Da Vinci Unsolicited Notifications Implementation Guide CI Build

Da Vinci Unsolicited Notifications, published by HL7 International - Infrastructure and Messaging Work Group. This is not an authorized publication; it is the continuous build for version 0.1.0). This version is based on the current content of https://github.com/HL7/davinci-alerts/ and changes regularly. See the Directory of published versions

Da Vinci Notifications Patient Admit/Discharge Use Case

Introduction

This use case demonstrates how the Da Vinci Notifications IG framework is used to define the Da Vinci Notification Bundle for admissions and discharge and how to send a notification between a Sender and a Recipient/Intermediary.

Use Case Background

Having the ability to send a notifications to update physicians and care management teams when a patient is admitted to a hospital or discharged from the hospital is key to improving patient care. The intent of these notifications is not to replace existing data exchange mechanisms, for example the discharge summary; but rather to notify of the discharge event and provide enough data to gather more information, if desired. These notifications improve post-discharge transitions, promote communication between providers and encourage follow up care. Figure 5 illustrates how some of the admit and discharge data elements corresponded to the resource in the message bundle.

Figure 5
bundle_graphic.svg

FHIR Resources for Admission and Discharge Notification

To carry information regarding admission and discharge event messages, the required resources for the message Bundle need to be defined. The core components of the Bundle are defined in the Framework page and include the MessageHeader and the “root” resource represented by the MessageHeader.focus. For admissions and discharge Encounter (US Core Encounter) is the focus of the event as shown in figure 6:

Figure 6
admit_message_graph1.svg

The other “required if present” resources defined in the framework are those referenced by MessageHeader.author, MessageHeader.responsible, MessageHeader.sender and by referenced by the US Core Encounter Profile. These combine to make up a ‘generic’ Encounter message bundle structure illustrated in figure 7 below:

Figure 7
admit_message_graph2.svg

The following additional resources (or rather profiles) have been determined to be “required if present” by the Da Vinci community to fulfill the data item requirements specific to admissions and discharge.

Notification Scenarios Additional Resource Requirements
Emergency and Inpatient Admissions US Core Condition, Da Vinci HRex Coverage
Emergency and Inpatient Discharges US Core Condition, Da Vinci HRex Coverage

Adding these additional components results in the following resource graph showing all the required resources and their relationships for the admission and discharge notification use case:

Figure 8
admit_message_graph3.svg

An alternate representation of this graph is a table with each row representing an “edge” - an ordered pair of the form (source profile, target profile):

Link Source Profile Path Target Profile Min Max Must Support
1 Da Vinci Notification MessageHeader Profile MessageHeader.focus US Core Encounter Profile 1 1 true
2 US Core Encounter Profile Encounter.location US Core Location Profile 1 * true
3 US Core Encounter Profile Encounter.participant.individual US Core Practitioner Profile 0 * true
4 US Core Encounter Profile Encounter.subject US Core Patient Profile 1 1 true
5 Da Vinci HRex Coverage Profile Coverage.beneficary US Core Patient Profile 0 1 true
6 US Core Condition Profile Condition.encounter US Core Encounter Profile 0 * true
7 Da Vinci Notification MessageHeader Profile MessageHeader.sender US Core Practitioner Profile|US Core PractitionerRole Profile|US Core Organization Profile 0 1 true
8 Da Vinci Notification MessageHeader Profile MessageHeader.responsible US Core Practitioner Profile|US Core PractitionerRole Profile|US Core Organization Profile 0 1 true
9 Da Vinci Notification MessageHeader Profile MessageHeader.author US Core Practitioner Profile|US Core PractitionerRole Profile 0 1 true

Note that an Admit/Discharge Bundle may contain more or less resources than this graph illustrates since:
a) having additional resources in the message bundle is not prohibited as long as the resources are reference by or reference another resource in the message bundle and
b) not all the resources listed above may be present in the source system. (For a more detailed discussion of when required resources may be absent, see the section on Must Support)

Formally Defining the Da Vinci Admit and Discharge Notification Message

As documented in the Framework page, there are two alternatives to defining the Bundle components using FHIR artifacts.

FHIR Profiles

The Following FHIR Profiles can be used to formally define this resource graph for the admission and discharge event. Note that except for the first profile listed below, these profiles constrain their references to other profile within the same bundle.

MessageDefinition and GraphDefinition

The Following MessageDefinition and GraphDefinition can be used to formally define this resource graph for the admission and discharge event:

MessageDefinition

  • Da Vinci Notification Admit Message Definition
  • Da Vinci Notification Discharge Message Definition
  • GraphDefinition

  • NotificationAdmitDischarge
  • Da Vinci Notification Message Bundle Examples

    A Da Vinci Notification Bundles such as these examples can be assembled based on any of the above definitions.

  • Bundle/discharge-notification-message-bundle-01
  • Bundle/admit-notification-message-bundle-01
  • Pushing Unsolicited Admit/Discharge Notification

    In the interaction shown in figures 9, the HealthCare facility is acting in the role of the Notification Sender and the Notification Recipient can be any of the actors listed on the home page. To notify the Notification Recipients/Intermediary of an admit or discharge event, the Notification Sender uses $process-message operation to submit the Notification Message to appropriate FHIR endpoints. Not shown in figure 9 is that when the Intermediary successfully receives and processes the notifications, it subsequently forwards the data the end users.

    Figure 9
    $process_message_admit_wf.svg


    Example Transaction

    The following transactions show an example of using the $process-message operation to send a Da Vinci Admission Notification Message and a Da Vinci Discharge Notification Message to a Recipient:

    Examples

    Scenario:

    Patient Y has been admitted to Provider X ‘s facility. Acting in the role of Sender, Provider X alerts Payer Z, who is acting in the Recipient role, of the admission. The Notification is transacted as the [$process-message] operation. The body of the operation is a Message Bundle containing:

    1. The Message Header which is the first resource in the bundle and contains the the message event code - that identifies the nature of the notification.
    2. The other resources in the bundle depend on the type of the notification use case as defined by either the MessageDefinition and GraphDefinition or FHIR Profiles.

