Da Vinci Clinical Data Exchange (CDex)
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Da Vinci Clinical Data Exchange (CDex), published by HL7 International - Patient Care Work Group. This is not an authorized publication; it is the continuous build for version 2.0.0-preview). This version is based on the current content of https://github.com/HL7/davinci-ecdx/ and changes regularly. See the Directory of published versions

Sending Attachments

The following page is DRAFT. It has not yet undergone HL7 balloting.

This page documents a FHIR-based approach to sending attachments for claims or prior authorization directly to a Payer. This transaction is used for both solicited and unsolicited attachments. It is intended to be compatible with the X12n 275 transaction.

$submit-attachment Operation

This guide defines $submit-attachment, a simple RESTful interaction for exchanging attachments using a FHIR Operation. This operation is used to submit attachments (additional documentation) for claims or prior authorization. The $submit-attachm,ent operation accepts the clinical/administrative attachments and the necessary information needed to associate them to the claim or prior authorization and returns a transaction layer HTTP response. The operation may be invoked before, at the same time as, or after the claim or pre-authorization has been supplied to the Payer. This operation can be used by any HTTP endpoint, not just FHIR RESTful servers.

The input parameters are:

  1. One or more attachments as FHIR Resources
    • Optionally, one or more unique line item numbers associated with the attachment
    • Optionally, the code, free text, or search string for information that was requested
  2. Data elements for the association to the claim/prior authorization
    • A unique identifier that ties the attachment(s) back to the claim or prior authorization. (referred to as the “re-association tracking control numbers”)*
    • What are the attachments for:
      • Claims
      • Prior Authorizations
    • Optionally, a unique payer identifier
    • A unique organization/location identifier (e.g., Type 2 NPI) and/or unique provider identifier (e.g., Type 1 NPI)
    • A unique Patient member identifier
    • A Date of Service
    • A Flag indicating whether the operation is the last attachment submission for the claim or prior authorization.

There are no output parameters.

See the $submit-attachment operation definition for further details.

Technical Workflow

As shown below in figure 7, the attachments are “pushed” using the $submit-attachment operation directly to the Payer or an Intermediary.

Figure 7
attachments-sequencediagram.svg

  1. Provider assembles the attachments and metadata to associate the attachments to a claim or prior authorization
  2. Provider invokes $submit-attachment operation to submit attachments to Payer
  3. Payer responds with an HTTP transaction layer response which either accepts or rejects the transaction.
    • The Payer SHOULD return an informational OperationOutcome with the HTTP accept response if the attachments can not be associated with a current claim or prior authorization and are being held for association with a future claim or prior authorization. An OperationOutcome example is used in Scenario 1b below.
  4. The Payer associates the attachments to the claim or prior authorization, and processes the claim.

Data Elements for Sending Attachments

The following data elements are needed to associate an attachment to a claim or prior authorization when sending attachments.

In a future version of this guide, the mapping between these data elements and the corresponding x12n 275 fields will be added

Data Element CDex $submit-attachment Parameter X12n 275 Submit Attachments Comments
Tracking ID (Provider or Payer Assigned) TrackingId - For unsolicited attachments, this is the provider-assigned tracking/control number. For solicited attachments, this is the payer-assigned tracking/control number.
Use AttachTo - Choice of “claim” or “preauthorization”
Payer URL (operation endpoint) - Payer endpoint where the attachments are submitted using the $submit-operation
Organization ID OrganizationId - Organization of provider who submitted claim/prior authorization
Provider ID ProviderId - Provider who submitted claim/prior authorization
Line Item(s) Attachment.LineItem - Claim/prior-authorization line item numbers
LOINC Attachment Code Attachment.Code - LOINC attachment codes
Date of Service ServiceDate - Date of service for claim/prior authorization
Member ID MemberId - Payer assigned patient identifier

The data element mapping table is available as a CSV and an Excel file.

For solicited attachments, the same data elements are sent in the request for attachments. See the Requesting Attachments page for a detailed discussion on how these data elements are used in the CDex Attachment Request Profile to request attachments and in the $submit-attachment response back to the Payer.

Examples

In the following examples, a Provider creates a claim and sends unsolicited attachments using the FHIR operation, $submit-attachment. For solicited attachments examples, see the Requesting Attachments page.

POST [base]/$submit-attachment

Scenario 1a: CCDA Document Attachments
  • Based on a set of pre-defined rules set by the Payer, the Provider submits CCDA Documents as additional documentation for a claim.
    • Typically, when the attachments are CCDA documents as in this scenario, they are already digitally signed and supply provenance information. Therefore, FHIR signatures and external Provenance resources are not needed.
  • Provider knows the Payer’s endpoint for sending attachments. Note that the $submit-attachment operation can be used by any HTTP endpoint, not just FHIR RESTful servers.
  • An unsolicited workflow implies that the Provider assigns the claim and line item identifiers upon claim generation.
  • Payer associates attachments to the claim.

