Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build
Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build
Consumer Real-Time Pharmacy Benefit Check FHIR IG, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-rtpbc/ and changes regularly. See the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="rtpbc-bundle-request-03"/>
<meta>
<profile
value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-bundle"/>
</meta>
<language value="en"/>
<type value="message"/>
<timestamp value="2019-11-15T13:10:13-05:00"/>
<entry>
<fullUrl
value="http://example.org/my-app/MessageHeader/rtpbc-messageheader-request-03a"/>
<resource>
<MessageHeader>
<id value="rtpbc-messageheader-request-03a"/>
<meta>
<profile
value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-messageheader"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="MessageHeader_rtpbc-messageheader-request-03a"> </a><p class="res-header-id"><b>Generated Narrative: MessageHeader rtpbc-messageheader-request-03a</b></p><a name="rtpbc-messageheader-request-03a"> </a><a name="hcrtpbc-messageheader-request-03a"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-request-messageheader.html">RTPBC Request MessageHeader</a></p></div><p><b>event</b>: <a href="CodeSystem-rtpbc-event-type.html#rtpbc-event-type-rtpbc-request">RTPBC Event Type Code System: rtpbc-request</a> (RTPBC Request)</p><h3>Sources</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style="display: none">*</td><td>MyPatientApp</td><td><a href="http://example.org/MyPatientApp">http://example.org/MyPatientApp</a></td></tr></table><p><b>focus</b>: <a href="Bundle-rtpbc-bundle-request-03.html#http-//example.org/my-app/Claim/rtpbc-claim-03a">Claim: identifier = rtpbc-03a; status = active; type = Pharmacy; use = predetermination; created = 2019-11-01 11:20:54-0500; priority = Normal</a></p><p><b>definition</b>: <a href="MessageDefinition-rtpbc-request.html">RTPBC Request Message Definition</a></p></div>
</text>
<eventCoding>
<system
value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type"/>
<code value="rtpbc-request"/>
<display value="RTPBC Request"/>
</eventCoding>
<source>
<name value="MyPatientApp"/>
<endpoint value="http://example.org/MyPatientApp"/>
</source>
<focus>
<reference value="http://example.org/my-app/Claim/rtpbc-claim-03a"/>
</focus>
<definition
value="http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-request"/>
</MessageHeader>
</resource>
</entry>
<entry>
<fullUrl value="http://example.org/my-app/Claim/rtpbc-claim-03a"/>
<resource>
<Claim>
<id value="rtpbc-claim-03a"/>
<meta>
<profile
value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Claim_rtpbc-claim-03a"> </a><p class="res-header-id"><b>Generated Narrative: Claim rtpbc-claim-03a</b></p><a name="rtpbc-claim-03a"> </a><a name="hcrtpbc-claim-03a"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-request-claim.html">RTPBC Request Using Claim</a></p></div><p><b>identifier</b>: rtpbc-03a</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}">Pharmacy</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href="Patient-rtpbc-patient-03.html">Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)</a></p><p><b>created</b>: 2019-11-01 11:20:54-0500</p><p><b>provider</b>: <a href="Organization-rtpbc-organization-03.html">Organization Hometown Drug</a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><p><b>prescription</b>: <a href="MedicationRequest-rtpbc-medicationrequest-03.html">MedicationRequest: status = draft; intent = proposal; reported[x] = true; medication[x] = fluoxetine 10 MG Oral Capsule [Prozac]; authoredOn = 2019-11-01</a></p><h3>CareTeams</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><a href="Practitioner-rtpbc-practitioner-03.html">Practitioner Johnson </a></td></tr></table><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td><a href="Coverage-rtpbc-coverage-01.html">Coverage: status = active; subscriberId = 121212; relationship = Self</a></td></tr></table><h3>Items</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>ProductOrService</b></td><td><b>Quantity</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>1</td><td><span title="Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 205535}">fluoxetine 10 MG Oral Capsule [Prozac]</span></td><td>60 {Each}</td></tr></table></div>
</text>
<identifier>
<value value="rtpbc-03a"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="pharmacy"/>
<display value="Pharmacy"/>
</coding>
</type>
<use value="predetermination"/>
<patient>🔗
<reference value="Patient/rtpbc-patient-03"/>
</patient>
<created value="2019-11-01T11:20:54-05:00"/>
<provider>🔗
<reference value="Organization/rtpbc-organization-03"/>
</provider>