    An HTTP Status success code is returned on successful submission.

    Push Notification using the $process-message

    POST [base]/$process-message

    Request body

    {
      "resourceType": "Bundle",
      "id": "admit-notification-message-bundle-01",
      "meta": {
        "profile": [
          "http://hl7.org/fhir/us/davinci-notifications/StructureDefinition/notifications-bundle"
        ]
      },
      "type": "message",
      "timestamp": "2019-11-14T08:08:47Z",
      "entry": [
        {
          "fullUrl": "urn:uuid:267b18ce-3d37-4581-9baa-6fada338038b",
          "resource": {
            "resourceType": "MessageHeader",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/davinci-notifications/StructureDefinition/discharge-notification-messageheader"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: admit-notification-messageheader-01</p><p><b>meta</b>: </p><p><b>event</b>: Notification admit (Details: http://hl7.org/fhir/us/davinci-notifications/CodeSystem/notification-event code notification-admit = 'Notification admit', stated as 'Notification admit')</p><h3>Destinations</h3><table class=\"grid\"><tr><td>-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td>*</td><td>Acme Message Gateway</td><td><a href=\"https://example.org/Endpoints/P123\">https://example.org/Endpoints/P123</a></td></tr></table><p><b>sender</b>: <a href=\"urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade\">Saint Luke W Endpoint</a></p><p><b>author</b>: <a href=\"urn:uuid:e4b71aed-1c54-4f85-bea0-48444aa31f59\">Ronald Bone</a></p><h3>Sources</h3><table class=\"grid\"><tr><td>-</td><td><b>Name</b></td><td><b>Software</b></td><td><b>Version</b></td><td><b>Contact</b></td><td><b>Endpoint</b></td></tr><tr><td>*</td><td>Acme Central Patient Registry</td><td>FooBar Patient Manager</td><td>3.1.45.AABB</td><td>ph: +1 (555) 123 4567</td><td><a href=\"https://example.org/Endpoints/P456\">https://example.org/Endpoints/P456</a></td></tr></table><p><b>responsible</b>: <a href=\"urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade\">Saint Luke W Endpoint</a></p><p><b>focus</b>: <a href=\"urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7\">Inpatient Encounter</a></p></div>"
            },
            "eventCoding": {
              "system": "http://hl7.org/fhir/us/davinci-notifications/CodeSystem/notification-event",
              "code": "notification-discharge",
              "display": "Notification discharge"
            },
            "destination": [
              {
                "name": "Acme Message Gateway",
                "endpoint": "https://example.org/Endpoints/P123"
              }
            ],
            "sender": {
              "reference": "urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade",
              "display": "Saint Luke W Endpoint"
            },
            "author": {
              "reference": "urn:uuid:e4b71aed-1c54-4f85-bea0-48444aa31f59",
              "display": "Ronald Bone"
            },
            "source": {
              "name": "Acme Central Patient Registry",
              "software": "FooBar Patient Manager",
              "version": "3.1.45.AABB",
              "contact": {
                "system": "phone",
                "value": "+1 (555) 123 4567"
              },
              "endpoint": "https://example.org/Endpoints/P456"
            },
            "responsible": {
              "reference": "urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade",
              "display": "Saint Luke W Endpoint"
            },
            "focus": [
              {
                "reference": "urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7",
                "display": "Inpatient Encounter"
              }
            ]
          }
        },
        {
          "fullUrl": "urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7",
          "resource": {
            "resourceType": "Encounter",
            "meta": {
              "lastUpdated": "2017-05-26T11:56:57.250-04:00",
              "profile": [
                "http://hl7.org/fhir/us/davinci-notifications/StructureDefinition/admit-discharge-notification-encounter"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: admit-discharge-notification-encounter-01</p><p><b>meta</b>: </p><p><b>status</b>: finished</p><p><b>class</b>: inpatient encounter (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code IMP = 'inpatient encounter', stated as 'inpatient encounter')</p><p><b>type</b>: Inpatient hospital care <span style=\"background: LightGoldenRodYellow\">(Details : {http://www.ama-assn.org/go/cpt code '99234' = '99234)</span></p><p><b>subject</b>: <a href=\"urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4\">Amy V. Shaw</a></p><h3>Participants</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Period</b></td><td><b>Individual</b></td></tr><tr><td>*</td><td>primary performer <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/v3-ParticipationType code 'PPRF' = 'primary performer)</span></td><td>Nov 1, 2015, 2:00:14 PM --&gt; Nov 1, 2015, 3:00:14 PM</td><td><a href=\"urn:uuid:e4b71aed-1c54-4f85-bea0-48444aa31f59\">Ronald Bone</a></td></tr></table><p><b>period</b>: Nov 1, 2015, 2:00:14 PM --&gt; Nov 1, 2015, 3:00:14 PM</p><h3>Locations</h3><table class=\"grid\"><tr><td>-</td><td><b>Location</b></td></tr><tr><td>*</td><td><a href=\"urn:uuid:75ea28b5-74b8-4d9c-9eb5-cfdc10b48fa\">Health Level Seven International - Amherst</a></td></tr></table></div>"
            },
            "status": "finished",
            "class": {
              "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code": "IMP",
              "display": "inpatient encounter"
            },
            "type": [
              {
                "coding": [
                  {
                    "system": "http://www.ama-assn.org/go/cpt",
                    "code": "99234"
                  }
                ],
                "text": "Inpatient hospital care"
              }
            ],
            "subject": {
              "reference": "urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4",
              "display": "Amy V. Shaw"
            },
            "participant": [
              {
                "type": [
                  {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                        "code": "PPRF"
                      }
                    ],
                    "text": "primary performer"
                  }
                ],
                "period": {
                  "start": "2015-11-01T17:00:14-05:00",
                  "end": "2015-11-01T18:00:14-05:00"
                },
                "individual": {
                  "reference": "urn:uuid:e4b71aed-1c54-4f85-bea0-48444aa31f59",
                  "display": "Ronald Bone"
                }
              }
            ],
            "period": {
              "start": "2015-11-01T17:00:14-05:00",
              "end": "2015-11-01T18:00:14-05:00"
            },
            "location": [
              {
                "location": {
                  "reference": "urn:uuid:75ea28b5-74b8-4d9c-9eb5-cfdc10b48fa",
                  "display": "Health Level Seven International - Amherst"
                }
              }
            ]
          }
        },
        {
          "fullUrl": "urn:uuid:75ea28b5-74b8-4d9c-9eb5-cfdc10b48fa",
          "resource": {
            "resourceType": "Location",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/core/StructureDefinition/us-core-location"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: hl7east</p><p><b>meta</b>: </p><p><b>identifier</b>: 29</p><p><b>status</b>: active</p><p><b>name</b>: Health Level Seven International - Amherst</p><p><b>description</b>: HL7 Headquarters - East</p><p><b>telecom</b>: ph: (+1) 734-677-7777</p><p><b>address</b>: 3300 Washtenaw Avenue, Suite 227 Amherst MA 01002 USA </p><h3>Positions</h3><table class=\"grid\"><tr><td>-</td><td><b>Longitude</b></td><td><b>Latitude</b></td></tr><tr><td>*</td><td>-72.519854</td><td>42.373222</td></tr></table><p><b>managingOrganization</b>: Health Level Seven International</p></div>"