Request

POST [base]/$submit-attachment

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Request Body

{
    "resourceType": "Parameters",
    "parameter": [
        {
            "name": "TrackingId",
            "valueString": "11234657"
        },
        {
            "name": "AttachTo",
            "valueCode": "claim"
        },
        {
            "name": "PayerId",
            "valueIdentifier": {
                "system": "http://example.org/cdex/payer-ids",
                "value": "payer123"
            }
        },
        {
            "name": "OrganizationId",
            "valueIdentifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "1407071236"
            }
        },
        {
            "name": "ProviderId",
            "valueIdentifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "9941339108"
            }
        },
        {
            "name": "MemberId",
            "valueIdentifier": {
                "system": "http://example.org/cdex/member-ids",
                "value": "234567"
            }
        },
        {
            "name": "ServiceDate",
            "valueDate": "2022-06-16"
        },
        {
            "name": "Attachment",
            "part": [
                {
                    "name": "LineItem",
                    "valueString": "1"
                },
                {
                    "name": "LineItem",
                    "valueString": "2"
                },
                {
                    "name": "LineItem",
                    "valueString": "3"
                },
                {
                    "name": "Code",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "system": "http://loinc.org",
                                "code": "11504-8",
                                "display": "Surgical operation note"
                            }
                        ],
                        "text": "Surgical operation note"
                    }
                },
                {
                    "name": "Content",
                    "resource": {
                        "resourceType": "DocumentReference",
                        "status": "current",
                        "type": {
                            "coding": [
                                {
                                    "system": "http://loinc.org",
                                    "code": "11504-8",
                                    "display": "Operative note"
                                }
                            ],
                            "text": "Surgical Note"
                        },
                        "category": [
                            {
                                "coding": [
                                    {
                                        "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
                                        "code": "clinical-note",
                                        "display": "Clinical Note"
                                    }
                                ],
                                "text": "Clinical Note 1"
                            }
                        ],
                        "date": "2022-07-13T10:30:00-05:00",
                        "content": [
                            {
                                "attachment": {
                                    "contentType": "text/xml",
                                    "data": "<?xml version="1.0" encoding="windows-1252" ?><ClinicalDocument xmlns="urn:hl7-org:v3"><realmCode code="US" /><typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3" /><templateId root="1.2.840.114350.1.72.1.51693" /><templateId root="2.16.840.1.113883.10.20.22.1.1" /><templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2015-08-01" /><templateId root="2.16.840.1.113883.10.20.22.1.7" /><templateId root="2.16.840.1.113883.10.20.22.1.7" extension="2015-08-01" /><id assigningAuthorityName="EPC" root="1.2.840.114350.1.13.451.2.7.8.688883.131600207" /><code code="11504-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Provider unspecified Operation Note" /><title>Operative Note</title><effectiveTime value="20200220012715-0600" /><confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25" displayName="Normal" /><languageCode code="en-US" /><setId assigningAuthorityName="EPC" extension="6ae263da-53b2-11ea-8099-005056861bc6" root="1.2.840.114350.1.13.451.2.7.1.1" /><versionNumber value="1" /><recordTarget><patientRole><id root="1.2.840.114350.1.13.451.2.7.3.688884.100" extension="MAY4682830" /><addr use="HP"><streetAddressLine>1 N Rhode Island Ave</streetAddressLine><county>CERRO GORD</county><city>Mason City</city><state>IA</state><postalCode>50401-1446</postalCode><country>USA</country></addr><telecom use="MC" value="tel:+1-641-666-6666" /><telecom value="mailto:johntest1@test.com" /><patient><name use="L"><prefix qualifier="TITLE">Mr. </prefix><given>John</given><given>TEST</given><family>TEST</family></name><name use="P"><given>John</given><family>TEST</family></name><name use="P"><given>John</given><given>P.</given><family>TEST</family></name><administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGenderCode" displayName="Male" /><birthTime value="19530920" /><sdtc:deceasedInd value="false" xmlns:sdtc="urn:hl7-org:sdtc" /><maritalStatusCode code="M" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatusCode" displayName="Married" /><religiousAffiliationCode code="1028" codeSystem="2.16.840.1.113883.5.1076" codeSystemName="ReligiousAffiliation" /><raceCode code="2106-3" codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDC Race and Ethnicity" displayName="White" /><ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDC Race and Ethnicity" displayName="Not Hispanic or Latino" /><languageCommunication><languageCode code="eng" /><modeCode code="EWR" codeSystem="2.16.840.1.113883.5.60" displayName="Expressed Written" /><preferenceInd value="true" /></languageCommunication></patient><providerOrganization><id root="1.2.840.114350.1.13.451.2.7.2.688879" extension="37200" /><name>PROVIDER Clinic</name><telecom nullFlavor="NA" /><addr use="WP"><streetAddressLine>2 1st St SW</streetAddressLine><county>OLMSTED</county><city>ROCHESTER</city><state>MN</state><postalCode>55905</postalCode><country>USA</country></addr></providerOrganization></patientRole></recordTarget><author><time value="20200220012715-0600" /><assignedAuthor><id root="1.2.840.114350.1.1" extension="8.9" /><addr nullFlavor="NA" /><telecom nullFlavor="NA" /><assignedAuthoringDevice><manufacturerModelName>Epic - Version 8.9</manufacturerModelName><softwareName>Epic - Version 8.9</softwareName></assignedAuthoringDevice><representedOrganization><id root="1.2.840.114350.1.13.451.2.7.2.688879" extension="37200" /><name>PROVIDER Clinic</name><telecom nullFlavor="NA" /><addr use="WP"><streetAddressLine>2 1st St SW</streetAddressLine><county>OLMSTED</county><city>ROCHESTER</city><state>MN</state><postalCode>55905</postalCode><country>USA</country></addr></representedOrganization></assignedAuthor></author><custodian><assignedCustodian><representedCustodianOrganization><id root="1.2.840.114350.1.13.451.2.7.2.688879" extension="37200" /><name>PROVIDER Clinic</name><telecom nullFlavor="NA" /><addr use="WP"><streetAddressLine>2 1st St SW</streetAddressLine><county>OLMSTED</county><city>ROCHESTER</city><state>MN</state><postalCode>55905</postalCode><country>USA</country></addr></representedCustodianOrganization></assignedCustodian></custodian><legalAuthenticator><time value="20200220012715-0600" /><signatureCode code="S" /><assignedEntity><id root="2.16.840.1.113883.4.6" extension="1111111111" /><code nullFlavor="UNK" /><addr use="WP"><streetAddressLine>2 1st St SW</streetAddressLine><county>OLMSTED</county><city>Rochester</city><state>MN</state><postalCode>55905-0001</postalCode><country>USA</country></addr><telecom use="WP" value="tel:+1-507-666-6666" /><assignedPerson><name use="L"><given>John</given><given>H</given><family>TEST</family><suffix qualifier="AC"> M.D.