German Dental FHIR Profiles (R4)
0.41.6 - trial-use Germany

German Dental FHIR Profiles (R4) - Local Development build (v0.41.6) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Beispiel DentalClaimDE Mischrechnung BEMA und GOZ - TTL Representation

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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/Claim/ExampleDentalClaimMixed> a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "ExampleDentalClaimMixed"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "https://fhir.cognovis.de/dental/StructureDefinition/dental-claim-de" ;
       fhir:index 0 ;
       fhir:link <https://fhir.cognovis.de/dental/StructureDefinition/dental-claim-de>
     ]
  ] ;
  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: Claim ExampleDentalClaimMixed</b></p><a name=\"ExampleDentalClaimMixed\"> </a><a name=\"hcExampleDentalClaimMixed\"> </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-dental-claim-de.html\">Zahnärztlicher Abrechnungsanspruch (DE)</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-pat-gkv-dental-01.html\">Aylin Özdemir (official) (no stated gender), DoB: 1988-03-14 ( Krankenversichertennummer)</a></p><p><b>billablePeriod</b>: 2026-05-01 --&gt; 2026-05-31</p><p><b>created</b>: 2026-05-31</p><p><b>insurer</b>: Barmer</p><p><b>provider</b>: <a href=\"PractitionerRole-role-schoell-gibitzenhof.html\">PractitionerRole Doctor</a></p><p><b>priority</b>: <span title=\"Codes:\">normal</span></p><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claiminformationcategory info}\">Information</span></p><p><b>value</b>: <a href=\"ChargeItem-ExampleMixedBemaChargeItem.html\">ChargeItem BEMA-91d</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claiminformationcategory info}\">Information</span></p><p><b>value</b>: <a href=\"ChargeItem-ExampleMixedGozChargeItem.html\">ChargeItem GOZ-5040</a></p></blockquote><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Condition-ExampleMixedDentalCondition.html\">Condition Karies des Dentins</a></td></tr></table><blockquote><p><b>insurance</b></p><p><b>sequence</b>: 1</p><p><b>focal</b>: true</p><p><b>coverage</b>: <a href=\"Coverage-cov-gkv-dental-01-gkv.html\">Coverage: status = active; type = Gesetzliche Krankenversicherung; period = 2024-01-01 --&gt; (ongoing)</a></p></blockquote><blockquote><p><b>insurance</b></p><p><b>sequence</b>: 2</p><p><b>focal</b>: false</p><p><b>coverage</b>: <a href=\"Coverage-cov-zzv-dental-01.html\">Coverage: status = active; type = private Krankenversicherung; period = 2024-01-01 --&gt; (ongoing)</a></p></blockquote><blockquote><p><b>item</b></p><p><b>ZE Versorgungsart</b>: gleichartig</p><blockquote><p><b>Versionierter Festzuschuss-Betrag</b></p><ul><li>finding: <a href=\"CodeSystem-festzuschuss-befund.html#festzuschuss-befund-1.461\">Festzuschuss-Befund nach §55 SGB V: 1.1</a> (Festzuschuss-Befund 1.1)</li><li>benefitPercentage: 75</li><li>amount: <span title=\"Euro\">€125,00</span> (EUR)</li><li>effectivePeriod: 2026-01-01 --&gt; 2026-12-31</li><li>source: <a href=\"https://simplifier.net/resolve?scope=de.basisprofil.r4@1.5.4&amp;canonical=https://example.org/festzuschuss/synthetic/2026\">https://example.org/festzuschuss/synthetic/2026</a></li></ul></blockquote><p><b>sequence</b>: 1</p><p><b>informationSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://fhir.de/CodeSystem/kzbv/bema 91d}\">BEMA-91d</span></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>210</td><td>Euro</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>210</td><td>Euro</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>ZE Versorgungsart</b>: gleichartig</p><p><b>sequence</b>: 2</p><p><b>informationSequence</b>: 2</p><p><b>productOrService</b>: <span title=\"Codes:{http://fhir.de/CodeSystem/bzaek/goz 5040}\">GOZ-5040</span></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>480</td><td>Euro</td></tr></table><p><b>factor</b>: 1</p><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>480</td><td>Euro</td></tr></table></blockquote><h3>Totals</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>690</td><td>Euro</td></tr></table></div>"