            },
            "identifier": [
              {
                "system": "http://www.acme.org/location",
                "value": "29"
              }
            ],
            "status": "active",
            "name": "Health Level Seven International - Amherst",
            "description": "HL7 Headquarters - East",
            "telecom": [
              {
                "system": "phone",
                "value": "(+1) 734-677-7777"
              }
            ],
            "address": {
              "line": [
                "3300 Washtenaw Avenue, Suite 227"
              ],
              "city": "Amherst",
              "state": "MA",
              "postalCode": "01002",
              "country": "USA"
            },
            "position": {
              "longitude": -72.519854,
              "latitude": 42.373222
            },
            "managingOrganization": {
              "display": "Health Level Seven International"
            }
          }
        },
        {
          "fullUrl": "urn:uuid:e4b71aed-1c54-4f85-bea0-48444aa31f59",
          "resource": {
            "resourceType": "Practitioner",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: practitioner-1</p><p><b>meta</b>: </p><p><b>identifier</b>: 9941339108, 25456</p><p><b>name</b>: Ronald Bone </p><p><b>address</b>: 1003 Healthcare Drive Amherst MA 01002 (HOME)</p></div>"
            },
            "identifier": [
              {
                "system": "http://hl7.org.fhir/sid/us-npi",
                "value": "9941339108"
              },
              {
                "system": "http://www.acme.org/practitioners",
                "value": "25456"
              }
            ],
            "name": [
              {
                "family": "Bone",
                "given": [
                  "Ronald"
                ],
                "prefix": [
                  "Dr"
                ]
              }
            ],
            "address": [
              {
                "use": "home",
                "line": [
                  "1003 Healthcare Drive"
                ],
                "city": "Amherst",
                "state": "MA",
                "postalCode": "01002"
              }
            ]
          }
        },
        {
          "fullUrl": "urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4",
          "resource": {
            "resourceType": "Patient",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>Generated Narrative with Details</b>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>id</b>: example</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>identifier</b>: Medical Record Number = 1032702 (USUAL)</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>active</b>: true</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>name</b>: Amy V. Shaw </p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>telecom</b>: ph: 555-555-5555(HOME), amy.shaw@example.com</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>gender</b>: </p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>birthsex</b>: Female</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>birthDate</b>: Feb 20, 2007</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>address</b>: 49 Meadow St Mounds OK 74047 US </p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>race</b>: White, American Indian or Alaska Native, Asian, Shoshone, Filipino</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>ethnicity</b>: Hispanic or Latino, Dominican, Mexican</p>\n\t\t\t\t\t</div>"
            },
            "extension": [
              {
                "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
                "extension": [
                  {
                    "url": "ombCategory",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2106-3",
                      "display": "White"
                    }
                  },
                  {
                    "url": "ombCategory",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "1002-5",
                      "display": "American Indian or Alaska Native"
                    }
                  },
                  {
                    "url": "ombCategory",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2028-9",
                      "display": "Asian"
                    }
                  },
                  {
                    "url": "detailed",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "1586-7",
                      "display": "Shoshone"
                    }
                  },
                  {
                    "url": "detailed",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2036-2",
                      "display": "Filipino"
                    }
                  },
                  {
                    "url": "text",
                    "valueString": "Mixed"
                  }
                ]
              },
              {
                "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
                "extension": [
                  {
                    "url": "ombCategory",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2135-2",
                      "display": "Hispanic or Latino"
                    }
                  },
                  {
                    "url": "detailed",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2184-0",
                      "display": "Dominican"
                    }
                  },
                  {
                    "url": "detailed",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2148-5",
                      "display": "Mexican"
                    }
                  },
                  {
                    "url": "text",
                    "valueString": "Hispanic or Latino"
                  }
                ]
              },
              {
                "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
                "valueCode": "F"
              }
            ],
            "identifier": [
              {
                "use": "usual",
                "type": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                      "code": "MR",
                      "display": "Medical Record Number"
                    }
                  ],
                  "text": "Medical Record Number"
                },
                "system": "http://hospital.smarthealthit.org",
                "value": "1032702"
              }
            ],
            "active": true,
            "name": [
              {
                "family": "Shaw",
                "given": [
                  "Amy",
                  "V."
                ]
              }
            ],
            "telecom": [
              {
                "system": "phone",
                "value": "555-555-5555",
                "use": "home"
              },
              {
                "system": "email",
                "value": "amy.shaw@example.com"
              }
            ],
            "gender": "female",
            "birthDate": "2007-02-20",
            "address": [
              {
                "line": [
                  "49 Meadow St"
                ],
                "city": "Mounds",
                "state": "OK",
                "postalCode": "74047",
                "country": "US"
              }
            ]
          }
        },
        {
          "fullUrl": "urn:uuid:c470de5b-345c-4945-bc4a-cbdec7d86f54",
          "resource": {