</suffix></name></assignedPerson></assignedEntity></legalAuthenticator><participant typeCode="IND"><time value="20180810" /><associatedEntity classCode="ECON"><id root="1.2.840.114350.1.13.451.2.7.2.827665" extension="11111111" /><code code="SPS" codeSystem="2.16.840.1.113883.5.111" codeSystemName="RoleCode" displayName="Spouse"><originalText>Spouse</originalText></code><addr use="HP"><streetAddressLine>1 North Island Avenue</streetAddressLine><city>Mason City</city><state>IA</state><postalCode>50401-1446</postalCode><country>USA</country></addr><telecom use="HP" value="tel:+1-641-666-6666" /><telecom use="MC" value="tel:+1-641-666-6666" /><associatedPerson><name>Carol Meyer</name></associatedPerson></associatedEntity></participant><documentationOf typeCode="DOC"><serviceEvent classCode="PROC"><code code="77777772" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Procedure" /><effectiveTime><low nullFlavor="UNK" /><high nullFlavor="UNK" /></effectiveTime><performer typeCode="PPRF"><assignedEntity><id root="2.16.840.1.113883.4.6" /><code codeSystem="2.16.840.1.113883.3.88.12.3221.4.2" codeSystemName="NUCC" nullFlavor="NI" /><addr nullFlavor="UNK" /><telecom nullFlavor="UNK" /></assignedEntity></performer></serviceEvent></documentationOf><component><structuredBody><component><section><templateId root="2.16.840.1.113883.10.20.22.2.27" /><code code="29554-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="SURGERY PROCEDURE" /><title>Surgery Details</title><text><table><colgroup><col width="10%" /><col width="15%" /><col width="15%" /><col width="10%" /><col width="10%" /><col width="15%" /><col width="10%" /><col width="10%" /></colgroup><thead><tr><th>Date/Time</th><th>Status</th><th>Location</th><th>OR</th><th>Service</th><th>Patient Class</th><th>Case Class</th><th>Case Type</th><th>Trauma Case?</th></tr></thead><tbody><tr><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr></tbody></table><br /><list><caption>Additonal Notes</caption><item><caption>TEST, JOHN H - 02/17/2020 11:15 AM CST</caption><paragraph> <br /> <br />PROCEDURE(S)<br />Open takedown of adhesions (1 hour). <br />Resection approximately 75 cm  of terminal ileum and cecum and portion of ascending colon. <br />Ileoascending colostomy with double-stapled side-to-side functional end-to-end running of the small bowel.<br /><br />SURGEON(S)<br />Dr. John TEST. <br /><br />GENERAL SURGERY RESIDENT: Dr. TEST.<br /><br />ANESTHESIA TYPE<br />General.<br /><br />PRE-OPERATIVE DIAGNOSIS<br />Crohn's disease, stricturing of an area and CT enterography evidence of Crohn's disease in the terminal 75 cm of ileum.<br /><br />POST-OPERATIVE DIAGNOSIS<br />Crohn's disease, stricturing of an area and CT enterography evidence of Crohn's disease in the terminal 75 cm of ileum.<br /><br />FINDINGS<br />See below.<br /><br />DESCRIPTION OF PROCEDURE<br />Under general anesthesia in the supine position, patient prepped and draped. A mid-midline incision made large enough for the HandPort to be placed except we ran into many adhesions. We then decided to proceed open. We really did not even begin to do the laparoscopic procedure. Takedown of adhesions took about 45 minutes to 1 hour. The anatomy was oriented correctly. Ureters were not seen. The terminal ileum was caught down into the pelvis. This was all mobilized. A point was chosen on the terminal ileum above the evidence of disease (75 cm) and a point chosen on the ascending colon just above the cecum as the line of distal transection. The intervening mesentery was alternatively clamped, tied, and LigaSured. The specimen was removed, and a double-stapled side-to-side functional end-to-end ileoascending colostomy was then constructed without difficulty. Post stapling, visualization revealed excellent blood supply, no tension, big anastomosis. The mesentery defect was relatively small and closed with running 3-0 chromic. The abdomen was thoroughly irrigated numerous times with normal saline, bleeding controlled with cautery, and the abdomen was again irrigated with normal saline. The small bowel was run back to the ligament of Treitz, and there was no other evidence of Crohn's disease. The abdomen was then closed over Seprafilm using a combination of running double PDS in the midline fascia and interrupted #1 Vicryl in the area of the old mesh. The skin was closed with a running subcuticular Vicryl.<br /><br />SPECIMENS<br />Terminal ileum, cecum, appendix, portion ascending colon<br /><br />DRAINS<br />No drains. <br /><br />No stomas.<br /><br />ESTIMATED BLOOD LOSS<br />Less than 100 cc.<br /><br />TPR:  2   <br /><br /><br />John H. TEST, M.D.<br />DD:  02/17/2020 11:02:41 CT<br />DT:  02/17/2020 11:28:58 CT<br />Job ID:  871622002/sjp<br /><br /></paragraph></item></list></text></section></component><component><section nullFlavor="NI"><templateId root="2.16.840.1.113883.10.20.22.2.25" /><templateId root="2.16.840.1.113883.10.20.22.2.25" extension="2014-06-09" /><code code="59774-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Anesthesia Records" /><title>Anesthesia Record</title><text><content ID="nof1">Not on file</content></text></section></component><component><section nullFlavor="NI"><templateId root="2.16.840.1.113883.10.20.22.2.34" /><templateId root="2.16.840.1.113883.10.20.22.2.34" extension="2015-08-01" /><code code="10219-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Preoperative Diagnosis" /><title>Preoperative Diagnosis</title><text><content ID="nof2">Not on file</content></text></section></component><component><section nullFlavor="NI"><templateId root="2.16.840.1.113883.10.20.22.2.35" /><code code="10218-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Postoperative Diagnosis" /><title>Postoperative Diagnosis</title><text><content ID="nof3">Not on file</content></text></section></component><component><section><templateId root="2.16.840.1.113883.10.20.22.2.37" /><templateId root="2.16.840.1.113883.10.20.22.2.37" extension="2015-08-01" /><code code="55109-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Complications" /><title>Complications</title><text><paragraph>Check Surgery Details section.</paragraph></text></section></component><component><section><templateId root="2.16.840.1.113883.10.20.18.2.9" /><code code="59770-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure Estimated Blood Loss" /><title>Procedure Estimated Blood Loss</title><text><paragraph>Check Surgery Details section.</paragraph></text></section></component><component><section><templateId root="2.16.840.1.113883.10.20.22.2.28" /><templateId root="2.16.840.1.113883.10.20.22.2.28" extension="2015-08-01" /><code code="59776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure Findings" /><title>Procedure Findings</title><text><paragraph>Check Surgery Details section.</paragraph></text></section></component><component><section><templateId root="2.16.840.1.113883.10.20.22.2.31" /><code code="59773-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure Specimens Taken" /><title>Procedure Specimens Taken</title><text><paragraph>Check Surgery Details section.</paragraph></text></section></component></structuredBody></component></ClinicalDocument>
",
                                    "title": "Example CCDA",
                                    "hash": "026d568297832e6e083e96549041a72aa383bb23"
                                }
                            }
                        ]
                    }
                }
            ]
        }
    ]
}

