# Ví dụ: Giải trình quyền lợi BHYT — 80% BHYT, 20% cùng chi trả - Bộ Hướng dẫn Triển khai Core FHIR cho Việt Nam v0.5.0

## Ví dụ ExplanationOfBenefit: Ví dụ: Giải trình quyền lợi BHYT — 80% BHYT, 20% cùng chi trả

Profile: [Giải trình quyền lợi BHYT VN Core — VN Core ExplanationOfBenefit Profile](StructureDefinition-vn-core-explanation-of-benefit.md)

> **Tổng chi phí theo nhóm — Claim Cost Summary Extension**
* totalInsurance: ₫560.000 (VND)
* totalPatientCopay: ₫140.000 (VND)
* totalPatientSelfPay: ₫0 (VND)

> **Kỳ thanh toán — Claim Payment Period Extension**
* year: 2026
* month: 4

**Phương thức thanh toán — Payment Method Extension**: Phí dịch vụ (FFS)

**status**: Active

**type**: Professional

**use**: Claim

**patient**: [Nguyễn Văn An](Patient-ExamplePatientNguyenVanAn.md)

**created**: 2026-04-20

**insurer**: [Bảo hiểm xã hội Việt Nam](Organization-ExampleOrganizationBHXH.md)

**provider**: [Bệnh viện Chợ Rẫy](Organization-ExampleOrganizationChoRay.md)

**outcome**: Processing Complete

### Diagnoses

| | | | |
| :--- | :--- | :--- | :--- |
| - | **Sequence** | **Diagnosis[x]** | **Type** |
| * | 1 | Tăng huyết áp nguyên phát | Principal Diagnosis |

### Insurances

| | | |
| :--- | :--- | :--- |
| - | **Focal** | **Coverage** |
| * | true | [Coverage: extension = Người lao động trong doanh nghiệp,->Bệnh viện Chợ Rẫy; identifier = http://fhir.hl7.org.vn/core/sid/bhyt#VNBHYT#001085012345; status = active; type = Medical; relationship = Self; period = 2025-08-01 --> 2026-07-31](Coverage-ExampleCoverageBHYTNew.md) |

> **item****sequence**: 1**category**: Khám bệnh**productOrService**: Khám chuyên khoa Tim mạch
> **adjudication****category**: Submitted Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 150000 | Vietnamese đồng |


> **adjudication****category**: Eligible Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 150000 | Vietnamese đồng |


> **adjudication****category**: Benefit Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 120000 | Vietnamese đồng |



> **item****sequence**: 2**category**: Xét nghiệm**productOrService**: Xét nghiệm sinh hóa máu (Glucose, HbA1c, Lipid)
> **adjudication****category**: Submitted Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 200000 | Vietnamese đồng |


> **adjudication****category**: Eligible Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 200000 | Vietnamese đồng |


> **adjudication****category**: Benefit Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 160000 | Vietnamese đồng |



> **item****sequence**: 3**category**: Thuốc, dịch truyền**productOrService**: Amlodipine 5mg x 30 viên + Atorvastatin 20mg x 30 viên
> **adjudication****category**: Submitted Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 350000 | Vietnamese đồng |


> **adjudication****category**: Eligible Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 350000 | Vietnamese đồng |


> **adjudication****category**: Benefit Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 280000 | Vietnamese đồng |



> **total****category**: Submitted Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 700000 | Vietnamese đồng |


> **total****category**: Benefit Amount

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 560000 | Vietnamese đồng |


> **payment****type**: Complete

### Amounts

| | | |
| :--- | :--- | :--- |
| - | **Value** | **Currency** |
| * | 560000 | Vietnamese đồng |