            "resourceType": "Coverage",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/davinci-notifications/StructureDefinition/admit-discharge-notification-coverage"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: admit-discharge-notification-coverage-01</p><p><b>meta</b>: </p><p><b>identifier</b>:     DZW9200000000</p><p><b>status</b>:     active</p><p><b>type</b>: health insurance plan policy <span style=\"background: LightGoldenRodYellow\">(Details : {    http://terminology.hl7.org/CodeSystem/v3-ActCode code '    HIP' = 'health insurance plan policy', given as 'health insurance plan policy'})</span></p><p><b>subscriber</b>: <a href=\"urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4\">    urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4</a></p><p><b>subscriberId</b>:     DZW9200000000</p><p><b>beneficiary</b>: <a href=\"urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4\">    urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4</a></p><p><b>relationship</b>:     Self <span style=\"background: LightGoldenRodYellow\">(Details : {    http://terminology.hl7.org/CodeSystem/subscriber-relationship code '    self' = 'Self', given as '    Self'})</span></p><p><b>period</b>: Jan 1, 2016, 12:00:00 AM --&gt; (ongoing)</p><p><b>payor</b>: Anthem Blue Cross of California</p><h3>Classes</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td>*</td><td>Plan <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/coverage-class code 'plan' = 'Plan)</span></td><td>1FZQ</td><td>Bronze D HSA</td></tr></table></div>"
            },
            "identifier": [
              {
                "system": "https://www.anthem.com/ca",
                "value": "DZW9200000000"
              }
            ],
            "status": "active",
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                  "code": "HIP",
                  "display": "health insurance plan policy"
                }
              ]
            },
            "subscriber": {
              "reference": "urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4"
            },
            "subscriberId": "DZW9200000000",
            "beneficiary": {
              "reference": "urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4"
            },
            "relationship": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                  "code": "self",
                  "display": "Self"
                }
              ]
            },
            "period": {
              "start": "2016-01-01"
            },
            "payor": [
              {
                "display": "Anthem Blue Cross of California"
              }
            ],
            "class": [
              {
                "type": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                      "code": "plan"
                    }
                  ]
                },
                "value": "1FZQ",
                "name": "Bronze D HSA"
              }
            ]
          }
        },
        {
          "fullUrl": "urn:uuid:54f0ea3f-dc89-4e71-8d98-8774a5add41e",
          "resource": {
            "resourceType": "Condition",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/davinci-notifications/StructureDefinition/admit-discharge-notification-condition"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: admit-discharge-notification-condition-01</p><p><b>meta</b>: </p><p><b>clinicalStatus</b>: Active <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/condition-clinical code 'active' = 'Active', given as 'Active'})</span></p><p><b>verificationStatus</b>: Confirmed <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/condition-ver-status code 'confirmed' = 'Confirmed', given as 'Confirmed'})</span></p><p><b>category</b>: Problem <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/condition-category code 'problem-list-item' = 'Problem List Item', given as 'Problem List Item'})</span></p><p><b>code</b>: Single liveborn, born in hospital <span style=\"background: LightGoldenRodYellow\">(Details : {SNOMED CT code '442311008' = 'Liveborn born in hospital', given as 'Liveborn born in hospital'})</span></p><p><b>subject</b>: <a href=\"urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4\">Amy V. Shaw</a></p><p><b>encounter</b>: <a href=\"urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7\">urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7</a></p><p><b>onset</b>: Aug 10, 2016, 12:00:00 AM</p></div>"
            },
            "clinicalStatus": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
                  "code": "active",
                  "display": "Active"
                }
              ],
              "text": "Active"
            },
            "verificationStatus": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                  "code": "confirmed",
                  "display": "Confirmed"
                }
              ],
              "text": "Confirmed"
            },
            "category": [
              {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/condition-category",
                    "code": "problem-list-item",
                    "display": "Problem List Item"
                  }
                ],
                "text": "Problem"
              }
            ],
            "code": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "442311008",
                  "display": "Liveborn born in hospital"
                }
              ],
              "text": "Single liveborn, born in hospital"
            },
            "subject": {
              "reference": "urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4",
              "display": "Amy V. Shaw"
            },
            "encounter": {
              "reference": "urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7"
            },
            "onsetDateTime": "2016-08-10"
          }
        },
        {
          "fullUrl": "urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade",
          "resource": {
            "resourceType": "Organization",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <h1>Organization</h1>\n            <div>\n                <p>ID: 393872</p>\n                <p>Name: Saint Luke's Hospital of Kansas City </p>\n                <p>NPI: 1063494177</p>\n                <p>Phone:(816)932-2000</p>\n                <p>Address:4401 Wornall Rd,, MO, 64111</p>\n            </div>\n        </div>"
            },
            "contained": [
              {
                "resourceType": "Endpoint",
                "id": "direct",
                "status": "active",
                "connectionType": {
                  "system": "http://terminology.hl7.org/CodeSystem/endpoint-connection-type",
                  "code": "direct-project"
                },
                "name": "Dr. Ronald Bone Direct Address",
                "managingOrganization": {
                  "reference": "urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade"
                },
                "payloadType": [
                  {
                    "coding": [
                      {
                        "system": "urn:oid:1.3.6.1.4.1.19376.1.2.3",
                        "code": "urn:hl7-org:sdwg:ccda-structuredBody:1.1"
                      }
                    ]
                  }
                ],
                "payloadMimeType": [
                  "text/xml"
                ],
                "address": "mailto:Interoperability@DirectAddress.com"
              }
            ],
            "identifier": [
              {
                "system": "http://example.org/fhir/sid/us-npi",
                "value": "1063494177"
              },
              {
                "system": "http://example.org/fhir/us/argo/sid/us-ein",
                "value": "00-0000000"
              }
            ],
            "active": true,
            "name": "Saint Luke's Hospital of Kansas City",
            "telecom": [
              {
                "system": "phone",
                "value": "(816)932-2000",
                "use": "work"
              },
              {
                "system": "other",
                "value": "http://www.saintlukeshealthsystem.org/locations/saint-lukes-hospital-kansas-city",
                "use": "work"
              }
            ],
            "address": [
              {
                "text": "3300 Washtenaw Avenue, Suite 227 Amherst MA 01002",
                "line": [
                  "4401 Wornall Rd,"
                ],
                "city": "Amherst",
                "state": "MA",
                "postalCode": "64111"
              }
            ],
            "endpoint": [
              {
                "reference": "#direct"
              }
            ]
          }
        }
      ]
    }
    

