Da Vinci - Payer Coverage Decision Exchange (PCDE)
1.0.0 - STU 1

Da Vinci - Payer Coverage Decision Exchange (PCDE), published by HL7 International - Financial Management Work Group. This is not an authorized publication; it is the continuous build for version 1.0.0). This version is based on the current content of https://github.com/HL7/davinci-pcde/ and changes regularly. See the Directory of published versions

## : PCDE Document example - TTL Representation

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix loinc: <http://loinc.org/rdf#> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:Bundle;
      fhir:nodeRole fhir:treeRoot;
      fhir:Resource.id [ fhir:value "pcde-document"];
      fhir:Resource.meta [
         fhir:Meta.lastUpdated [ fhir:value "2019-07-21T11:01:00+05:00"^^xsd:dateTime ]
      ];
      fhir:Bundle.identifier [
         fhir:Identifier.system [ fhir:value "http://originalinsuranceinc.com/documentIDs" ];
         fhir:Identifier.value [ fhir:value "A12345" ]
      ];
      fhir:Bundle.type [ fhir:value "document"];
      fhir:Bundle.timestamp [ fhir:value "2019-07-21T11:01:00+05:00"^^xsd:dateTime];
      fhir:Bundle.entry [
         fhir:index 0;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Composition/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Composition/1>
      ], [
         fhir:index 1;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Patient/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Patient/1>
      ], [
         fhir:index 2;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Coverage/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Coverage/1>
      ], [
         fhir:index 3;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Organization/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Organization/1>
      ], [
         fhir:index 4;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/CarePlan/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/CarePlan/1>
      ], [
         fhir:index 5;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Claim/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Claim/1>
      ], [
         fhir:index 6;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/ClaimResponse/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/ClaimResponse/1>
      ], [
         fhir:index 7;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Practitioner/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Practitioner/1>
      ], [
         fhir:index 8;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/ServiceRequest/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/ServiceRequest/1>
      ], [
         fhir:index 9;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Condition/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Condition/1>
      ], [
         fhir:index 10;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/PractitionerRole/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/PractitionerRole/1>
      ], [
         fhir:index 11;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/Practitioner/2" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/Practitioner/2>
      ], [
         fhir:index 12;
         fhir:Bundle.entry.fullUrl [ fhir:value "http://originalinsuranceinc.com/fhir/DocumentReference/1" ];
         fhir:Bundle.entry.resource <http://originalinsuranceinc.com/fhir/DocumentReference/1>
      ].

