Polaris FHIR Implementation Guide
1.10.0 - ci-build

Polaris FHIR Implementation Guide - Local Development build (v1.10.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Polaris Invoice Example - JSON Representation

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{
  "resourceType" : "Invoice",
  "id" : "polaris-invoice-example",
  "meta" : {
    "profile" : [
      🔗 "https://fhir.apps.health/StructureDefinition/polaris-core-invoice"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">OHIP bill for Avery Linwood, April 8, 2026 visit — general assessment A007 ($37.95) with chronic care premium K030. Total $61.45.</div>"
  },
  "extension" : [
    {
      "url" : "https://fhir.apps.health/StructureDefinition/oscar-billing-status-extension",
      "valueCode" : "O"
    },
    {
      "url" : "https://fhir.apps.health/StructureDefinition/oscar-billing-shadow-bill-extension",
      "valueBoolean" : false
    },
    {
      "url" : "https://fhir.apps.health/StructureDefinition/oscar-service-location-extension",
      "valueReference" : {
        🔗 "reference" : "Location/cedarbrook-site-a"
      }
    }
  ],
  "identifier" : [
    {
      "use" : "official",
      "system" : "https://fhir.apps.health/NamingSystem/cedarbrook-clinic-invoice-identifier",
      "value" : "INV-avery-20250408-001"
    },
    {
      "use" : "secondary",
      "system" : "https://fhir.apps.health/NamingSystem/cedarbrook-clinic-invoice-header-id",
      "value" : "78234"
    }
  ],
  "status" : "issued",
  "type" : {
    "coding" : [
      {
        "system" : "https://fhir.apps.health/CodeSystem/oscar-pay-program-cs",
        "code" : "HCP",
        "display" : "OHIP HCP"
      }
    ]
  },
  "subject" : {
    🔗 "reference" : "Patient/avery-linwood"
  },
  "date" : "2026-04-08T10:15:00-04:00",
  "participant" : [
    {
      "role" : {
        "text" : "billing"
      },
      "actor" : {
        "reference" : "Practitioner/dr-navarro"
      }
    }
  ],
  "issuer" : {
    🔗 "reference" : "Organization/cedarbrook-clinic"
  },
  "lineItem" : [
    {
      "extension" : [
        {
          "url" : "https://apps.health/InvoiceLineItem/diagnostic1",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/sid/icd-9-cm",
                "code" : "250"
              }
            ],
            "text" : "Diabetes mellitus"
          }
        }
      ],
      "sequence" : 1,
      "chargeItemCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://fhir.apps.health/CodeSystem/on-ohip-schedule-of-benefits",
            "code" : "A007",
            "display" : "General Assessment"
          }
        ],
        "text" : "General Assessment"
      },
      "priceComponent" : [
        {
          "type" : "base",
          "factor" : 1,
          "amount" : {
            "value" : 37.95,
            "currency" : "CAD"
          }
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "https://apps.health/InvoiceLineItem/diagnostic1",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/sid/icd-9-cm",
                "code" : "250"
              }
            ],
            "text" : "Diabetes mellitus"
          }
        }
      ],
      "sequence" : 2,
      "chargeItemCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://fhir.apps.health/CodeSystem/on-ohip-schedule-of-benefits",
            "code" : "K030",
            "display" : "Chronic Disease Management Premium"
          }
        ],
        "text" : "Chronic Disease Management Premium"
      },
      "priceComponent" : [
        {
          "type" : "base",
          "factor" : 1,
          "amount" : {
            "value" : 23.50,
            "currency" : "CAD"
          }
        }
      ]
    }
  ],
  "totalGross" : {
    "value" : 61.45,
    "currency" : "CAD"
  },
  "note" : [
    {
      "text" : "15-minute visit, diabetes management discussion"
    }
  ]
}