    Response

    HTTP/1.1 200 OK
    [other headers]
    


    Examples

    Scenario:

    Patient Y has been discharged from Provider X ‘s facility. Acting in the role of Sender, Provider X notifies Payer Z, who is acting in the Recipient role, of the admission. The Notification is transacted as the [$process-message] operation. The body of the operation is a Message Bundle containing:

    1. The Message Header which is the first resource in the bundle and contains the the message event code - that identifies the nature of the notification.
    2. The other resources in the bundle depend on the type of the notification use case as defined by either the MessageDefinition and GraphDefinition or FHIR Profiles.

    An HTTP Status success code is returned on successful submission.

    Push Notification using the $process-message

    POST [base]/$process-message

    Request body

    {
      "resourceType": "Bundle",
      "id": "discharge-notification-message-bundle-01",
      "meta": {
        "profile": [
          "http://hl7.org/fhir/us/davinci-notifications/StructureDefinition/notifications-bundle"
        ]
      },
      "type": "message",
      "timestamp": "2019-11-14T08:08:47Z",
      "entry": [
        {
          "fullUrl": "urn:uuid:267b18ce-3d37-4581-9baa-6fada338038b",
          "resource": {
            "resourceType": "MessageHeader",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/davinci-notifications/StructureDefinition/discharge-notification-messageheader"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>Generated Narrative with Details</b>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>id</b>: discharge-notification-messageheader-01</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>meta</b>:\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>event</b>: Notification discharge (Details: http://hl7.org/fhir/us/davinci-notifications/CodeSystem/notification-event code notification-discharge = 'Notification Discharge', stated as 'Notification discharge')</p>\n\t\t\t\t\t\t<h3>Destinations</h3>\n\t\t\t\t\t\t<table class=\"grid\">\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>-</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Name</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Endpoint</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>*</td>\n\t\t\t\t\t\t\t\t<td>Acme Message Gateway</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<a href=\"https://example.org/Endpoints/P123\">https://example.org/Endpoints/P123</a>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t</table>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>sender</b>:\n\t\t\t\t\t\t\t<a href=\"urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade\">Saint Luke W Endpoint</a>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>author</b>:\n\t\t\t\t\t\t\t<a href=\"urn:uuid:e4b71aed-1c54-4f85-bea0-48444aa31f59\">Ronald Bone</a>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<h3>Sources</h3>\n\t\t\t\t\t\t<table class=\"grid\">\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>-</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Name</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Software</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Version</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Contact</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Endpoint</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>*</td>\n\t\t\t\t\t\t\t\t<td>Acme Central Patient Registry</td>\n\t\t\t\t\t\t\t\t<td>FooBar Patient Manager</td>\n\t\t\t\t\t\t\t\t<td>3.1.45.AABB</td>\n\t\t\t\t\t\t\t\t<td>ph: +1 (555) 123 4567</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<a href=\"https://example.org/Endpoints/P456\">https://example.org/Endpoints/P456</a>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t</table>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>responsible</b>:\n\t\t\t\t\t\t\t<a href=\"urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade\">Saint Luke W Endpoint</a>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>focus</b>:\n\t\t\t\t\t\t\t<a href=\"urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7\">Inpatient Encounter</a>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t</div>"
            },
            "eventCoding": {
              "system": "http://hl7.org/fhir/us/davinci-notifications/CodeSystem/notification-event",
              "code": "notification-discharge",
              "display": "Notification discharge"
            },
            "destination": [
              {
                "name": "Acme Message Gateway",
                "endpoint": "https://example.org/Endpoints/P123"
              }
            ],
            "sender": {
              "reference": "urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade",
              "display": "Saint Luke W Endpoint"
            },
            "author": {
              "reference": "urn:uuid:e4b71aed-1c54-4f85-bea0-48444aa31f59",
              "display": "Ronald Bone"
            },
            "source": {
              "name": "Acme Central Patient Registry",
              "software": "FooBar Patient Manager",
              "version": "3.1.45.AABB",
              "contact": {
                "system": "phone",
                "value": "+1 (555) 123 4567"
              },
              "endpoint": "https://example.org/Endpoints/P456"
            },
            "responsible": {
              "reference": "urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade",
              "display": "Saint Luke W Endpoint"
            },
            "focus": [
              {
                "reference": "urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7",
                "display": "Inpatient Encounter"
              }
            ]
          }
        },
        {
          "fullUrl": "urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7",
          "resource": {
            "resourceType": "Encounter",
            "meta": {
              "lastUpdated": "2017-05-26T11:56:57.250-04:00",
              "profile": [
                "http://hl7.org/fhir/us/davinci-notifications/StructureDefinition/admit-discharge-notification-encounter"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>Generated Narrative with Details</b>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>id</b>: admit-discharge-notification-encounter-01</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>meta</b>:\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>status</b>: finished</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>class</b>: inpatient encounter (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code IMP = 'inpatient encounter', stated as 'inpatient encounter')</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>type</b>: Inpatient hospital care\n\t\t\t\t\t\t\t<span style=\"background: LightGoldenRodYellow\">(Details : {http://www.ama-assn.org/go/cpt code '99234' = '99234)</span>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>subject</b>:\n\t\t\t\t\t\t\t<a href=\"urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4\">Amy V. Shaw</a>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<h3>Participants</h3>\n\t\t\t\t\t\t<table class=\"grid\">\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>-</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Type</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Period</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Individual</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>*</td>\n\t\t\t\t\t\t\t\t<td>primary performer\n\t\t\t\t\t\t\t\t\t<span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/v3-ParticipationType code 'PPRF' = 'primary performer)</span>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>Nov 1, 2015, 2:00:14 PM --&gt; Nov 1, 2015, 3:00:14 PM</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<a href=\"urn:uuid:e4b71aed-1c54-4f85-bea0-48444aa31f59\">Ronald Bone</a>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t</table>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>period</b>: Nov 1, 2015, 2:00:14 PM --&gt; Nov 1, 2015, 3:00:14 PM</p>\n\t\t\t\t\t\t<h3>Locations</h3>\n\t\t\t\t\t\t<table class=\"grid\">\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>-</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Location</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>*</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<a href=\"urn:uuid:75ea28b5-74b8-4d9c-9eb5-cfdc10b48fa\">Health Level Seven International - Amherst</a>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t</table>\n\t\t\t\t\t</div>"