    <http://originalinsuranceinc.com/fhir/Composition/1> a fhir:Composition;
      fhir:Resource.id [ fhir:value "1"];
      fhir:Resource.meta [
         fhir:Meta.profile [
           fhir:value "http://hl7.org/fhir/us/davinci-pcde/StructureDefinition/profile-composition";
           fhir:index 0;
           fhir:link <http://hl7.org/fhir/us/davinci-pcde/StructureDefinition/profile-composition>     ]
      ];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Composition</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 Composition \"1\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-composition.html\">PCDE Coverage Transition Composition Profile</a></p></div><p><b>status</b>: final</p><p><b>type</b>: Coverage Transition Document <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PCDEtempCodes.html\">PCDE Temporary Codes</a>#pcde)</span></p><p><b>date</b>: 2019-07-21 11:09:00+0700</p><p><b>author</b>: <a href=\"#Practitioner_1\">See above (Practitioner/1)</a></p><p><b>title</b>: Coverage Decision Exchange Document (Joe Smith, 2019-07-21)</p><h3>Events</h3><table class=\"grid\"><tr><td>-</td><td><b>Detail</b></td></tr><tr><td>*</td><td><a href=\"#Coverage_1\">See above (Coverage/1)</a></td></tr></table></div>"
      ];
      fhir:Composition.status [ fhir:value "final"];
      fhir:Composition.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes" ];
           fhir:Coding.code [ fhir:value "pcde" ]     ]
      ];
      fhir:Composition.subject [
         fhir:Reference.reference [ fhir:value "Patient/1" ]
      ];
      fhir:Composition.date [ fhir:value "2019-07-21T23:09:00+07:00"^^xsd:dateTime];
      fhir:Composition.author [
         fhir:index 0;
         fhir:Reference.reference [ fhir:value "Practitioner/1" ]
      ];
      fhir:Composition.title [ fhir:value "Coverage Decision Exchange Document (Joe Smith, 2019-07-21)"];
      fhir:Composition.event [
         fhir:index 0;
         fhir:Composition.event.detail [
           fhir:index 0;
           fhir:Reference.reference [ fhir:value "Coverage/1" ]     ]
      ];
      fhir:Composition.section [
         fhir:index 0;
         fhir:Composition.section.title [ fhir:value "Active Treatments" ];
         fhir:Composition.section.code [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes" ];
             fhir:Coding.code [ fhir:value "activeTreatment" ]       ]     ];
         fhir:Composition.section.section [
           fhir:index 0;
           fhir:Composition.section.title [ fhir:value "Consulation re: MCI" ];
           fhir:Composition.section.code [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes" ];
               fhir:Coding.code [ fhir:value "treatment" ]         ]       ];
           fhir:Composition.section.entry [
             fhir:index 0;
             fhir:Reference.reference [ fhir:value "CarePlan/1" ]       ]     ], [
           fhir:index 1;
           fhir:Composition.section.title [ fhir:value "Prior coverage" ];
           fhir:Composition.section.code [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes" ];
               fhir:Coding.code [ fhir:value "priorCoverage" ]         ]       ];
           fhir:Composition.section.entry [
             fhir:index 0;
             fhir:Reference.reference [ fhir:value "Claim/1" ]       ], [
             fhir:index 1;
             fhir:Reference.reference [ fhir:value "ClaimResponse/1" ]       ]     ], [
           fhir:index 2;
           fhir:Composition.section.title [ fhir:value "Supporting information" ];
           fhir:Composition.section.code [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pcde/CodeSystem/PCDEtempCodes" ];
               fhir:Coding.code [ fhir:value "supportingInfo" ]         ]       ];
           fhir:Composition.section.text [
             fhir:Narrative.status [ fhir:value "generated" ];
             fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n                                Joe Smith is a subscriber to Maryland Capital Insurance Company. During a regular physical, Dr. James Gardener, Joe’s primary care physician, diagnosed a potential heart problem, acute myocardial infarction; unspecified site. \n                                Dr. Gardener had referred Joe to Dr. Susan Watson, a cardiologist for a consultation.\n                                During the consultation examination, Dr. Watson determined that Joe’s diagnosis requires hospitalization and a surgical procedure, a triple bypass venous graft. \n                                The operation and recovery was at Montgomery Hospital.\n                            </div>"       ];
           fhir:Composition.section.entry [
             fhir:index 0;
             fhir:Reference.reference [ fhir:value "DocumentReference/1" ]       ]     ]
      ].

    <http://originalinsuranceinc.com/fhir/Patient/1> a fhir:Patient;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</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 Patient \"1\" </p></div><p><b>identifier</b>: id: 444222222</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>"
      ];
      fhir:Patient.identifier [
         fhir:index 0;
         fhir:Identifier.system [ fhir:value "http://originalinsuranceinc.com/fhir/NamingSystem/client-ids" ];
         fhir:Identifier.value [ fhir:value "444222222" ]
      ];
      fhir:Patient.name [
         fhir:index 0;
         fhir:HumanName.family [ fhir:value "SMITH" ];
         fhir:HumanName.given [
           fhir:value "JOE";
           fhir:index 0     ]
      ];
      fhir:Patient.gender [ fhir:value "male"].

    <http://originalinsuranceinc.com/fhir/Coverage/1> a fhir:Coverage;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</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 Coverage \"1\" </p></div><p><b>status</b>: active</p><p><b>subscriberId</b>: 12345678</p><p><b>beneficiary</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>payor</b>: <a href=\"#Organization_1\">See above (Organization/1)</a></p></div>"
      ];
      fhir:Coverage.status [ fhir:value "active"];
      fhir:Coverage.subscriberId [ fhir:value "12345678"];
      fhir:Coverage.beneficiary [
         fhir:Reference.reference [ fhir:value "Patient/1" ]
      ];
      fhir:Coverage.payor [
         fhir:index 0;
         fhir:Reference.reference [ fhir:value "Organization/1" ]
      ].

