eLTSS data elements example - Electronic Long-Term Services and Supports (eLTSS) Release 1

Electronic Long-Term Services and Supports (eLTSS) Release 1 - US Realm, published by HL7 International / Human and Social Services. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/eLTSS/ and changes regularly. See the Directory of published versions

Example Bundle: eLTSS data elements example

NOTE

Review JSON and/or XML, as not all elements are rendered by the publisher in the narrative content

Bundle 2039212f3fa5406bb4ffd4a of type searchset

Entry 1 - fullUrl = https://hl7.org/fhir/Patient/patientBSJ1

Resource Patient:

Anonymous Patient Female, DoB: 1950-11-01 ( Medical Record Number: United States Medicare Number#10A3D58WH1600 (use: usual))

Entry 2 - fullUrl = https://hl7.org/fhir/CarePlan/careplan1

Resource CarePlan:

Generated Narrative: CarePlan
Resource CarePlan "careplan1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: CarePlan_eltss
status: ACTIVE
intent: PLAN
category: Assessment and Plan of Treatment (US Core CarePlan Category Extension Codes#assess-plan)
title: Betsy Smith Johnson's Services and Supports Plan
description: A service and support plan that outlines Betsy's assessed needs, goals, strengths, preferences, and services/providers to meet those needs and goals.
subject: See on this page: Patient/patientBSJ1
period: 2020-05-01 --> 2020-12-31
addresses:
Condition/need1
Condition/need2
Condition/need3
Condition/need4
supportingInfo:
See on this page: Observation/strength1
See on this page: Observation/strength2
See on this page: Observation/pref1
See on this page: QuestionnaireResponse/questionnaireresponse1
See on this page: Contract/contract1
See on this page: RiskAssessment/risk1
goal:
See on this page: Goal/goal1
See on this page: Goal/goal2
activity
activity
activity
activity
activity
progress: Betsy will start doing balance exercises ( @2020-05-10)
activity
progress: Betsy working on mobility to dance at son's upcoming wedding ( @2020-05-10)

Entry 3 - fullUrl = https://hl7.org/fhir/Task/Task1

Resource Task:

Generated Narrative: Task
Resource Task "Task1"
ServiceRequest Pertains To Goal: See on this page: Goal/goal1
status: READY
intent: ORDER
priority: ROUTINE
code: Fulfill the focal request (Task Codes#fulfill)
description: Perform exercises to improve balance skills.
for: See on this page: Patient/patientBSJ1: Betsy
requester: See on this page: Practitioner/planner1: Mark Planner
owner: See on this page: Patient/patientBSJ1: Betsy

Entry 4 - fullUrl = https://hl7.org/fhir/Task/Task2

Resource Task:

Generated Narrative: Task
Resource Task "Task2"
ServiceRequest Pertains To Goal: See on this page: Goal/goal2
status: READY
intent: ORDER
priority: ROUTINE
code: Fulfill the focal request (Task Codes#fulfill)
description: Son working with Besty to work on mobility to dance at son's upcoming wedding.
for: See on this page: Patient/patientBSJ1: Betsy
requester: See on this page: Practitioner/planner1: Mark Planner
owner: See on this page: RelatedPerson/son1: Charles - Betsy's son

Entry 5 - fullUrl = https://hl7.org/fhir/Goal/goal2

Resource Goal:

Generated Narrative: Goal
Resource Goal "goal2" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Goal_eltss
lifecycleStatus: ACCEPTED
description: Dance at son's upcoming wedding ()
subject: See on this page: Patient/patientBSJ1

Entry 6 - fullUrl = https://hl7.org/fhir/Goal/goal1

Resource Goal:

Generated Narrative: Goal
Resource Goal "goal1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Goal_eltss
lifecycleStatus: ACCEPTED
description: Improve balance skills ()
subject: See on this page: Patient/patientBSJ1

Entry 7 - fullUrl = https://hl7.org/fhir/Practitioner/planner1

Resource Practitioner:

Generated Narrative: Practitioner
Resource Practitioner "planner1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Practitioner_eltss
identifier: United States National Provider Identifier/9941339100, http://www.acme.org/practitioners/25456
name: Mark Planner
telecom: ph: (210) 555 1221

Entry 8 - fullUrl = https://hl7.org/fhir/ServiceRequest/service2

Resource ServiceRequest:

Generated Narrative: ServiceRequest
Resource ServiceRequest "service2" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: ServiceRequest_eltss
status: ACTIVE
intent: PLAN
code: Non-emergency transportation; encounter/trip (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#T2003)
quantity: 2 trips (Details: http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl code C141286 = 'Transportation')/1 month (Details: UCUM code mo = 'mo')
subject: See on this page: Patient/patientBSJ1
occurrence: 2020-07-01 --> 2020-12-31
performer: See on this page: Organization/provider2a
insurance: See on this page: Coverage/coverage1
supportingInfo: Claim/claim1
note: Service provider will provide a reminder the business day before the trip, and will call when on the way.

Entry 9 - fullUrl = https://hl7.org/fhir/ServiceRequest/service3

Resource ServiceRequest:

Generated Narrative: ServiceRequest
Resource ServiceRequest "service3" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: ServiceRequest_eltss
status: ACTIVE
intent: PLAN
code: Diabetes outpatient self-management training services, individual, per 30 minutes (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#G0108)
quantity: 1 visit (Details: http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl code C25716 = 'Visit')/1 week (Details: UCUM code wk = 'wk')
subject: See on this page: Patient/patientBSJ1
occurrence: 2020-05-01 --> 2020-08-01
performer: See on this page: Practitioner/provider3
supportingInfo: Claim/claim2

Entry 10 - fullUrl = https://hl7.org/fhir/ServiceRequest/service4

Resource ServiceRequest:

Generated Narrative: ServiceRequest
Resource ServiceRequest "service4" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: ServiceRequest_eltss
status: ACTIVE
intent: PLAN
code: therapeutic exercises to improve balance skills (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#97110)
quantity: 1 visit (Details: http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl code C25716 = 'Visit')/1 week (Details: UCUM code wk = 'wk')
subject: See on this page: Patient/patientBSJ1
occurrence: 2020-05-01 --> 2020-08-01
performer: See on this page: Practitioner/provider4
supportingInfo:
Goal/goal1
Goal/goal2
Claim/claim3

Entry 11 - fullUrl = https://hl7.org/fhir/RelatedPerson/son1

Resource RelatedPerson:

Generated Narrative: RelatedPerson
Resource RelatedPerson "son1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: eLTSS RelatedPerson Profile
active: true
patient: See on this page: Patient/patientBSJ1
relationship: son (RoleCode#SONC)
name: Charles Johnson

Entry 12 - fullUrl = https://hl7.org/fhir/Observation/strength1

Resource Observation:

Generated Narrative: Observation
Resource Observation "strength1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Observation_eltss
status: FINAL
category: Social History (Observation Category Codes#social-history)
code: Strength (eLTSS Observation Codes#strength)
subject: See on this page: Patient/patientBSJ1
effective: 2013-04-02 10:30:10+0100
issued: Apr 3, 2013, 2:30:10 PM
performer: See on this page: Practitioner/caremgr1: Care Manager
value: Able to manage her bills.

Entry 13 - fullUrl = https://hl7.org/fhir/Observation/strength2

Resource Observation:

Generated Narrative: Observation
Resource Observation "strength2" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Observation_eltss
status: FINAL
category: Social History (Observation Category Codes#social-history)
code: Strength (eLTSS Observation Codes#strength)
subject: See on this page: Patient/patientBSJ1
effective: 2013-04-02 10:30:10+0100
issued: Apr 3, 2013, 2:30:10 PM
performer: See on this page: Practitioner/caremgr1: Care Manager
value: Independent walking with cane.