            },
            "status": "finished",
            "class": {
              "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code": "IMP",
              "display": "inpatient encounter"
            },
            "type": [
              {
                "coding": [
                  {
                    "system": "http://www.ama-assn.org/go/cpt",
                    "code": "99234"
                  }
                ],
                "text": "Inpatient hospital care"
              }
            ],
            "subject": {
              "reference": "urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4",
              "display": "Amy V. Shaw"
            },
            "participant": [
              {
                "type": [
                  {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                        "code": "PPRF"
                      }
                    ],
                    "text": "primary performer"
                  }
                ],
                "period": {
                  "start": "2015-11-01T17:00:14-05:00",
                  "end": "2015-11-01T18:00:14-05:00"
                },
                "individual": {
                  "reference": "urn:uuid:e4b71aed-1c54-4f85-bea0-48444aa31f59",
                  "display": "Ronald Bone"
                }
              }
            ],
            "period": {
              "start": "2015-11-01T17:00:14-05:00",
              "end": "2015-11-01T18:00:14-05:00"
            },
            "hospitalization": {
              "dischargeDisposition": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/discharge-disposition",
                    "code": "home",
                    "display": "Home"
                  }
                ],
                "text": "The patient was dicharged to home"
              }
            },
            "location": [
              {
                "location": {
                  "reference": "urn:uuid:75ea28b5-74b8-4d9c-9eb5-cfdc10b48fa",
                  "display": "Health Level Seven International - Amherst"
                }
              }
            ]
          }
        },
        {
          "fullUrl": "urn:uuid:75ea28b5-74b8-4d9c-9eb5-cfdc10b48fa",
          "resource": {
            "resourceType": "Location",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/core/StructureDefinition/us-core-location"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>Generated Narrative with Details</b>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>id</b>: hl7east</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>meta</b>:\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>identifier</b>: 29</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>status</b>: active</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>name</b>: Health Level Seven International - Amherst</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>description</b>: HL7 Headquarters - East</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>telecom</b>: ph: (+1) 734-677-7777</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>address</b>: 3300 Washtenaw Avenue, Suite 227 Amherst MA 01002 USA\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<h3>Positions</h3>\n\t\t\t\t\t\t<table class=\"grid\">\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>-</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Longitude</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Latitude</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>*</td>\n\t\t\t\t\t\t\t\t<td>-72.519854</td>\n\t\t\t\t\t\t\t\t<td>42.373222</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t</table>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>managingOrganization</b>: Health Level Seven International</p>\n\t\t\t\t\t</div>"
            },
            "identifier": [
              {
                "system": "http://www.acme.org/location",
                "value": "29"
              }
            ],
            "status": "active",
            "name": "Health Level Seven International - Amherst",
            "description": "HL7 Headquarters - East",
            "telecom": [
              {
                "system": "phone",
                "value": "(+1) 734-677-7777"
              }
            ],
            "address": {
              "line": [
                "3300 Washtenaw Avenue, Suite 227"
              ],
              "city": "Amherst",
              "state": "MA",
              "postalCode": "01002",
              "country": "USA"
            },
            "position": {
              "longitude": -72.519854,
              "latitude": 42.373222
            },
            "managingOrganization": {
              "display": "Health Level Seven International"
            }
          }
        },
        {
          "fullUrl": "urn:uuid:e4b71aed-1c54-4f85-bea0-48444aa31f59",
          "resource": {
            "resourceType": "Practitioner",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>Generated Narrative with Details</b>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>id</b>: practitioner-1</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>meta</b>:\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>identifier</b>: 9941339108, 25456</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>name</b>: Ronald Bone\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>address</b>: 1003 Healthcare Drive Amherst MA 01002 (HOME)</p>\n\t\t\t\t\t</div>"
            },
            "identifier": [
              {
                "system": "http://hl7.org.fhir/sid/us-npi",
                "value": "9941339108"
              },
              {
                "system": "http://www.acme.org/practitioners",
                "value": "25456"
              }
            ],
            "name": [
              {
                "family": "Bone",
                "given": [
                  "Ronald"
                ],
                "prefix": [
                  "Dr"
                ]
              }
            ],
            "address": [
              {
                "use": "home",
                "line": [
                  "1003 Healthcare Drive"
                ],
                "city": "Amherst",
                "state": "MA",
                "postalCode": "01002"
              }
            ]
          }
        },
        {
          "fullUrl": "urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4",
          "resource": {