    <http://originalinsuranceinc.com/fhir/Organization/1> a fhir:Organization;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</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 Organization \"1\" </p></div><p><b>identifier</b>: id: 789312</p><p><b>active</b>: true</p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>"
      ];
      fhir:Organization.identifier [
         fhir:index 0;
         fhir:Identifier.system [ fhir:value "http://originalinsuranceinc.com/fhir/NamingSystem/ETIN" ];
         fhir:Identifier.value [ fhir:value "789312" ]
      ];
      fhir:Organization.active [ fhir:value "true"^^xsd:boolean];
      fhir:Organization.name [ fhir:value "MARYLAND CAPITAL INSURANCE COMPANY"].

    <http://originalinsuranceinc.com/fhir/CarePlan/1> a fhir:CarePlan;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: CarePlan</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 CarePlan \"1\" </p></div><p><b>instantiatesUri</b>: <a href=\"http://originalinsuranceinc.com/consultReviewURI\">http://originalinsuranceinc.com/consultReviewURI</a></p><p><b>status</b>: active</p><p><b>intent</b>: plan</p><p><b>category</b>: Assessment and Plan of Treatment <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-careplan-category.html\">US Core CarePlan Category Extension Codes</a>#assess-plan)</span></p><p><b>subject</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><blockquote><p><b>activity</b></p><h3>Details</h3><table class=\"grid\"><tr><td>-</td><td><b>Code</b></td><td><b>ReasonReference</b></td><td><b>Status</b></td></tr><tr><td>*</td><td>Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (SERVICE_TYPE_CODE#3)</span></td><td><a href=\"#Condition_1\">See above (Condition/1)</a></td><td>in-progress</td></tr></table></blockquote></div>"
      ];
      fhir:CarePlan.instantiatesUri [
         fhir:value "http://originalinsuranceinc.com/consultReviewURI";
         fhir:index 0
      ];
      fhir:CarePlan.status [ fhir:value "active"];
      fhir:CarePlan.intent [ fhir:value "plan"];
      fhir:CarePlan.category [
         fhir:index 0;
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/core/CodeSystem/careplan-category" ];
           fhir:Coding.code [ fhir:value "assess-plan" ]     ]
      ];
      fhir:CarePlan.subject [
         fhir:Reference.reference [ fhir:value "Patient/1" ]
      ];
      fhir:CarePlan.activity [
         fhir:index 0;
         fhir:CarePlan.activity.detail [
           fhir:CarePlan.activity.detail.code [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://example.org/SERVICE_TYPE_CODE" ];
               fhir:Coding.code [ fhir:value "3" ];
               fhir:Coding.display [ fhir:value "Consultation" ]         ]       ];
           fhir:CarePlan.activity.detail.reasonReference [
             fhir:index 0;
             fhir:Reference.reference [ fhir:value "Condition/1" ]       ];
           fhir:CarePlan.activity.detail.status [ fhir:value "in-progress" ]     ]
      ].