**benefitPeriod**: 2026-01-01 --> 2026-12-31



## Resource Content

```json
{
  "resourceType" : "ExplanationOfBenefit",
  "id" : "ExampleEOBPartialCoverage",
  "meta" : {
    "profile" : ["http://fhir.hl7.org.vn/core/StructureDefinition/vn-core-explanation-of-benefit"]
  },
  "extension" : [{
    "extension" : [{
      "url" : "totalInsurance",
      "valueMoney" : {
        "value" : 560000,
        "currency" : "VND"
      }
    },
    {
      "url" : "totalPatientCopay",
      "valueMoney" : {
        "value" : 140000,
        "currency" : "VND"
      }
    },
    {
      "url" : "totalPatientSelfPay",
      "valueMoney" : {
        "value" : 0,
        "currency" : "VND"
      }
    }],
    "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-cost-summary"
  },
  {
    "extension" : [{
      "url" : "year",
      "valueInteger" : 2026
    },
    {
      "url" : "month",
      "valueInteger" : 4
    }],
    "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-claim-payment-period"
  },
  {
    "url" : "http://fhir.hl7.org.vn/core/StructureDefinition/vn-ext-payment-method",
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-payment-method-cs",
        "code" : "1",
        "display" : "Phí dịch vụ (FFS)"
      }]
    }
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "professional",
      "display" : "Professional"
    }]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/ExamplePatientNguyenVanAn",
    "display" : "Nguyễn Văn An"
  },
  "created" : "2026-04-20",
  "insurer" : {
    "reference" : "Organization/ExampleOrganizationBHXH",
    "display" : "Bảo hiểm xã hội Việt Nam"
  },
  "provider" : {
    "reference" : "Organization/ExampleOrganizationChoRay",
    "display" : "Bệnh viện Chợ Rẫy"
  },
  "outcome" : "complete",
  "diagnosis" : [{
    "sequence" : 1,
    "diagnosisCodeableConcept" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/sid/icd-10",
        "code" : "I10",
        "display" : "Essential (primary) hypertension"
      }],
      "text" : "Tăng huyết áp nguyên phát"
    },
    "type" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
        "code" : "principal",
        "display" : "Principal Diagnosis"
      }]
    }]
  }],
  "insurance" : [{
    "focal" : true,
    "coverage" : {
      "reference" : "Coverage/ExampleCoverageBHYTNew"
    }
  }],
  "item" : [{
    "sequence" : 1,
    "category" : {
      "coding" : [{
        "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs",
        "code" : "1",
        "display" : "Khám bệnh"
      }]
    },
    "productOrService" : {
      "text" : "Khám chuyên khoa Tim mạch"
    },
    "adjudication" : [{
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "submitted",
          "display" : "Submitted Amount"
        }]
      },
      "amount" : {
        "value" : 150000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "eligible",
          "display" : "Eligible Amount"
        }]
      },
      "amount" : {
        "value" : 150000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "benefit",
          "display" : "Benefit Amount"
        }]
      },
      "amount" : {
        "value" : 120000,
        "currency" : "VND"
      }
    }]
  },
  {
    "sequence" : 2,
    "category" : {
      "coding" : [{
        "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs",
        "code" : "3",
        "display" : "Xét nghiệm"
      }]
    },
    "productOrService" : {
      "text" : "Xét nghiệm sinh hóa máu (Glucose, HbA1c, Lipid)"
    },
    "adjudication" : [{
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "submitted",
          "display" : "Submitted Amount"
        }]
      },
      "amount" : {
        "value" : 200000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "eligible",
          "display" : "Eligible Amount"
        }]
      },
      "amount" : {
        "value" : 200000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "benefit",
          "display" : "Benefit Amount"
        }]
      },
      "amount" : {
        "value" : 160000,
        "currency" : "VND"
      }
    }]
  },
  {
    "sequence" : 3,
    "category" : {
      "coding" : [{
        "system" : "http://fhir.hl7.org.vn/core/CodeSystem/vn-cost-category-cs",
        "code" : "8",
        "display" : "Thuốc, dịch truyền"
      }]
    },
    "productOrService" : {
      "text" : "Amlodipine 5mg x 30 viên + Atorvastatin 20mg x 30 viên"
    },
    "adjudication" : [{
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "submitted",
          "display" : "Submitted Amount"
        }]
      },
      "amount" : {
        "value" : 350000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "eligible",
          "display" : "Eligible Amount"
        }]
      },
      "amount" : {
        "value" : 350000,
        "currency" : "VND"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "benefit",
          "display" : "Benefit Amount"
        }]
      },
      "amount" : {
        "value" : 280000,
        "currency" : "VND"
      }
    }]
  }],
  "total" : [{
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "submitted",
        "display" : "Submitted Amount"
      }]
    },
    "amount" : {
      "value" : 700000,
      "currency" : "VND"
    }
  },
  {
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "benefit",
        "display" : "Benefit Amount"
      }]
    },
    "amount" : {
      "value" : 560000,
      "currency" : "VND"
    }
  }],
  "payment" : {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
        "code" : "complete",
        "display" : "Complete"
      }]
    },
    "amount" : {
      "value" : 560000,
      "currency" : "VND"
    }
  },
  "benefitPeriod" : {
    "start" : "2026-01-01",
    "end" : "2026-12-31"
  }
}

```
