
       fhir:reference [ fhir:v "Coverage/InsuranceExample" ]
     ]
  ] ) ; # 
  fhir:item ( [
     fhir:extension ( [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber"^^xsd:anyURI ] ;
       fhir:value [
         a fhir:Identifier ;
         fhir:system [ fhir:v "http://example.org/ITEM_TRACE_NUMBER"^^xsd:anyURI ] ;
         fhir:value [ fhir:v "1122334" ]
       ]
     ] [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "1122445" ]
     ] [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "9988311" ]
     ] [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [ fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "SC" ] ;
           fhir:display [ fhir:v "Specialty Care Review" ]
         ] )
       ]
     ] [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [ fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "I" ] ;
           fhir:display [ fhir:v "Initial" ]
         ] )
       ]
     ] [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService"^^xsd:anyURI ] ;
       fhir:value [
         a fhir:Reference ;
         fhir:link <http://hl7.org/fhir/us/davinci-pas/ServiceRequest/ReferralRequestExample> ;
         fhir:reference [ fhir:v "ServiceRequest/ReferralRequestExample" ]
       ]
     ] [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "false"^^xsd:boolean ]
     ] [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus"^^xsd:anyURI ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [ fhir:v "https://codesystem.x12.org/005010/1345"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "2" ] ;
           fhir:display [ fhir:v "Newly Admitted" ]
         ] )
       ]
     ] [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare"^^xsd:anyURI ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [ fhir:v "https://codesystem.x12.org/005010/1337"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "2" ] ;
           fhir:display [ fhir:v "Intermediate Care Facility (ICF)" ]
         ] )
       ]
     ] [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "100"^^xsd:decimal ]
     ] ) ;
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:diagnosisSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:category [
       fhir:coding ( [
         fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "3" ] ;
         fhir:display [ fhir:v "Consultation" ]
       ] )
     ] ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "3" ] ;
         fhir:display [ fhir:v "Consultation" ]
       ] )
     ] ;
     fhir:location [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "11" ]
       ] )
     ]
  ] ) . # 

<http://hl7.org/fhir/us/davinci-pas/Patient/SubscriberExample> a fhir:us .

<http://hl7.org/fhir/us/davinci-pas/Organization/InsurerExample> a fhir:us .

<http://hl7.org/fhir/us/davinci-pas/Organization/UMOExample> a fhir:us .

<http://hl7.org/fhir/us/davinci-pas/PractitionerRole/ReferralPractitionerRoleExample> a fhir:us .

<http://hl7.org/fhir/us/davinci-pas/Coverage/InsuranceExample> a fhir:us .

<http://hl7.org/fhir/us/davinci-pas/ServiceRequest/ReferralRequestExample> a fhir:us .

# -------------------------------------------------------------------------------------