    <http://originalinsuranceinc.com/fhir/Claim/1> a fhir:Claim;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Claim</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 Claim \"1\" </p></div><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>created</b>: 2019-07-20</p><p><b>insurer</b>: <a href=\"#Organization_1\">See above (Organization/1)</a></p><p><b>provider</b>: <a href=\"http://example.org/fhir/Organization/provider\">http://example.org/fhir/Organization/provider</a></p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><h3>CareTeams</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td>*</td><td>1</td><td><a href=\"http://example.org/fhir/Organization/provider\">http://example.org/fhir/Organization/provider</a></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td>*</td><td>1</td><td>Chronic pain syndrome <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G89.4)</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><a href=\"#Coverage_1\">See above (Coverage/1)</a></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>DiagnosisSequence</b></td><td><b>ProductOrService</b></td><td><b>Location[x]</b></td></tr><tr><td>*</td><td>, , </td><td>1</td><td>1</td><td>1</td><td>Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1365#3)</span></td><td>11 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-CMSPlaceofServiceCodes.html\">CMS Place of Service Codes (POS)</a>#11)</span></td></tr></table></div>"
      ];
      fhir:Claim.identifier [
         fhir:index 0;
         fhir:Identifier.system [ fhir:value "http://example.org/PATIENT_EVENT_TRACE_NUMBER" ];
         fhir:Identifier.value [ fhir:value "111099" ];
         fhir:Identifier.assigner [
           fhir:Reference.identifier [
             fhir:Identifier.system [ fhir:value "http://example.org/USER_ASSIGNED" ];
             fhir:Identifier.value [ fhir:value "9012345678" ]       ]     ]
      ];
      fhir:Claim.status [ fhir:value "active"];
      fhir:Claim.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
           fhir:Coding.code [ fhir:value "professional" ]     ]
      ];
      fhir:Claim.use [ fhir:value "preauthorization"];
      fhir:Claim.patient [
         fhir:Reference.reference [ fhir:value "Patient/1" ]
      ];
      fhir:Claim.created [ fhir:value "2019-07-20"^^xsd:date];
      fhir:Claim.insurer [
         fhir:Reference.reference [ fhir:value "Organization/1" ]
      ];
      fhir:Claim.provider [
         fhir:link <http://example.org/fhir/Organization/provider>;
         fhir:Reference.reference [ fhir:value "http://example.org/fhir/Organization/provider" ]
      ];
      fhir:Claim.priority [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ];
           fhir:Coding.code [ fhir:value "normal" ];
           fhir:Coding.display [ fhir:value "Normal" ]     ]
      ];
      fhir:Claim.careTeam [
         fhir:index 0;
         fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
         fhir:Claim.careTeam.provider [
           fhir:link <http://example.org/fhir/Organization/provider>;
           fhir:Reference.reference [ fhir:value "http://example.org/fhir/Organization/provider" ]     ]
      ];
      fhir:Claim.diagnosis [
         fhir:index 0;
         fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
         fhir:Claim.diagnosis.diagnosisCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ];
             fhir:Coding.code [ fhir:value "G89.4" ]       ]     ]
      ];
      fhir:Claim.insurance [
         fhir:index 0;
         fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
         fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
         fhir:Claim.insurance.coverage [
           fhir:Reference.reference [ fhir:value "Coverage/1" ]     ]
      ];
      fhir:Claim.item [
         fhir:index 0;
         fhir:Element.extension [
           fhir:index 0;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType" ];
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1525" ];
               fhir:Coding.code [ fhir:value "SC" ];
               fhir:Coding.display [ fhir:value "Specialty Care Review" ]         ]       ]     ], [
           fhir:index 1;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType" ];
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1322" ];
               fhir:Coding.code [ fhir:value "I" ];
               fhir:Coding.display [ fhir:value "Initial" ]         ]       ]     ], [
           fhir:index 2;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService" ];
           fhir:Extension.valueReference [
             fhir:Reference.reference [ fhir:value "ServiceRequest/1" ]       ]     ];
         fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
         fhir:Claim.item.careTeamSequence [
           fhir:value "1"^^xsd:positiveInteger;
           fhir:index 0     ];
         fhir:Claim.item.diagnosisSequence [
           fhir:value "1"^^xsd:positiveInteger;
           fhir:index 0     ];
         fhir:Claim.item.productOrService [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1365" ];
             fhir:Coding.code [ fhir:value "3" ];
             fhir:Coding.display [ fhir:value "Consultation" ]       ]     ];
         fhir:Claim.item.locationCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set" ];
             fhir:Coding.code [ fhir:value "11" ]       ]     ]
      ].