Response Headers

HTTP/1.1 200 OK
Server: nginx/1.14.0 (Ubuntu)
Date: Fri, 23 Oct 2020 04:54:56 GMT
Content-Type: application/fhir+json;charset=utf-8
...(other headers)
Rendered Documents


Scenario 1b: CCDA Document Attachments Submitted Prior to Claim

This Scenario is the same as Scenario 1a above except that the attachments are submitted prior to the claim. The Payer accepts the attachments and returns an OperationOutcome informing the Provider system that the attachments are waiting for the claim.

Request

POST [base]/$submit-attachment

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Request Body

{
    "resourceType": "Parameters",
    "parameter": [
        {
            "name": "TrackingId",
            "valueString": "11234657"
        },
        {
            "name": "AttachTo",
            "valueCode": "claim"
        },
        {
            "name": "PayerId",
            "valueIdentifier": {
                "system": "http://example.org/cdex/payer-ids",
                "value": "payer123"
            }
        },
        {
            "name": "OrganizationId",
            "valueIdentifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "1407071236"
            }
        },
        {
            "name": "ProviderId",
            "valueIdentifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "9941339108"
            }
        },
        {
            "name": "MemberId",
            "valueIdentifier": {
                "system": "http://example.org/cdex/member-ids",
                "value": "234567"
            }
        },
        {
            "name": "ServiceDate",
            "valueDate": "2022-06-16"
        },
        {
            "name": "Attachment",
            "part": [
                {
                    "name": "LineItem",
                    "valueString": "1"
                },
                {
                    "name": "LineItem",
                    "valueString": "2"
                },
                {
                    "name": "LineItem",
                    "valueString": "3"
                },
                {
                    "name": "Code",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "system": "http://loinc.org",
                                "code": "11504-8",
                                "display": "Surgical operation note"
                            }
                        ],
                        "text": "Surgical operation note"
                    }
                },
                {
                    "name": "Content",
                    "resource": {
                        "resourceType": "DocumentReference",
                        "status": "current",
                        "type": {
                            "coding": [
                                {
                                    "system": "http://loinc.org",
                                    "code": "11504-8",
                                    "display": "Operative note"
                                }
                            ],
                            "text": "Surgical Note"
                        },
                        "category": [
                            {
                                "coding": [
                                    {
                                        "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
                                        "code": "clinical-note",
                                        "display": "Clinical Note"
                                    }
                                ],
                                "text": "Clinical Note 1"
                            }
                        ],
                        "date": "2022-07-13T10:30:00-05:00",
                        "content": [
                            {
                                "attachment": {
                                    "contentType": "text/xml",
                                    "data": "<?xml version="1.0" encoding="windows-1252" ?><ClinicalDocument xmlns="urn:hl7-org:v3"><realmCode code="US" /><typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3" /><templateId root="1.2.840.114350.1.72.1.51693" /><templateId root="2.16.840.1.113883.10.20.22.1.1" /><templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2015-08-01" /><templateId root="2.16.840.1.113883.10.20.22.1.7" /><templateId root="2.16.840.1.113883.10.20.22.1.7" extension="2015-08-01" /><id assigningAuthorityName="EPC" root="1.2.840.114350.1.13.451.2.7.8.688883.131600207" /><code code="11504-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Provider unspecified Operation Note" /><title>Operative Note</title><effectiveTime value="20200220012715-0600" /><confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25" displayName="Normal" /><languageCode code="en-US" /><setId assigningAuthorityName="EPC" extension="6ae263da-53b2-11ea-8099-005056861bc6" root="1.2.840.114350.1.13.451.2.7.1.1" /><versionNumber value="1" /><recordTarget><patientRole><id root="1.2.840.114350.1.13.451.2.7.3.688884.100" extension="MAY4682830" /><addr use="HP"><streetAddressLine>1 N Rhode Island Ave</streetAddressLine><county>CERRO GORD</county><city>Mason City</city><state>IA</state><postalCode>50401-1446</postalCode><country>USA</country></addr><telecom use="MC" value="tel:+1-641-666-6666" /><telecom value="mailto:johntest1@test.com" /><patient><name use="L"><prefix qualifier="TITLE">Mr. </prefix><given>John</given><given>TEST</given><family>TEST</family></name><name use="P"><given>John</given><family>TEST</family></name><name use="P"><given>John</given><given>P.</given><family>TEST</family></name><administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGenderCode" displayName="Male" /><birthTime value="19530920" /><sdtc:deceasedInd value="false" xmlns:sdtc="urn:hl7-org:sdtc" /><maritalStatusCode code="M" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatusCode" displayName="Married" /><religiousAffiliationCode code="1028" codeSystem="2.16.840.1.113883.5.1076" codeSystemName="ReligiousAffiliation" /><raceCode code="2106-3" codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDC Race and Ethnicity" displayName="White" /><ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDC Race and Ethnicity" displayName="Not Hispanic or Latino" /><languageCommunication><languageCode code="eng" /><modeCode code="EWR" codeSystem="2.16.840.1.113883.5.60" displayName="Expressed Written" /><preferenceInd value="true" /></languageCommunication></patient><providerOrganization><id root="1.2.840.114350.1.13.451.2.7.2.688879" extension="37200" /><name>PROVIDER Clinic</name><telecom nullFlavor="NA" /><addr use="WP"><streetAddressLine>2 1st St SW</streetAddressLine><county>OLMSTED</county><city>ROCHESTER</city><state>MN</state><postalCode>55905</postalCode><country>USA</country></addr></providerOrganization></patientRole></recordTarget><author><time value="20200220012715-0600" /><assignedAuthor><id root="1.2.840.114350.1.1" extension="8.9" /><addr nullFlavor="NA" /><telecom nullFlavor="NA" /><assignedAuthoringDevice><manufacturerModelName>Epic - Version 8.9</manufacturerModelName><softwareName>Epic - Version 8.9</softwareName></assignedAuthoringDevice><representedOrganization><id root="1.2.840.114350.1.13.451.2.7.2.688879" extension="37200" /><name>PROVIDER Clinic</name><telecom nullFlavor="NA" /><addr use="WP"><streetAddressLine>2 1st St SW</streetAddressLine><county>OLMSTED</county><city>ROCHESTER</city><state>MN</state><postalCode>55905</postalCode><country>USA</country></addr></representedOrganization></assignedAuthor></author><custodian><assignedCustodian><representedCustodianOrganization><id root="1.2.840.114350.1.13.451.2.7.2.688879" extension="37200" /><name>PROVIDER Clinic</name><telecom nullFlavor="NA" /><addr use="WP"><streetAddressLine>2 1st St SW</streetAddressLine><county>OLMSTED</county><city>ROCHESTER</city><state>MN</state><postalCode>55905</postalCode><country>USA</country></addr></representedCustodianOrganization></assignedCustodian></custodian><legalAuthenticator><time value="20200220012715-0600" /><signatureCode code="S" /><assignedEntity><id root="2.16.840.1.113883.4.6" extension="1111111111" /><code nullFlavor="UNK" /><addr use="WP"><streetAddressLine>2 1st St SW</streetAddressLine><county>OLMSTED</county><city>Rochester</city><state>MN</state><postalCode>55905-0001</postalCode><country>USA</country></addr><telecom use="WP" value="tel:+1-507-666-6666" /><assignedPerson><name use="L"><given>John</given><given>H</given><family>TEST</family><suffix qualifier="AC"> M.D.