Generated Narrative: ExplanationOfBenefit haau3-explanation-of-benefit-outpatient

Profiles: haau3 Explanation of Benefit, http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional

identifier: https://haau3.com/fhir/NamingSystem/source-resource-id/ExplanationOfBenefit/example-source-record, https://bluebutton.cms.gov/resources/variables/clm_id/EXAMPLE-CLM-0001

status: Active

type: Institutional

use: Claim

patient: Derrick Lin Male, DoB: 1965-04-12 ( https://haau3.com/fhir/NamingSystem/haau3-patient-id#Haau3PatientId#example-haau3-patient (use: usual, ))

created: 2026-02-04

insurer: Identifier: United States Employer Identification Number/EXAMPLE-INSURER

provider: Organization Valley Outpatient Center

outcome: Processing Complete

Insurances

Focal

Coverage

true

Coverage: extension = ->display: string (PrimitiveType/Coverage.extension[0].value[x].display): element = string -> display=string[Northgate Supplemental Benefits]; identifier = https://haau3.com/fhir/NamingSystem/source-resource-id#Coverage/example-source-record; status = active; subscriberId = VM-88214; relationship = 01

Items

Sequence

ProductOrService

Serviced[x]

EXAMPLE01

2026-02-01

total
category: submitted
Amounts
- Value Currency
* 412.5 United States dollar

Generated Narrative: Organization #ExampleClaimProviderOrganization

active: true
name: Valley Outpatient Center