  ] ;
  fhir:Claim.status [ fhir:value "active"] ;
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ] ;
       fhir:Coding.code [ fhir:value "professional" ]
     ]
  ] ;
  fhir:Claim.use [ fhir:value "claim"] ;
  fhir:Claim.patient [
     fhir:link <http://hl7.org/fhir/Patient/pat-gkv-dental-01> ;
     fhir:Reference.reference [ fhir:value "Patient/pat-gkv-dental-01" ]
  ] ;
  fhir:Claim.billablePeriod [
     fhir:Period.start [ fhir:value "2026-05-01"^^xsd:date ] ;
     fhir:Period.end [ fhir:value "2026-05-31"^^xsd:date ]
  ] ;
  fhir:Claim.created [ fhir:value "2026-05-31"^^xsd:date] ;
  fhir:Claim.insurer [
     fhir:Reference.display [ fhir:value "Barmer" ]
  ] ;
  fhir:Claim.provider [
     fhir:link <http://hl7.org/fhir/PractitionerRole/role-schoell-gibitzenhof> ;
     fhir:Reference.reference [ fhir:value "PractitionerRole/role-schoell-gibitzenhof" ]
  ] ;
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.code [ fhir:value "normal" ]
     ]
  ] ;
  fhir:Claim.supportingInfo [
     fhir:index 0 ;
     fhir:Claim.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ] ;
         fhir:Coding.code [ fhir:value "info" ]
       ]
     ] ;
     fhir:Claim.supportingInfo.valueReference [
       fhir:link <http://hl7.org/fhir/ChargeItem/ExampleMixedBemaChargeItem> ;
       fhir:Reference.reference [ fhir:value "ChargeItem/ExampleMixedBemaChargeItem" ]
     ]
  ], [
     fhir:index 1 ;
     fhir:Claim.supportingInfo.sequence [ fhir:value "2"^^xsd:positiveInteger ] ;
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ] ;
         fhir:Coding.code [ fhir:value "info" ]
       ]
     ] ;
     fhir:Claim.supportingInfo.valueReference [
       fhir:link <http://hl7.org/fhir/ChargeItem/ExampleMixedGozChargeItem> ;
       fhir:Reference.reference [ fhir:value "ChargeItem/ExampleMixedGozChargeItem" ]
     ]
  ] ;
  fhir:Claim.diagnosis [
     fhir:index 0 ;
     fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.diagnosis.diagnosisReference [
       fhir:link <http://hl7.org/fhir/Condition/ExampleMixedDentalCondition> ;
       fhir:Reference.reference [ fhir:value "Condition/ExampleMixedDentalCondition" ]
     ]
  ] ;
  fhir:Claim.insurance [
     fhir:index 0 ;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ] ;
     fhir:Claim.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/cov-gkv-dental-01-gkv> ;
       fhir:Reference.reference [ fhir:value "Coverage/cov-gkv-dental-01-gkv" ]
     ]
  ], [
     fhir:index 1 ;
     fhir:Claim.insurance.sequence [ fhir:value "2"^^xsd:positiveInteger ] ;
     fhir:Claim.insurance.focal [ fhir:value "false"^^xsd:boolean ] ;
     fhir:Claim.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/cov-zzv-dental-01> ;
       fhir:Reference.reference [ fhir:value "Coverage/cov-zzv-dental-01" ]
     ]
  ] ;
  fhir:Claim.item [
     fhir:index 0 ;
     fhir:Element.extension [
       fhir:index 0 ;
       fhir:Extension.url [ fhir:value "https://fhir.cognovis.de/dental/StructureDefinition/ze-versorgungsart" ] ;
       fhir:Extension.valueCode [ fhir:value "gleichartig" ]
     ], [
       fhir:index 1 ;
       fhir:Element.extension [
         fhir:index 0 ;
         fhir:Extension.url [ fhir:value "finding" ] ;
         fhir:Extension.valueCoding [