</suffix></name></assignedPerson></assignedEntity></legalAuthenticator><participant typeCode="IND"><time value="20180810" /><associatedEntity classCode="ECON"><id root="1.2.840.114350.1.13.451.2.7.2.827665" extension="11111111" /><code code="SPS" codeSystem="2.16.840.1.113883.5.111" codeSystemName="RoleCode" displayName="Spouse"><originalText>Spouse</originalText></code><addr use="HP"><streetAddressLine>1 North Island Avenue</streetAddressLine><city>Mason City</city><state>IA</state><postalCode>50401-1446</postalCode><country>USA</country></addr><telecom use="HP" value="tel:+1-641-666-6666" /><telecom use="MC" value="tel:+1-641-666-6666" /><associatedPerson><name>Carol Meyer</name></associatedPerson></associatedEntity></participant><documentationOf typeCode="DOC"><serviceEvent classCode="PROC"><code code="77777772" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Procedure" /><effectiveTime><low nullFlavor="UNK" /><high nullFlavor="UNK" /></effectiveTime><performer typeCode="PPRF"><assignedEntity><id root="2.16.840.1.113883.4.6" /><code codeSystem="2.16.840.1.113883.3.88.12.3221.4.2" codeSystemName="NUCC" nullFlavor="NI" /><addr nullFlavor="UNK" /><telecom nullFlavor="UNK" /></assignedEntity></performer></serviceEvent></documentationOf><component><structuredBody><component><section><templateId root="2.16.840.1.113883.10.20.22.2.27" /><code code="29554-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="SURGERY PROCEDURE" /><title>Surgery Details</title><text><table><colgroup><col width="10%" /><col width="15%" /><col width="15%" /><col width="10%" /><col width="10%" /><col width="15%" /><col width="10%" /><col width="10%" /></colgroup><thead><tr><th>Date/Time</th><th>Status</th><th>Location</th><th>OR</th><th>Service</th><th>Patient Class</th><th>Case Class</th><th>Case Type</th><th>Trauma Case?</th></tr></thead><tbody><tr><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr></tbody></table><br /><list><caption>Additonal Notes</caption><item><caption>TEST, JOHN H - 02/17/2020 11:15 AM CST</caption><paragraph> <br /> <br />PROCEDURE(S)<br />Open takedown of adhesions (1 hour). <br />Resection approximately 75 cm  of terminal ileum and cecum and portion of ascending colon. <br />Ileoascending colostomy with double-stapled side-to-side functional end-to-end running of the small bowel.<br /><br />SURGEON(S)<br />Dr. John TEST. <br /><br />GENERAL SURGERY RESIDENT: Dr. TEST.<br /><br />ANESTHESIA TYPE<br />General.<br /><br />PRE-OPERATIVE DIAGNOSIS<br />Crohn's disease, stricturing of an area and CT enterography evidence of Crohn's disease in the terminal 75 cm of ileum.<br /><br />POST-OPERATIVE DIAGNOSIS<br />Crohn's disease, stricturing of an area and CT enterography evidence of Crohn's disease in the terminal 75 cm of ileum.<br /><br />FINDINGS<br />See below.<br /><br />DESCRIPTION OF PROCEDURE<br />Under general anesthesia in the supine position, patient prepped and draped. A mid-midline incision made large enough for the HandPort to be placed except we ran into many adhesions. We then decided to proceed open. We really did not even begin to do the laparoscopic procedure. Takedown of adhesions took about 45 minutes to 1 hour. The anatomy was oriented correctly. Ureters were not seen. The terminal ileum was caught down into the pelvis. This was all mobilized. A point was chosen on the terminal ileum above the evidence of disease (75 cm) and a point chosen on the ascending colon just above the cecum as the line of distal transection. The intervening mesentery was alternatively clamped, tied, and LigaSured. The specimen was removed, and a double-stapled side-to-side functional end-to-end ileoascending colostomy was then constructed without difficulty. Post stapling, visualization revealed excellent blood supply, no tension, big anastomosis. The mesentery defect was relatively small and closed with running 3-0 chromic. The abdomen was thoroughly irrigated numerous times with normal saline, bleeding controlled with cautery, and the abdomen was again irrigated with normal saline. The small bowel was run back to the ligament of Treitz, and there was no other evidence of Crohn's disease. The abdomen was then closed over Seprafilm using a combination of running double PDS in the midline fascia and interrupted #1 Vicryl in the area of the old mesh. The skin was closed with a running subcuticular Vicryl.<br /><br />SPECIMENS<br />Terminal ileum, cecum, appendix, portion ascending colon<br /><br />DRAINS<br />No drains. <br /><br />No stomas.<br /><br />ESTIMATED BLOOD LOSS<br />Less than 100 cc.<br /><br />TPR:  2   <br /><br /><br />John H. TEST, M.D.<br />DD:  02/17/2020 11:02:41 CT<br />DT:  02/17/2020 11:28:58 CT<br />Job ID:  871622002/sjp<br /><br /></paragraph></item></list></text></section></component><component><section nullFlavor="NI"><templateId root="2.16.840.1.113883.10.20.22.2.25" /><templateId root="2.16.840.1.113883.10.20.22.2.25" extension="2014-06-09" /><code code="59774-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Anesthesia Records" /><title>Anesthesia Record</title><text><content ID="nof1">Not on file</content></text></section></component><component><section nullFlavor="NI"><templateId root="2.16.840.1.113883.10.20.22.2.34" /><templateId root="2.16.840.1.113883.10.20.22.2.34" extension="2015-08-01" /><code code="10219-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Preoperative Diagnosis" /><title>Preoperative Diagnosis</title><text><content ID="nof2">Not on file</content></text></section></component><component><section nullFlavor="NI"><templateId root="2.16.840.1.113883.10.20.22.2.35" /><code code="10218-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Postoperative Diagnosis" /><title>Postoperative Diagnosis</title><text><content ID="nof3">Not on file</content></text></section></component><component><section><templateId root="2.16.840.1.113883.10.20.22.2.37" /><templateId root="2.16.840.1.113883.10.20.22.2.37" extension="2015-08-01" /><code code="55109-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Complications" /><title>Complications</title><text><paragraph>Check Surgery Details section.</paragraph></text></section></component><component><section><templateId root="2.16.840.1.113883.10.20.18.2.9" /><code code="59770-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure Estimated Blood Loss" /><title>Procedure Estimated Blood Loss</title><text><paragraph>Check Surgery Details section.</paragraph></text></section></component><component><section><templateId root="2.16.840.1.113883.10.20.22.2.28" /><templateId root="2.16.840.1.113883.10.20.22.2.28" extension="2015-08-01" /><code code="59776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure Findings" /><title>Procedure Findings</title><text><paragraph>Check Surgery Details section.</paragraph></text></section></component><component><section><templateId root="2.16.840.1.113883.10.20.22.2.31" /><code code="59773-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure Specimens Taken" /><title>Procedure Specimens Taken</title><text><paragraph>Check Surgery Details section.</paragraph></text></section></component></structuredBody></component></ClinicalDocument>
",
                                    "title": "Example CCDA",
                                    "hash": "026d568297832e6e083e96549041a72aa383bb23"
                                }
                            }
                        ]
                    }
                }
            ]
        }
    ]
}