<priority>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/processpriority"/>
<code value="normal"/>
<display value="Normal"/>
</coding>
</priority>
<prescription>🔗
<reference value="MedicationRequest/rtpbc-medicationrequest-03"/>
</prescription>
<careTeam>
<sequence value="1"/>
<provider>🔗
<reference value="Practitioner/rtpbc-practitioner-03"/>
</provider>
</careTeam>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>🔗
<reference value="Coverage/rtpbc-coverage-01"/>
</coverage>
</insurance>
<item>
<sequence value="1"/>
<careTeamSequence value="1"/>
<productOrService>
<coding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="205535"/>
<display value="fluoxetine 10 MG Oral Capsule [Prozac]"/>
</coding>
</productOrService>
<quantity>
<value value="60"/>
<unit value="{Each}"/>
</quantity>
</item>
</Claim>
</resource>
</entry>
<entry>
<fullUrl value="http://example.org/my-app/Patient/rtpbc-patient-03"/>
<resource>
<Patient>
<id value="rtpbc-patient-03"/>
<meta>
<profile
value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_rtpbc-patient-03"> </a><p class="res-header-id"><b>Generated Narrative: Patient rtpbc-patient-03</b></p><a name="rtpbc-patient-03"> </a><a name="hcrtpbc-patient-03"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-patient.html">RTPBC Patient</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3">100 Oak Court Madison WI 53510 US </td></tr></table></div>
</text>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="PI"/>
<display value="Patient internal identifier"/>
</coding>
<text value="Patient internal identifier"/>
</type>
<system value="http://example.org/MyPatientApp"/>
<value value="30455"/>
</identifier>
<name>
<family value="Doe"/>
<given value="Jane"/>
</name>
<gender value="female"/>
<birthDate value="1975-12-05"/>
<address>
<line value="100 Oak Court"/>
<city value="Madison"/>
<state value="WI"/>
<postalCode value="53510"/>
<country value="US"/>
</address>
</Patient>
</resource>
</entry>
<entry>
<fullUrl value="http://example.org/my-app/Coverage/rtpbc-coverage-01"/>
<resource>
<Coverage>
<id value="rtpbc-coverage-01"/>
<meta>
<profile
value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Coverage_rtpbc-coverage-01"> </a><p class="res-header-id"><b>Generated Narrative: Coverage rtpbc-coverage-01</b></p><a name="rtpbc-coverage-01"> </a><a name="hcrtpbc-coverage-01"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-coverage.html">RTPBC Coverage</a></p></div><p><b>status</b>: Active</p><p><b>subscriberId</b>: 121212</p><p><b>beneficiary</b>: <a href="Patient-rtpbc-patient-03.html">Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>payor</b>: Identifier: Pharmacy Plans US</p><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxbin}">RX BIN</span></p><p><b>value</b>: BIN001</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxpcn}">RX PCN</span></p><p><b>value</b>: PCN002</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxgroup}">RX Group</span></p><p><b>value</b>: GROUP0001</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxid}">RX Id</span></p><p><b>value</b>: MEMBER000001</p></blockquote></div>
</text>
<status value="active"/>
<subscriberId value="121212"/>
<beneficiary>🔗
<reference value="Patient/rtpbc-patient-03"/>
</beneficiary>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
<code value="self"/>
</coding>
</relationship>
<payor>
<identifier>
<value value="Pharmacy Plans US"/>
</identifier>
</payor>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="rxbin"/>
</coding>
</type>
<value value="BIN001"/>
</class>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="rxpcn"/>
</coding>
</type>
<value value="PCN002"/>
</class>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="rxgroup"/>
</coding>
</type>
<value value="GROUP0001"/>
</class>
<class>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
<code value="rxid"/>
</coding>
</type>
<value value="MEMBER000001"/>
</class>
</Coverage>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/my-app/MedicationRequest/rtpbc-medicationrequest-03"/>
<resource>
<MedicationRequest>
<id value="rtpbc-medicationrequest-03"/>
<meta>
<profile