    <http://originalinsuranceinc.com/fhir/ClaimResponse/1> a fhir:ClaimResponse;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "extensions" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</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 ClaimResponse \"1\" </p></div><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>created</b>: 2019-07-20</p><p><b>insurer</b>: <a href=\"#Organization_1\">See above (Organization/1)</a></p><p><b>requestor</b>: <a href=\"http://example.org/fhir/Organization/provider\">http://example.org/fhir/Organization/provider</a></p><p><b>outcome</b>: complete</p><blockquote><p><b>item</b></p><blockquote><p><b>ReviewAction</b></p><p><b>value</b>: AUTH0001</p><p><b>value</b>: Certified in total <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (306#A1)</span></p></blockquote><p><b>AuthorizedDate</b>: 2005-05-02 --&gt; 2005-06-02</p><p><b>itemSequence</b>: 1</p><h3>Adjudications</h3><table class=\"grid\"><tr><td>-</td><td><b>Category</b></td></tr><tr><td>*</td><td>Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></td></tr></table></blockquote></div>"
      ];
      fhir:ClaimResponse.identifier [
         fhir:index 0;
         fhir:Identifier.system [ fhir:value "http://example.org/PATIENT_EVENT_TRACE_NUMBER" ];
         fhir:Identifier.value [ fhir:value "111099" ];
         fhir:Identifier.assigner [
           fhir:Reference.identifier [
             fhir:Identifier.system [ fhir:value "http://example.org/USER_ASSIGNED" ];
             fhir:Identifier.value [ fhir:value "9012345678" ]       ]     ]
      ];
      fhir:ClaimResponse.status [ fhir:value "active"];
      fhir:ClaimResponse.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
           fhir:Coding.code [ fhir:value "professional" ]     ]
      ];
      fhir:ClaimResponse.use [ fhir:value "preauthorization"];
      fhir:ClaimResponse.patient [
         fhir:Reference.reference [ fhir:value "Patient/1" ]
      ];
      fhir:ClaimResponse.created [ fhir:value "2019-07-20"^^xsd:date];
      fhir:ClaimResponse.insurer [
         fhir:Reference.reference [ fhir:value "Organization/1" ]
      ];
      fhir:ClaimResponse.requestor [
         fhir:link <http://example.org/fhir/Organization/provider>;
         fhir:Reference.reference [ fhir:value "http://example.org/fhir/Organization/provider" ]
      ];
      fhir:ClaimResponse.outcome [ fhir:value "complete"];
      fhir:ClaimResponse.item [
         fhir:index 0;
         fhir:Element.extension [
           fhir:index 0;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction" ];
           fhir:Element.extension [
             fhir:index 0;
             fhir:Extension.url [ fhir:value "number" ];
             fhir:Extension.valueString [ fhir:value "AUTH0001" ]       ], [
             fhir:index 1;
             fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode" ];
             fhir:Extension.valueCodeableConcept [
               fhir:CodeableConcept.coding [
                 fhir:index 0;
                 fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/306" ];
                 fhir:Coding.code [ fhir:value "A1" ];
                 fhir:Coding.display [ fhir:value "Certified in total" ]           ]         ]       ]     ], [
           fhir:index 1;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDate" ];
           fhir:Extension.valuePeriod [
             fhir:Period.start [ fhir:value "2005-05-02"^^xsd:date ];
             fhir:Period.end [ fhir:value "2005-06-02"^^xsd:date ]       ]     ];
         fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ];
         fhir:ClaimResponse.item.adjudication [
           fhir:index 0;
           fhir:ClaimResponse.item.adjudication.category [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ];
               fhir:Coding.code [ fhir:value "submitted" ]         ]       ]     ]
      ].

    <http://originalinsuranceinc.com/fhir/Practitioner/1> a fhir:Practitioner;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Practitioner</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 Practitioner \"1\" </p></div><p><b>identifier</b>: id: 8189991234</p><p><b>name</b>: JAMES GARDENER </p></div>"
      ];
      fhir:Practitioner.identifier [
         fhir:index 0;
         fhir:Identifier.system [ fhir:value "http://originalinsuranceinc.com/fhir/NamingSystem/ETIN" ];
         fhir:Identifier.value [ fhir:value "8189991234" ]
      ];
      fhir:Practitioner.name [
         fhir:index 0;
         fhir:HumanName.family [ fhir:value "GARDENER" ];
         fhir:HumanName.given [
           fhir:value "JAMES";
           fhir:index 0     ]
      ].

    <http://originalinsuranceinc.com/fhir/ServiceRequest/1> a fhir:ServiceRequest;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ServiceRequest</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 ServiceRequest \"1\" </p></div><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>code</b>: Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1365#3)</span></p><p><b>quantity</b>: 1 VS</p><p><b>subject</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>performer</b>: <a href=\"#PractitionerRole_1\">See above (PractitionerRole/1)</a></p></div>"
      ];
      fhir:ServiceRequest.status [ fhir:value "active"];
      fhir:ServiceRequest.intent [ fhir:value "order"];
      fhir:ServiceRequest.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1365" ];
           fhir:Coding.code [ fhir:value "3" ];
           fhir:Coding.display [ fhir:value "Consultation" ]     ]
      ];
      fhir:ServiceRequest.quantityQuantity [
         fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ];
         fhir:Quantity.unit [ fhir:value "VS" ]
      ];
      fhir:ServiceRequest.subject [
         fhir:Reference.reference [ fhir:value "Patient/1" ]
      ];
      fhir:ServiceRequest.performer [
         fhir:index 0;
         fhir:Reference.reference [ fhir:value "PractitionerRole/1" ]
      ].

