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