value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-medicationrequest"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="MedicationRequest_rtpbc-medicationrequest-03"> </a><p class="res-header-id"><b>Generated Narrative: MedicationRequest rtpbc-medicationrequest-03</b></p><a name="rtpbc-medicationrequest-03"> </a><a name="hcrtpbc-medicationrequest-03"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-medicationrequest.html">RTPBC Medication Request</a></p></div><p><b>status</b>: Draft</p><p><b>intent</b>: Proposal</p><p><b>reported</b>: true</p><p><b>medication</b>: <span title="Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 205535}">fluoxetine 10 MG Oral Capsule [Prozac]</span></p><p><b>subject</b>: <a href="Patient-rtpbc-patient-03.html">Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)</a></p><p><b>authoredOn</b>: 2019-11-01</p><p><b>requester</b>: <a href="Practitioner-rtpbc-practitioner-03.html">Practitioner Johnson </a></p><h3>DosageInstructions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Text</b></td></tr><tr><td style="display: none">*</td><td>Take 2 capsules once a day</td></tr></table><blockquote><p><b>dispenseRequest</b></p><p><b>quantity</b>: 60 {Each}</p><h3>ExpectedSupplyDurations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Unit</b></td><td><b>System</b></td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td>30</td><td>days</td><td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-ucum.html">http://unitsofmeasure.org</a></td><td>d</td></tr></table><p><b>performer</b>: <a href="Organization-rtpbc-organization-03.html">Organization Hometown Drug</a></p></blockquote><h3>Substitutions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Allowed[x]</b></td></tr><tr><td style="display: none">*</td><td>false</td></tr></table></div>
</text>
<status value="draft"/>
<intent value="proposal"/>
<reportedBoolean value="true"/>
<medicationCodeableConcept>
<coding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="205535"/>
<display value="fluoxetine 10 MG Oral Capsule [Prozac]"/>
</coding>
</medicationCodeableConcept>
<subject>🔗
<reference value="Patient/rtpbc-patient-03"/>
</subject>
<authoredOn value="2019-11-01"/>
<requester>🔗
<reference value="Practitioner/rtpbc-practitioner-03"/>
</requester>
<dosageInstruction>
<text value="Take 2 capsules once a day"/>
</dosageInstruction>
<dispenseRequest>
<quantity>
<value value="60"/>
<unit value="{Each}"/>
</quantity>
<expectedSupplyDuration>
<value value="30"/>
<unit value="days"/>
<system value="http://unitsofmeasure.org"/>
<code value="d"/>
</expectedSupplyDuration>
<performer>🔗
<reference value="Organization/rtpbc-organization-03"/>
</performer>
</dispenseRequest>
<substitution>
<allowedBoolean value="false"/>
</substitution>
</MedicationRequest>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/my-app/Practitioner/rtpbc-practitioner-03"/>
<resource>
<Practitioner>
<id value="rtpbc-practitioner-03"/>
<meta>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_rtpbc-practitioner-03"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner rtpbc-practitioner-03</b></p><a name="rtpbc-practitioner-03"> </a><a name="hcrtpbc-practitioner-03"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU8.0.1/StructureDefinition-us-core-practitioner.html">US Core Practitioner Profile</a></p></div><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.5.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/1234567893</p><p><b>name</b>: Johnson </p></div>
</text>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1234567893"/>
</identifier>
<name>
<family value="Johnson"/>
</name>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl
value="http://example.org/my-app/Organization/rtpbc-organization-03"/>
<resource>
<Organization>
<id value="rtpbc-organization-03"/>
<meta>
<profile
value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_rtpbc-organization-03"> </a><p class="res-header-id"><b>Generated Narrative: Organization rtpbc-organization-03</b></p><a name="rtpbc-organization-03"> </a><a name="hcrtpbc-organization-03"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-pharmacy-organization.html">RTPBC Pharmacy Organization</a></p></div><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.5.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/9876543213</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType R}">Retail</span></p><p><b>name</b>: Hometown Drug</p><p><b>telecom</b>: ph: 6081234567</p><p><b>address</b>: 900 9th Street Madison WI 53535 US </p></div>
</text>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="9876543213"/>
</identifier>
<active value="true"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType"/>
<code value="R"/>
<display value="Retail"/>
</coding>
</type>
<name value="Hometown Drug"/>
<telecom>
<system value="phone"/>
<value value="6081234567"/>
</telecom>
<address>
<line value="900 9th Street"/>
<city value="Madison"/>
<state value="WI"/>
<postalCode value="53535"/>
<country value="US"/>
</address>
</Organization>
</resource>
</entry>
</Bundle>
IG © 2024+ HL7 International / Pharmacy.
Package hl7.fhir.us.carin-rtpbc#2.0.0 based on FHIR 4.0.1.
Generated
2025-12-16
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