    <http://originalinsuranceinc.com/fhir/Condition/1> a fhir:Condition;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Condition</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 Condition \"1\" </p></div><p><b>category</b>: Encounter Diagnosis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-condition-category.html\">Condition Category Codes</a>#encounter-diagnosis)</span></p><p><b>code</b>: Acute myocardial infarction of unspecified site, episode of care unspecified <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (icd-9-cm#410.90)</span></p><p><b>subject</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>recordedDate</b>: 2005-04-30</p></div>"
      ];
      fhir:Condition.category [
         fhir:index 0;
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/condition-category" ];
           fhir:Coding.code [ fhir:value "encounter-diagnosis" ]     ]
      ];
      fhir:Condition.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-9-cm" ];
           fhir:Coding.code [ fhir:value "410.90" ]     ]
      ];
      fhir:Condition.subject [
         fhir:Reference.reference [ fhir:value "Patient/1" ]
      ];
      fhir:Condition.recordedDate [ fhir:value "2005-04-30"^^xsd:date].

    <http://originalinsuranceinc.com/fhir/PractitionerRole/1> a fhir:PractitionerRole;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: PractitionerRole</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 PractitionerRole \"1\" </p></div><p><b>practitioner</b>: <a href=\"#Practitioner_2\">See above (Practitioner/2)</a></p><p><b>code</b>: Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (ENTITY_IDENTIFIER_CODE#1P)</span></p></div>"
      ];
      fhir:PractitionerRole.practitioner [
         fhir:Reference.reference [ fhir:value "Practitioner/2" ]
      ];
      fhir:PractitionerRole.code [
         fhir:index 0;
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/NamingSystem/ENTITY_IDENTIFIER_CODE" ];
           fhir:Coding.code [ fhir:value "1P" ];
           fhir:Coding.display [ fhir:value "Provider" ]     ]
      ].

    <http://originalinsuranceinc.com/fhir/Practitioner/2> a fhir:Practitioner;
      fhir:Resource.id [ fhir:value "2"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Practitioner</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 Practitioner \"2\" </p></div><p><b>identifier</b>: id: 987654321</p><p><b>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>"
      ];
      fhir:Practitioner.identifier [
         fhir:index 0;
         fhir:Identifier.system [ fhir:value "http://originalinsuranceinc.com/fhir/NamingSystem/practitioner-id" ];
         fhir:Identifier.value [ fhir:value "987654321" ]
      ];
      fhir:Practitioner.name [
         fhir:index 0;
         fhir:HumanName.family [ fhir:value "WATSON" ];
         fhir:HumanName.given [
           fhir:value "SUSAN";
           fhir:index 0     ]
      ];
      fhir:Practitioner.telecom [
         fhir:index 0;
         fhir:ContactPoint.system [ fhir:value "phone" ];
         fhir:ContactPoint.value [ fhir:value "4029993456" ]
      ].

    <http://originalinsuranceinc.com/fhir/DocumentReference/1> a fhir:DocumentReference;
      fhir:Resource.id [ fhir:value "1"];
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ];
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: DocumentReference</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 DocumentReference \"1\" </p></div><p><b>status</b>: current</p><p><b>docStatus</b>: final</p><p><b>type</b>: Discharge summary <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://loinc.org/\">LOINC</a>#18842-5)</span></p><p><b>subject</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p><p><b>author</b>: <a href=\"#Practitioner_1\">See above (Practitioner/1)</a></p><blockquote><p><b>content</b></p></blockquote></div>"
      ];
      fhir:DocumentReference.status [ fhir:value "current"];
      fhir:DocumentReference.docStatus [ fhir:value "final"];
      fhir:DocumentReference.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           a loinc:18842-5;
           fhir:Coding.system [ fhir:value "http://loinc.org" ];
           fhir:Coding.code [ fhir:value "18842-5" ]     ]
      ];
      fhir:DocumentReference.subject [
         fhir:Reference.reference [ fhir:value "Patient/1" ]
      ];
      fhir:DocumentReference.author [
         fhir:index 0;
         fhir:Reference.reference [ fhir:value "Practitioner/1" ]
      ];
      fhir:DocumentReference.content [
         fhir:index 0;
         fhir:DocumentReference.content.attachment [
           fhir:Attachment.url [ fhir:value "http://originalinsuranceinc.com/fhir/Binary/DischargeSummaryDocument" ]     ]
      ].

    # - ontology header ------------------------------------------------------------

     a owl:Ontology;
      owl:imports fhir:fhir.ttl.