Charge Item
A charge item is a single billable line for one service or product given to a patient — a consultation fee, a lab test, a dispensed medicine, a bed-day. It is the atom of billing in Care: the smallest unit that records what was charged, how much, and why, before anything is grouped onto an invoice.
What it represents
In Care's FHIR-aligned model, a charge item maps to the ChargeItem resource. Each one ties four things together:
- What — the service or product, named by a title and an optional billing code
- How much — the quantity and a full price breakdown that resolves to a total
- Why — the activity that produced it, such as a service request, a dispensed medication, an appointment, or a bed stay, and who performed it
- Where — the patient and the account it sits on, and optionally the encounter it relates to
The key idea is that a charge item is self-contained: it carries its own pricing rather than looking up a live rate, so the cost is locked at the moment of charging and never drifts when the catalogue changes later. And a charge item is not an invoice. Charges accumulate on an account as care happens; an invoice is the separate, later act of selecting some of them and presenting them for payment.
How it connects
A charge item never floats on its own — it always points back at the records around it:
- Account — every charge item lives on exactly one account, the running ledger for a patient. Omit the account and it lands on the patient's default one.
- Patient — the person being billed. Charge against an encounter and the patient is inherited from it automatically.
- Encounter — the visit or admission the charge relates to. Optional: charges can also exist outside any single encounter.
- Charge item definition — an optional template. Applying a charge item definition builds a fully-priced charge item from the facility's catalogue, so staff never re-key prices by hand.
- Invoice — once a charge is billed and settled, it links back to the invoice that paid it.
Pricing model
Price is never a single number. A charge item holds a list of monetary components that stack up to the total: a base per-unit price (exactly one, multiplied by quantity), surcharges added on top, discounts subtracted (optionally capped by a discount rule), and tax applied to what remains. A component can also be marked informational — shown for reference but excluded from the total.
Care recomputes this breakdown on the server every time a charge is created or edited; clients never set the total themselves. When a price departs from the catalogue rate, an override reason can be recorded alongside it.
Lifecycle
A charge item moves through billing states as it is priced, invoiced, and settled:
billable → billed → paid
- billable — priced and ready to be placed on an invoice
- billed — included on an invoice (set by the platform, not by hand)
- paid — settled, with a link to the invoice and the date it cleared (also platform-set)
Off to the side, a charge can instead be cancelled — recorded but never billed (not_billable), called off before billing (aborted), or withdrawn as a mistake (entered_in_error). Cancelling a charge that was sitting on a draft invoice pulls it off and rebalances that invoice; a charge already on a finalised invoice cannot be cancelled at all. The billed and paid states are never set manually — they only ever reflect what billing has actually done. Cancellation is free for a short window after creation; after that it requires an explicit permission.
Permissions
Access to charge items is governed by facility-scoped permissions.
| Permission | Description | System Roles |
|---|---|---|
can_create_charge_item | Create a charge item, apply charge item definitions, and move charge items between accounts | Facility Admin, Admin, Staff, Doctor, Nurse, Pharmacist |
can_create_negative_charge_item | Allow charge items priced below zero (reversals/credits) when applying definitions | Facility Admin, Admin |
can_read_charge_item | View charge items and their pricing | Facility Admin, Administrator, Admin, Staff, Doctor, Nurse, Volunteer, Pharmacist |
can_update_charge_item | Edit an existing charge item | Facility Admin, Admin |
can_cancel_charge_item | Cancel a charge item after the free-cancel window has elapsed | Facility Admin, Admin |
Roles are granted to users through facility and organization memberships, and permissions cascade down the organization tree — a role held higher up applies to the facilities and patients beneath it.
Related
- Reference: Charge Item (technical)
- Concept: Account
- Concept: Charge Item Definition
- Concept: Invoice