Response Headers

HTTP/1.1 200 OK
Server: nginx/1.14.0 (Ubuntu)
Date: Fri, 23 Oct 2020 04:54:56 GMT
Content-Type: application/fhir+json;charset=utf-8
...(other headers)

Response Body

{
    "resourceType": "OperationOutcome",
    "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n      <p>The attachments can not be associated with a current claim or prior authorization and are being held for association with a future claim or prior authorization.</p>\n    </div>"
    },
    "issue": [
        {
            "severity": "information",
            "code": "informational",
            "details": {
                "text": "The attachments can not be associated with a current claim or prior authorization and are being held for association with a future claim or prior authorization."
            }
        }
    ]
}
Rendered Documents


Scenario 2: Laboratory Results Attachments

This scenario is the same as Scenario 1a, except the Provider is submitting laboratory results in support of a claim. There are multiple attachments each populated with a FHIR Observation resource. If a signature were required it would be converted to a signed FHIR document like the example in the Signatures section.

  # unsolicited-attachment-scenario2

Request

POST [base]/$submit-attachment

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Request Body

{
    "resourceType": "Parameters",
    "parameter": [
        {
            "name": "TrackingId",
            "valueString": "targetid123"
        },
        {
            "name": "AttachTo",
            "valueCode": "claim"
        },
        {
            "name": "PayerId",
            "valueIdentifier": {
                "system": "http://example.org/cdex/payer-ids",
                "value": "Payer123"
            }
        },
        {
            "name": "OrganizationId",
            "valueIdentifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "1407071236"
            }
        },
        {
            "name": "ProviderId",
            "valueIdentifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "9941339108"
            }
        },
        {
            "name": "MemberId",
            "valueIdentifier": {
                "system": "http://example.org/cdex/member-ids",
                "value": "Member123"
            }
        },
        {
            "name": "ServiceDate",
            "valueDate": "2022-06-16"
        },
        {
            "name": "Attachment",
            "part": [
                {
                    "name": "LineItem",
                    "valueString": "1"
                },
                {
                    "name": "Code",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "system": "http://loinc.org",
                                "code": "11502-2",
                                "display": "Laboratory report"
                            }
                        ],
                        "text": "Laboratory report"
                    }
                },
                {
                    "name": "Content",
                    "resource": {
                        "resourceType": "Observation",
                        "id": "cdex-2020-04-23-hba1c-example",
                        "status": "final",
                        "category": [
                            {
                                "coding": [
                                    {
                                        "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                                        "code": "laboratory",
                                        "display": "Laboratory"
                                    }
                                ],
                                "text": "Laboratory"
                            }
                        ],
                        "code": {
                            "coding": [
                                {
                                    "system": "http://loinc.org",
                                    "code": "4548-4",
                                    "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
                                },
                                {
                                    "system": "http://www.ama-assn.org/go/cpt",
                                    "code": "83036",
                                    "display": "Hemoglobin; glycosylated (A1c)"
                                },
                                {
                                    "system": "http://example.org/lab-results",
                                    "code": "HBA1C",
                                    "display": "Hglycated hemoglobin (HbA1c)"
                                }
                            ],
                            "text": "glycated hemoglobin (HbA1c)"
                        },
                        "subject": {
                            "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b",
                            "display": "Elden718 Halvorson124"
                        },
                        "effectiveDateTime": "2022-06-16T10:21:08-07:00",
                        "valueQuantity": {
                            "value": 7.2,
                            "unit": "%",
                            "system": "http://unitsofmeasure.org",
                            "code": "%"
                        }
                    }
                }
            ]
        },
        {
            "name": "Attachment",
            "part": [
                {
                    "name": "LineItem",
                    "valueString": "1"
                },
                {
                    "name": "Code",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "system": "http://loinc.org",
                                "code": "11502-2",
                                "display": "Laboratory report"
                            }
                        ],
                        "text": "Laboratory report"
                    }
                },
                {
                    "name": "Content",
                    "resource": {
                        "resourceType": "Observation",
                        "id": "cdex-2020-10-23-hba1c-example",
                        "status": "final",
                        "category": [
                            {
                                "coding": [
                                    {
                                        "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                                        "code": "laboratory",
                                        "display": "Laboratory"
                                    }
                                ],
                                "text": "Laboratory"
                            }
                        ],
                        "code": {
                            "coding": [
                                {
                                    "system": "http://loinc.org",
                                    "code": "4548-4",
                                    "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
                                },
                                {
                                    "system": "http://www.ama-assn.org/go/cpt",
                                    "code": "83036",
                                    "display": "Hemoglobin; glycosylated (A1c)"
                                },
                                {
                                    "system": "http://example.org/lab-results",
                                    "code": "HBA1C",
                                    "display": "Hglycated hemoglobin (HbA1c)"
                                }
                            ],
                            "text": "glycated hemoglobin (HbA1c)"
                        },
                        "subject": {
                            "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b",
                            "display": "Elden718 Halvorson124"
                        },
                        "effectiveDateTime": "2022-05-16T10:21:08-07:00",
                        "valueQuantity": {
                            "value": 7,
                            "unit": "%",
                            "system": "http://unitsofmeasure.org",
                            "code": "%"
                        }
                    }
                }
            ]
        },
        {
            "name": "Attachment",
            "part": [
                {
                    "name": "LineItem",
                    "valueString": "1"
                },
                {
                    "name": "Code",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "system": "http://loinc.org",
                                "code": "11502-2",
                                "display": "Laboratory report"
                            }
                        ],
                        "text": "Laboratory report"
                    }
                },
                {
                    "name": "Content",
                    "resource": {
                        "resourceType": "Observation",
                        "id": "cdex-2020-07-23-hba1c-example",
                        "status": "final",
                        "category": [
                            {
                                "coding": [
                                    {
                                        "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                                        "code": "laboratory",
                                        "display": "Laboratory"
                                    }
                                ],
                                "text": "Laboratory"
                            }
                        ],
                        "code": {
                            "coding": [
                                {
                                    "system": "http://loinc.org",
                                    "code": "4548-4",
                                    "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
                                },
                                {
                                    "system": "http://www.ama-assn.org/go/cpt",
                                    "code": "83036",
                                    "display": "Hemoglobin; glycosylated (A1c)"
                                },
                                {
                                    "system": "http://example.org/lab-results",
                                    "code": "HBA1C",
                                    "display": "Hglycated hemoglobin (HbA1c)"
                                }
                            ],
                            "text": "glycated hemoglobin (HbA1c)"
                        },
                        "subject": {
                            "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b",
                            "display": "Elden718 Halvorson124"
                        },
                        "effectiveDateTime": "2022-04-16T10:21:08-07:00",
                        "valueQuantity": {
                            "value": 7,
                            "unit": "%",
                            "system": "http://unitsofmeasure.org",
                            "code": "%"
                        }
                    }
                }
            ]
        }
    ]
}

Response Headers

HTTP/1.1 200 OK
Server: nginx/1.14.0 (Ubuntu)
Date: Fri, 23 Oct 2020 04:54:56 GMT
Content-Type: application/fhir+json;charset=utf-8
...(other headers)



Signatures

Some data consumers may require that the data they receive are signed. When signatures are required, the following general rules apply:

  • The signature represents a provider signature attesting that the information is true and accurate to the best of their knowledge.*
  • The returned information is either already inherently signed (for example, a wet signature on a PDF or a digitally signed CCDA) or it is transformed into a signed FHIR Document and Bundle.signature used to exchange the signature.

* Consult with your Payer and your legal team for questions regarding legal liability associated with sharing and signing data.

The Payer Requirements

  • For Unsolicited Attachments, the Payer/Requester pre-negotiates with the organization representing the Provider/Responder on whether electronic or digital signatures are required. If signatures are required, all attachments will be signed by the provider submitting them.
  • For Solicited Attachments, the Payer/Requester pre-negotiates with the organization representing the Provider/Responder on whether electronic or digital signatures are required for:
    1. all attachments or
    2. only for attachments where the attachment request communicates the signature requirement using the Task.input signature flag input parameter.
  • The Payer/Requester follows the documentation on the Signatures page for validating signatures.
    • If the signatures fail verification when processing the ‘$submit-attachments’ operation, the Data Source/Responder SHALL return an HTTP 400 Bad Request and an OperationOutcome declaring that the signature was invalid.

Provider Requirements

  • When an electronic or digital signature is required for a Task-based request, the Data Source/Responder returns a document that is either already inherently signed or transforms it into a signed FHIR Document.
    • if multiple documents need to be signed, systems should minimize the number of interactions required by the user
  • The Data Source/Responder follows the documentation on the Signatures page for producing signatures.
  • As discussed in the What is Signed section, a signed FHIR document could have objects that are individually signed within it as well. If the Consumer/Requester assumed there would be a signature (wet, electronic, or digital) on an individual returned object (e.g CCDA, PDF, Image, CDA on FHIR ) and it is not present, they can re-request the data using a Task-based request to indicate it needs to be signed with the Task.input signature flag.

