Below is an annotated screenshot of the claims form of openIMIS.  

The three major blocks contain individual information on the patient, the facility, the unique claim ID as well as the diagnosis (according to ICD10).

Thereafter the interface offers a selection from a drop-down list of services with the respective price (adjustable by the system administrator in accordance with the schemes benefit package – see the blue box). The same applies to prescriptions of items that can be selected from the list. The prices can be populated automatically or overwritten manually. 

Functionality to attach pictures/scans to provide additional information on lab results/diagnostics relevant to the particular claim is also present.

Please visit the Demo server to try it out for yourself!