           fhir:Coding.system [ fhir:value "https://fhir.cognovis.de/dental/CodeSystem/festzuschuss-befund" ] ;
           fhir:Coding.code [ fhir:value "1.1" ] ;
           fhir:Coding.display [ fhir:value "Festzuschuss-Befund 1.1" ]
         ]
       ], [
         fhir:index 1 ;
         fhir:Extension.url [ fhir:value "benefitPercentage" ] ;
         fhir:Extension.valuePositiveInt [ fhir:value "75"^^xsd:positiveInteger ]
       ], [
         fhir:index 2 ;
         fhir:Extension.url [ fhir:value "amount" ] ;
         fhir:Extension.valueMoney [
           fhir:Money.value [ fhir:value "125"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "EUR" ]
         ]
       ], [
         fhir:index 3 ;
         fhir:Extension.url [ fhir:value "effectivePeriod" ] ;
         fhir:Extension.valuePeriod [
           fhir:Period.start [ fhir:value "2026-01-01"^^xsd:date ] ;
           fhir:Period.end [ fhir:value "2026-12-31"^^xsd:date ]
         ]
       ], [
         fhir:index 4 ;
         fhir:Extension.url [ fhir:value "source" ] ;
         fhir:Extension.valueUri [ fhir:value "https://example.org/festzuschuss/synthetic/2026" ]
       ] ;
       fhir:Extension.url [ fhir:value "https://fhir.cognovis.de/dental/StructureDefinition/festzuschuss-betrag" ]
     ] ;
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.item.informationSequence [
       fhir:value "1"^^xsd:positiveInteger ;
       fhir:index 0
     ] ;
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://fhir.de/CodeSystem/kzbv/bema" ] ;
         fhir:Coding.code [ fhir:value "91d" ] ;
         fhir:Coding.display [ fhir:value "BEMA-91d" ]
       ]
     ] ;
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "210"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "EUR" ]
     ] ;
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "210"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "EUR" ]
     ]
  ], [
     fhir:index 1 ;
     fhir:Element.extension [
       fhir:index 0 ;
       fhir:Extension.url [ fhir:value "https://fhir.cognovis.de/dental/StructureDefinition/ze-versorgungsart" ] ;
       fhir:Extension.valueCode [ fhir:value "gleichartig" ]
     ] ;
     fhir:Claim.item.sequence [ fhir:value "2"^^xsd:positiveInteger ] ;
     fhir:Claim.item.informationSequence [
       fhir:value "2"^^xsd:positiveInteger ;
       fhir:index 0
     ] ;
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://fhir.de/CodeSystem/bzaek/goz" ] ;
         fhir:Coding.code [ fhir:value "5040" ] ;
         fhir:Coding.display [ fhir:value "GOZ-5040" ]
       ]
     ] ;
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "480"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "EUR" ]
     ] ;
     fhir:Claim.item.factor [ fhir:value "1"^^xsd:decimal ] ;
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "480"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "EUR" ]
     ]
  ] ;
  fhir:Claim.total [
     fhir:Money.value [ fhir:value "690"^^xsd:decimal ] ;
     fhir:Money.currency [ fhir:value "EUR" ]
  ] .

<http://hl7.org/fhir/Patient/pat-gkv-dental-01> a fhir:Patient .

<http://hl7.org/fhir/PractitionerRole/role-schoell-gibitzenhof> a fhir:PractitionerRole .

<http://hl7.org/fhir/ChargeItem/ExampleMixedBemaChargeItem> a fhir:ChargeItem .

<http://hl7.org/fhir/ChargeItem/ExampleMixedGozChargeItem> a fhir:ChargeItem .

<http://hl7.org/fhir/Condition/ExampleMixedDentalCondition> a fhir:Condition .

<http://hl7.org/fhir/Coverage/cov-gkv-dental-01-gkv> a fhir:Coverage .

<http://hl7.org/fhir/Coverage/cov-zzv-dental-01> a fhir:Coverage .

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

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