Example: Signed FHIR Resource Attachments

  • in this example, the Provider submits a patient’s active conditions to the Payer to support a prior authorization.
  • Unlike Scenario 1 which uses DocumentReference resource to index the CCDA attachment, FHIR resources representing the patient’s active conditions are transformed into a FHIR Document bundle and the bundle is digitally signed.
  • See the Signatures page for complete examples of how the signature was created.

Request

POST [base]/$submit-attachment

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Request Body

{
    "resourceType": "Parameters",
    "parameter": [
        {
            "name": "TrackingId",
            "valueString": "11234657"
        },
        {
            "name": "AttachTo",
            "valueCode": "claim"
        },
        {
            "name": "PayerId",
            "valueIdentifier": {
                "system": "http://example.org/cdex/payer-ids",
                "value": "payer123"
            }
        },
        {
            "name": "OrganizationId",
            "valueIdentifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "1407071236"
            }
        },
        {
            "name": "ProviderId",
            "valueIdentifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "9941339108"
            }
        },
        {
            "name": "MemberId",
            "valueIdentifier": {
                "system": "http://example.org/cdex/member-ids",
                "value": "234567"
            }
        },
        {
            "name": "ServiceDate",
            "valueDate": "2022-06-16"
        },
        {
            "name": "Attachment",
            "part": [
                {
                    "name": "LineItem",
                    "valueString": "1"
                },
                {
                    "name": "Code",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "system": "http://loinc.org",
                                "code": "11503-0",
                                "display": "Medical records"
                            }
                        ],
                        "text": "Medical records"
                    }
                },
                {
                    "name": "Content",
                    "resource": {
                        "resourceType": "Bundle",
                        "id": "cdex-document-digital-sig-example",
                        "identifier": {
                            "system": "urn:ietf:rfc:3986",
                            "value": "urn:uuid:c173535e-135e-48e3-ab64-38bacc68dba8"
                        },
                        "type": "document",
                        "timestamp": "2021-10-25T20:16:29-07:00",
                        "entry": [
                            {
                                "fullUrl": "urn:uuid:17a80a8d-4cf1-4deb-a1fd-2db1130e5f76",
                                "resource": {
                                    "resourceType": "Composition",
                                    "id": "17a80a8d-4cf1-4deb-a1fd-2db1130e5f76",
                                    "text": {
                                        "status": "generated",
                                        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><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\">Resource \"17a80a8d-4cf1-4deb-a1fd-2db1130e5f76\" </p></div><p><b>status</b>: final</p><p><b>type</b>: Medical records <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://loinc.org/\">LOINC</a>#11503-0)</span></p><p><b>encounter</b>: <a href=\"#Encounter_5ce5c83a-000f-47d2-941c-039358cc9112\">See above (urn:uuid:5ce5c83a-000f-47d2-941c-039358cc9112: Example Encounter)</a></p><p><b>date</b>: 2021-10-25T20:16:29-07:00</p><p><b>author</b>: <a href=\"#Practitioner_0820c16d-91de-4dfa-a3a6-f140a516a9bc\">See above (urn:uuid:0820c16d-91de-4dfa-a3a6-f140a516a9bc: Example Practitioner)</a></p><p><b>title</b>: Active Conditions</p><h3>Attesters</h3><table class=\"grid\"><tr><td>-</td><td><b>Mode</b></td><td><b>Time</b></td><td><b>Party</b></td></tr><tr><td>*</td><td>legal</td><td>2021-10-25T20:16:29-07:00</td><td><a href=\"#Practitioner_0820c16d-91de-4dfa-a3a6-f140a516a9bc\">See above (urn:uuid:0820c16d-91de-4dfa-a3a6-f140a516a9bc: Example Practitioner)</a></td></tr></table></div>"
                                    },
                                    "status": "final",
                                    "type": {
                                        "coding": [
                                            {
                                                "system": "http://loinc.org",
                                                "code": "11503-0"
                                            }
                                        ],
                                        "text": "Medical records"
                                    },
                                    "subject": {
                                        "reference": "urn:uuid:970af6c9-5bbd-4067-b6c1-d9b2c823aece",
                                        "display": "Example Patient"
                                    },
                                    "encounter": {
                                        "reference": "urn:uuid:5ce5c83a-000f-47d2-941c-039358cc9112",
                                        "display": "Example Encounter"
                                    },
                                    "date": "2021-10-25T20:16:29-07:00",
                                    "author": [
                                        {
                                            "reference": "urn:uuid:0820c16d-91de-4dfa-a3a6-f140a516a9bc",
                                            "display": "Example Practitioner"
                                        }
                                    ],
                                    "title": "Active Conditions",
                                    "attester": [
                                        {
                                            "mode": "legal",
                                            "time": "2021-10-25T20:16:29-07:00",
                                            "party": {
                                                "reference": "urn:uuid:0820c16d-91de-4dfa-a3a6-f140a516a9bc",
                                                "display": "Example Practitioner"
                                            }
                                        }
                                    ],
                                    "section": [
                                        {
                                            "title": "Active Condition 1",
                                            "entry": [
                                                {
                                                    "reference": "urn:uuid:014a68ec-d691-49e0-b980-91b0d924e570"
                                                }
                                            ]
                                        }
                                    ]
                                }
                            },
                            {
                                "fullUrl": "urn:uuid:0820c16d-91de-4dfa-a3a6-f140a516a9bc",
                                "resource": {
                                    "resourceType": "Practitioner",
                                    "id": "0820c16d-91de-4dfa-a3a6-f140a516a9bc",
                                    "meta": {
                                        "lastUpdated": "2013-05-05T16:13:03+00:00"
                                    },
                                    "text": {
                                        "status": "generated",
                                        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><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\">Resource \"0820c16d-91de-4dfa-a3a6-f140a516a9bc\" Updated \"2013-05-05T16:13:03Z\" </p></div><p><b>name</b>: John Hancock </p></div>"
                                    },
                                    "name": [
                                        {
                                            "family": "Hancock",
                                            "given": [
                                                "John"
                                            ]
                                        }
                                    ]
                                }
                            },
                            {
                                "fullUrl": "urn:uuid:970af6c9-5bbd-4067-b6c1-d9b2c823aece",
                                "resource": {
                                    "resourceType": "Patient",
                                    "id": "970af6c9-5bbd-4067-b6c1-d9b2c823aece",
                                    "text": {
                                        "status": "generated",
                                        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><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\">Resource \"970af6c9-5bbd-4067-b6c1-d9b2c823aece\" </p></div><p><b>active</b>: true</p><p><b>name</b>: CDEX Example Patient</p></div>"
                                    },
                                    "active": true,
                                    "name": [
                                        {
                                            "text": "CDEX Example Patient",
                                            "family": "Patient",
                                            "given": [
                                                "CDEX Example"
                                            ]
                                        }
                                    ]
                                }
                            },
                            {
                                "fullUrl": "urn:uuid:014a68ec-d691-49e0-b980-91b0d924e570",
                                "resource": {
                                    "resourceType": "Condition",
                                    "id": "014a68ec-d691-49e0-b980-91b0d924e570",
                                    "text": {
                                        "status": "generated",