            "resourceType": "Patient",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>Generated Narrative with Details</b>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>id</b>: example</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>identifier</b>: Medical Record Number = 1032702 (USUAL)</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>active</b>: true</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>name</b>: Amy V. Shaw\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>telecom</b>: ph: 555-555-5555(HOME), amy.shaw@example.com</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>gender</b>:\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>birthsex</b>: Female</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>birthDate</b>: Feb 20, 2007</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>address</b>: 49 Meadow St Mounds OK 74047 US\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>race</b>: White, American Indian or Alaska Native, Asian, Shoshone, Filipino</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>ethnicity</b>: Hispanic or Latino, Dominican, Mexican</p>\n\t\t\t\t\t</div>"
            },
            "extension": [
              {
                "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
                "extension": [
                  {
                    "url": "ombCategory",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2106-3",
                      "display": "White"
                    }
                  },
                  {
                    "url": "ombCategory",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "1002-5",
                      "display": "American Indian or Alaska Native"
                    }
                  },
                  {
                    "url": "ombCategory",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2028-9",
                      "display": "Asian"
                    }
                  },
                  {
                    "url": "detailed",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "1586-7",
                      "display": "Shoshone"
                    }
                  },
                  {
                    "url": "detailed",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2036-2",
                      "display": "Filipino"
                    }
                  },
                  {
                    "url": "text",
                    "valueString": "Mixed"
                  }
                ]
              },
              {
                "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
                "extension": [
                  {
                    "url": "ombCategory",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2135-2",
                      "display": "Hispanic or Latino"
                    }
                  },
                  {
                    "url": "detailed",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2184-0",
                      "display": "Dominican"
                    }
                  },
                  {
                    "url": "detailed",
                    "valueCoding": {
                      "system": "urn:oid:2.16.840.1.113883.6.238",
                      "code": "2148-5",
                      "display": "Mexican"
                    }
                  },
                  {
                    "url": "text",
                    "valueString": "Hispanic or Latino"
                  }
                ]
              },
              {
                "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
                "valueCode": "F"
              }
            ],
            "identifier": [
              {
                "use": "usual",
                "type": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                      "code": "MR",
                      "display": "Medical Record Number"
                    }
                  ],
                  "text": "Medical Record Number"
                },
                "system": "http://hospital.smarthealthit.org",
                "value": "1032702"
              }
            ],
            "active": true,
            "name": [
              {
                "family": "Shaw",
                "given": [
                  "Amy",
                  "V."
                ]
              }
            ],
            "telecom": [
              {
                "system": "phone",
                "value": "555-555-5555",
                "use": "home"
              },
              {
                "system": "email",
                "value": "amy.shaw@example.com"
              }
            ],
            "gender": "female",
            "birthDate": "2007-02-20",
            "address": [
              {
                "line": [
                  "49 Meadow St"
                ],
                "city": "Mounds",
                "state": "OK",
                "postalCode": "74047",
                "country": "US"
              }
            ]
          }
        },
        {
          "fullUrl": "urn:uuid:c470de5b-345c-4945-bc4a-cbdec7d86f54",
          "resource": {
            "resourceType": "Coverage",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/davinci-notifications/StructureDefinition/admit-discharge-notification-coverage"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>Generated Narrative with Details</b>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>id</b>: admit-discharge-notification-coverage-01</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>meta</b>:\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>identifier</b>: DZW9200000000</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>status</b>: active</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>type</b>: health insurance plan policy\n\t\t\t\t\t\t\t<span style=\"background: LightGoldenRodYellow\">(Details : { http://terminology.hl7.org/CodeSystem/v3-ActCode code ' HIP' = 'health insurance plan policy', given as 'health insurance plan policy'})</span>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>subscriber</b>:\n\t\t\t\t\t\t\t<a href=\"urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4\">\n\t\t\t\t\t\t\t\turn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4</a>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>subscriberId</b>: DZW9200000000</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>beneficiary</b>:\n\t\t\t\t\t\t\t<a href=\"urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4\">\n\t\t\t\t\t\t\t\turn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4</a>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>relationship</b>: Self\n\t\t\t\t\t\t\t<span style=\"background: LightGoldenRodYellow\">(Details : { http://terminology.hl7.org/CodeSystem/subscriber-relationship code ' self' = 'Self', given as ' Self'})</span>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>period</b>: Jan 1, 2016, 12:00:00 AM --&gt; (ongoing)</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>payor</b>: Anthem Blue Cross of California</p>\n\t\t\t\t\t\t<h3>Classes</h3>\n\t\t\t\t\t\t<table class=\"grid\">\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>-</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Type</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Value</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>\n\t\t\t\t\t\t\t\t\t<b>Name</b>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t<td>*</td>\n\t\t\t\t\t\t\t\t<td>Plan\n\t\t\t\t\t\t\t\t\t<span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/coverage-class code 'plan' = 'Plan)</span>\n\t\t\t\t\t\t\t\t</td>\n\t\t\t\t\t\t\t\t<td>1FZQ</td>\n\t\t\t\t\t\t\t\t<td>Bronze D HSA</td>\n\t\t\t\t\t\t\t</tr>\n\t\t\t\t\t\t</table>\n\t\t\t\t\t</div>"
            },
            "identifier": [
              {
                "system": "https://www.anthem.com/ca",
                "value": "DZW9200000000"
              }
            ],