                                        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><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\">Resource \"014a68ec-d691-49e0-b980-91b0d924e570\" </p></div><p><b>identifier</b>: id: 1</p><p><b>clinicalStatus</b>: Active <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-condition-clinical.html\">Condition Clinical Status Codes</a>#active)</span></p><p><b>category</b>: Problem <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#55607006; <a href=\"https://loinc.org/\">LOINC</a>#75326-9)</span></p><p><b>code</b>: Type 2 Diabetes Mellitus <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#44054006)</span></p><p><b>subject</b>: <a href=\"#Patient_970af6c9-5bbd-4067-b6c1-d9b2c823aece\">See above (urn:uuid:970af6c9-5bbd-4067-b6c1-d9b2c823aece)</a></p><p><b>onset</b>: 2006-01-01</p><p><b>asserter</b>: <a href=\"#Practitioner_0820c16d-91de-4dfa-a3a6-f140a516a9bc\">See above (urn:uuid:0820c16d-91de-4dfa-a3a6-f140a516a9bc)</a></p></div>"
                                    },
                                    "identifier": [
                                        {
                                            "system": "urn:oid:1.3.6.1.4.1.22812.4.111.0.4.1.2.1",
                                            "value": "1"
                                        }
                                    ],
                                    "clinicalStatus": {
                                        "coding": [
                                            {
                                                "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
                                                "code": "active"
                                            }
                                        ]
                                    },
                                    "category": [
                                        {
                                            "coding": [
                                                {
                                                    "system": "http://snomed.info/sct",
                                                    "code": "55607006",
                                                    "display": "Problem"
                                                },
                                                {
                                                    "system": "http://loinc.org",
                                                    "code": "75326-9",
                                                    "display": "Problem"
                                                }
                                            ]
                                        }
                                    ],
                                    "code": {
                                        "coding": [
                                            {
                                                "system": "http://snomed.info/sct",
                                                "code": "44054006",
                                                "display": "Type 2 Diabetes Mellitus"
                                            }
                                        ]
                                    },
                                    "subject": {
                                        "reference": "urn:uuid:970af6c9-5bbd-4067-b6c1-d9b2c823aece"
                                    },
                                    "onsetDateTime": "2006",
                                    "asserter": {
                                        "reference": "urn:uuid:0820c16d-91de-4dfa-a3a6-f140a516a9bc"
                                    }
                                }
                            },
                            {
                                "fullUrl": "urn:uuid:5ce5c83a-000f-47d2-941c-039358cc9112",
                                "resource": {
                                    "resourceType": "Encounter",
                                    "id": "5ce5c83a-000f-47d2-941c-039358cc9112",
                                    "text": {
                                        "status": "generated",
                                        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><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\">Resource \"5ce5c83a-000f-47d2-941c-039358cc9112\" </p></div><p><b>status</b>: finished</p><p><b>class</b>: emergency (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code EMER = 'emergency', stated as 'null')</p><p><b>type</b>: Unknown (qualifier value) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#261665006)</span></p><p><b>subject</b>: <a href=\"#Patient_970af6c9-5bbd-4067-b6c1-d9b2c823aece\">See above (urn:uuid:970af6c9-5bbd-4067-b6c1-d9b2c823aece: CDEX Example Patient)</a></p><h3>Participants</h3><table class=\"grid\"><tr><td>-</td><td><b>Individual</b></td></tr><tr><td>*</td><td><a href=\"#Practitioner_0820c16d-91de-4dfa-a3a6-f140a516a9bc\">See above (urn:uuid:0820c16d-91de-4dfa-a3a6-f140a516a9bc: John Hancock)</a></td></tr></table><p><b>period</b>: 2021-10-25T20:10:29-07:00 --&gt; 2021-10-25T20:16:29-07:00</p><p><b>serviceProvider</b>: <a href=\"#Organization_e37f004b-dc10-422b-b833-cdaa10a055a3\">See above (urn:uuid:e37f004b-dc10-422b-b833-cdaa10a055a3: CDEX Example Organization)</a></p></div>"
                                    },
                                    "status": "finished",
                                    "class": {
                                        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                                        "code": "EMER"
                                    },
                                    "type": [
                                        {
                                            "coding": [
                                                {
                                                    "system": "http://snomed.info/sct",
                                                    "code": "261665006",
                                                    "display": "Unknown (qualifier value)"
                                                }
                                            ],
                                            "text": "Unknown (qualifier value)"
                                        }
                                    ],
                                    "subject": {
                                        "reference": "urn:uuid:970af6c9-5bbd-4067-b6c1-d9b2c823aece",
                                        "display": "CDEX Example Patient"
                                    },
                                    "participant": [
                                        {
                                            "individual": {
                                                "reference": "urn:uuid:0820c16d-91de-4dfa-a3a6-f140a516a9bc",
                                                "display": "John Hancock"
                                            }
                                        }
                                    ],
                                    "period": {
                                        "start": "2021-10-25T20:10:29-07:00",
                                        "end": "2021-10-25T20:16:29-07:00"
                                    },
                                    "serviceProvider": {
                                        "reference": "urn:uuid:e37f004b-dc10-422b-b833-cdaa10a055a3",
                                        "display": "CDEX Example Organization"
                                    }
                                }
                            },
                            {
                                "fullUrl": "urn:uuid:e37f004b-dc10-422b-b833-cdaa10a055a3",
                                "resource": {
                                    "resourceType": "Organization",
                                    "id": "e37f004b-dc10-422b-b833-cdaa10a055a3",
                                    "text": {
                                        "status": "generated",
                                        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><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\">Resource \"e37f004b-dc10-422b-b833-cdaa10a055a3\" </p></div><p><b>active</b>: true</p><p><b>name</b>: CDEX Example Organization</p><p><b>telecom</b>: ph: (+1) 555-555-5555, <a href=\"mailto:customer-service@example.org\">customer-service@example.org</a></p><p><b>address</b>: 1 CDEX Lane Boston MA 01002 USA </p></div>"
                                    },
                                    "active": true,
                                    "name": "CDEX Example Organization",
                                    "telecom": [
                                        {
                                            "system": "phone",
                                            "value": "(+1) 555-555-5555"
                                        },
                                        {
                                            "system": "email",
                                            "value": "customer-service@example.org"
                                        }
                                    ],
                                    "address": [
                                        {
                                            "line": [
                                                "1 CDEX Lane"
                                            ],
                                            "city": "Boston",
                                            "state": "MA",
                                            "postalCode": "01002",
                                            "country": "USA"
                                        }
                                    ]
                                }
                            }
                        ],
                        "signature": {
                            "type": [
                                {
                                    "system": "urn:iso-astm:E1762-95:2013",
                                    "code": "1.2.840.10065.1.12.1.5",
                                    "display": "Verification Signature"
                                }
                            ],
                            "when": "2021-10-05T22:42:19-07:00",
                            "who": {
                                "reference": "https://example.org/Practitioner/123"
                            },
                            "onBehalfOf": {
                                "reference": "https://example.org/Organization/123"
                            },
                            "data": "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"
                        }
                    }
                }
            ]
        }
    ]
}

Response Headers

HTTP/1.1 200 OK
Server: nginx/1.14.0 (Ubuntu)
Date: Fri, 23 Oct 2020 04:54:56 GMT
Content-Type: application/fhir+json;charset=utf-8
...(other headers)