            "status": "active",
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                  "code": "HIP",
                  "display": "health insurance plan policy"
                }
              ]
            },
            "subscriber": {
              "reference": "urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4"
            },
            "subscriberId": "DZW9200000000",
            "beneficiary": {
              "reference": "urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4"
            },
            "relationship": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                  "code": "self",
                  "display": "Self"
                }
              ]
            },
            "period": {
              "start": "2016-01-01"
            },
            "payor": [
              {
                "display": "Anthem Blue Cross of California"
              }
            ],
            "class": [
              {
                "type": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                      "code": "plan"
                    }
                  ]
                },
                "value": "1FZQ",
                "name": "Bronze D HSA"
              }
            ]
          }
        },
        {
          "fullUrl": "urn:uuid:54f0ea3f-dc89-4e71-8d98-8774a5add41e",
          "resource": {
            "resourceType": "Condition",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/davinci-notifications/StructureDefinition/admit-discharge-notification-condition"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>Generated Narrative with Details</b>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>id</b>: admit-discharge-notification-condition-01</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>meta</b>:\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>clinicalStatus</b>: Active\n\t\t\t\t\t\t\t<span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/condition-clinical code 'active' = 'Active', given as 'Active'})</span>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>verificationStatus</b>: Confirmed\n\t\t\t\t\t\t\t<span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/condition-ver-status code 'confirmed' = 'Confirmed', given as 'Confirmed'})</span>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>category</b>: Problem\n\t\t\t\t\t\t\t<span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/condition-category code 'problem-list-item' = 'Problem List Item', given as 'Problem List Item'})</span>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>code</b>: Single liveborn, born in hospital\n\t\t\t\t\t\t\t<span style=\"background: LightGoldenRodYellow\">(Details : {SNOMED CT code '442311008' = 'Liveborn born in hospital', given as 'Liveborn born in hospital'})</span>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>subject</b>:\n\t\t\t\t\t\t\t<a href=\"urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4\">Amy V. Shaw</a>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>encounter</b>:\n\t\t\t\t\t\t\t<a href=\"urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7\">urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7</a>\n\t\t\t\t\t\t</p>\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<b>onset</b>: Aug 10, 2016, 12:00:00 AM</p>\n\t\t\t\t\t</div>"
            },
            "clinicalStatus": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
                  "code": "active",
                  "display": "Active"
                }
              ],
              "text": "Active"
            },
            "verificationStatus": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                  "code": "confirmed",
                  "display": "Confirmed"
                }
              ],
              "text": "Confirmed"
            },
            "category": [
              {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/condition-category",
                    "code": "problem-list-item",
                    "display": "Problem List Item"
                  }
                ],
                "text": "Problem"
              }
            ],
            "code": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "442311008",
                  "display": "Liveborn born in hospital"
                }
              ],
              "text": "Single liveborn, born in hospital"
            },
            "subject": {
              "reference": "urn:uuid:e442c924-df77-47fa-838f-24a8253bbdd4",
              "display": "Amy V. Shaw"
            },
            "encounter": {
              "reference": "urn:uuid:a33d1eed-c4ad-4def-8087-042b7ac0f2b7"
            },
            "onsetDateTime": "2016-08-10"
          }
        },
        {
          "fullUrl": "urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade",
          "resource": {
            "resourceType": "Organization",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n\t\t\t\t\t\t<h1>Organization</h1>\n\t\t\t\t\t\t<div>\n\t\t\t\t\t\t\t<p>ID: 393872</p>\n\t\t\t\t\t\t\t<p>Name: Saint Luke's Hospital of Kansas City\n\t\t\t\t\t\t\t</p>\n\t\t\t\t\t\t\t<p>NPI: 1063494177</p>\n\t\t\t\t\t\t\t<p>Phone:(816)932-2000</p>\n\t\t\t\t\t\t\t<p>Address:4401 Wornall Rd,, MO, 64111</p>\n\t\t\t\t\t\t</div>\n\t\t\t\t\t</div>"
            },
            "contained": [
              {
                "resourceType": "Endpoint",
                "id": "direct",
                "status": "active",
                "connectionType": {
                  "system": "http://terminology.hl7.org/CodeSystem/endpoint-connection-type",
                  "code": "direct-project"
                },
                "name": "Dr. Ronald Bone Direct Address",
                "managingOrganization": {
                  "reference": "urn:uuid:7221aa91-d9e1-44fa-8b90-c5a8c7caeade"
                },
                "payloadType": [
                  {
                    "coding": [
                      {
                        "system": "urn:oid:1.3.6.1.4.1.19376.1.2.3",
                        "code": "urn:hl7-org:sdwg:ccda-structuredBody:1.1"
                      }
                    ]
                  }
                ],
                "payloadMimeType": [
                  "text/xml"
                ],
                "address": "mailto:Interoperability@DirectAddress.com"
              }
            ],
            "identifier": [
              {
                "system": "http://example.org/fhir/sid/us-npi",
                "value": "1063494177"
              },
              {
                "system": "http://example.org/fhir/us/argo/sid/us-ein",
                "value": "00-0000000"
              }
            ],
            "active": true,
            "name": "Saint Luke's Hospital of Kansas City",
            "telecom": [
              {
                "system": "phone",
                "value": "(816)932-2000",
                "use": "work"
              },
              {
                "system": "other",
                "value": "http://www.saintlukeshealthsystem.org/locations/saint-lukes-hospital-kansas-city",
                "use": "work"
              }
            ],
            "address": [
              {
                "text": "3300 Washtenaw Avenue, Suite 227 Amherst MA 01002",
                "line": [
                  "4401 Wornall Rd,"
                ],
                "city": "Amherst",
                "state": "MA",
                "postalCode": "64111"
              }
            ],
            "endpoint": [
              {
                "reference": "#direct"
              }
            ]
          }
        }
      ]
    }
    

    Response

    HTTP/1.1 200 OK
    [other headers]