Entry 14 - fullUrl = https://hl7.org/fhir/Practitioner/caremgr1

Resource Practitioner:

Generated Narrative: Practitioner
Resource Practitioner "caremgr1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Practitioner_eltss
identifier: United States National Provider Identifier/1144221847, http://www.acme.org/practitioners/25457
name: Sam Monitor
telecom: ph: (210) 224 1599

Entry 15 - fullUrl = https://hl7.org/fhir/CarePlan/careplan2

Resource CarePlan:

Generated Narrative: CarePlan
Resource CarePlan "careplan2" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: CarePlan_eltss
partOf: See on this page: CarePlan/careplan1
status: ACTIVE
intent: PLAN
category: Assessment and Plan of Treatment (US Core CarePlan Category Extension Codes#assess-plan)
description: Weather Emergency: A shelf-stable meal is delivered to Meals On Wheels clients. It is to be eaten in the unlikely event of cancellation. Weather meals are donated by the Sheboygan Service Club.
subject: See on this page: Patient/patientBSJ1

Entry 16 - fullUrl = https://hl7.org/fhir/Claim/claim1

Resource Claim:

Generated Narrative: Claim
Resource Claim "claim1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Claim_eltss
status: ACTIVE
type: Professional (Claim Type Codes#professional)
use: CLAIM
patient: See on this page: Patient/patientBSJ1
created: 2020-05-01
provider: See on this page: Organization/funding1
priority: Normal (Process Priority Codes#normal)
Insurances
- Sequence Focal Coverage
* 1 true See on this page: Coverage/coverage1
item
sequence: 1
productOrService: T2003 (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#T2003)
UnitPrices
- Value Currency
* 60 USD
Nets
- Value Currency
* 600 USD

Entry 17 - fullUrl = https://hl7.org/fhir/Claim/claim2

Resource Claim:

Generated Narrative: Claim
Resource Claim "claim2" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Claim_eltss
status: ACTIVE
type: Professional (Claim Type Codes#professional)
use: CLAIM
patient: See on this page: Patient/patientBSJ1
created: 2020-05-01
provider: See on this page: Organization/funding1
priority: Normal (Process Priority Codes#normal)
Insurances
- Sequence Focal Coverage
* 1 true See on this page: Coverage/coverage1
item
sequence: 1
productOrService: G0108 (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#G0108)
UnitPrices
- Value Currency
* 55 USD
Nets
- Value Currency
* 660 USD

Entry 18 - fullUrl = https://hl7.org/fhir/Claim/claim3

Resource Claim:

Generated Narrative: Claim
Resource Claim "claim3" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Claim_eltss
status: ACTIVE
type: Professional (Claim Type Codes#professional)
use: CLAIM
patient: See on this page: Patient/patientBSJ1
created: 2020-05-01
provider: See on this page: Organization/funding1
priority: Normal (Process Priority Codes#normal)
Insurances
- Sequence Focal Coverage
* 1 true See on this page: Coverage/coverage1
item
sequence: 1
productOrService: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility (Current Procedural Terminology (CPT®)#97110)
UnitPrices
- Value Currency
* 65 USD
Nets
- Value Currency
* 780 USD

Entry 19 - fullUrl = https://hl7.org/fhir/Contract/contract1

Resource Contract:

Generated Narrative: Contract
Resource Contract "contract1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Contract_eltss
signer
type: Patient (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code PAT = 'Patient', stated as 'null')
party: See on this page: Patient/patientBSJ1
Signatures
- Type When Who Data
* Consent Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.7 = 'Consent Signature', stated as 'null') Apr 2, 2020, 3:00:00 AM See on this page: Patient/patientBSJ1 (base64 data - 187 bytes)
signer
type: Guardian (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code GUARD = 'Guardian', stated as 'null')
party: See on this page: RelatedPerson/guardian1
Signatures
- Type When Who Data
* Consent Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.7 = 'Consent Signature', stated as 'null') Apr 2, 2020, 3:00:00 AM See on this page: RelatedPerson/guardian1 (base64 data - 187 bytes)
signer
type: Author (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code AUT = 'Author', stated as 'null')
party: See on this page: Practitioner/planner1
Signatures
- Type When Who Data
* Author's Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.1 = 'Author's Signature', stated as 'null') Apr 2, 2020, 3:00:00 AM See on this page: Practitioner/planner1 (base64 data - 187 bytes)
signer
type: Co-Author (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code COAUTH = 'Co-Author', stated as 'null')
party: See on this page: Practitioner/caremgr1
Signatures
- Type When Who Data
* Author's Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.1 = 'Author's Signature', stated as 'null') Apr 2, 2020, 3:00:00 AM See on this page: Practitioner/caremgr1 (base64 data - 187 bytes)
signer
type: Healthcare Provider (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code HPROV = 'Healthcare Provider', stated as 'null')
party: See on this page: Practitioner/provider3
Signatures
- Type When Who Data
* Consent Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.7 = 'Consent Signature', stated as 'null') Apr 2, 2020, 3:00:00 AM See on this page: Practitioner/provider3 (base64 data - 187 bytes)
signer
type: Healthcare Provider (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code HPROV = 'Healthcare Provider', stated as 'null')
party: See on this page: Practitioner/provider2b
Signatures
- Type When Who Data
* Consent Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.7 = 'Consent Signature', stated as 'null') Apr 2, 2020, 3:00:00 AM See on this page: Practitioner/provider2b (base64 data - 187 bytes)
signer
type: Healthcare Provider (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code HPROV = 'Healthcare Provider', stated as 'null')
party: See on this page: RelatedPerson/son1
Signatures
- Type When Who Data
* Consent Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.7 = 'Consent Signature', stated as 'null') Apr 2, 2020, 3:00:00 AM See on this page: RelatedPerson/son1 (base64 data - 187 bytes)
signer
type: Healthcare Provider (Details: http://terminology.hl7.org/CodeSystem/contractsignertypecodes code HPROV = 'Healthcare Provider', stated as 'null')
party: See on this page: Practitioner/provider4
Signatures
- Type When Who Data
* Consent Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.7 = 'Consent Signature', stated as 'null') Apr 2, 2020, 3:00:00 AM See on this page: Practitioner/provider4 (base64 data - 187 bytes)

Entry 20 - fullUrl = https://hl7.org/fhir/Coverage/coverage1

Resource Coverage:

Generated Narrative: Coverage
Resource Coverage "coverage1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
status: ACTIVE
beneficiary: See on this page: Patient/patientBSJ1

Entry 21 - fullUrl = https://hl7.org/fhir/EpisodeOfCare/episode1

Resource EpisodeOfCare:

Generated Narrative: EpisodeOfCare
Resource EpisodeOfCare "episode1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: EpisodeOfCare_eltss
status: ACTIVE
patient: See on this page: Patient/patientBSJ1
careManager: See on this page: Practitioner/caremgr1

Entry 22 - fullUrl = https://hl7.org/fhir/Organization/funding1

Resource Organization:

Generated Narrative: Organization
Resource Organization "funding1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: US Core Organization Profile
identifier: United States National Provider Identifier/1144221847, Clinical Laboratory Improvement Amendments/12D4567890
active: true
name: Texas Department of Community Health
Contacts
- Address
* 7430 Louis Pasteur Dr, San Antonio, TX 78229

Entry 23 - fullUrl = https://hl7.org/fhir/RelatedPerson/guardian1

Resource RelatedPerson:

Generated Narrative: RelatedPerson
Resource RelatedPerson "guardian1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: eLTSS RelatedPerson Profile
active: true
patient: See on this page: Patient/patientBSJ1
relationship: guardian (RoleCode#GUARD)
name: Charles Johnson

Entry 24 - fullUrl = https://hl7.org/fhir/Location/location1

Resource Location:

Generated Narrative: Location
Resource Location "location1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Location_eltss
name: In Home
address: 111 Maple Ct, San Antonio, TX 78212

Entry 25 - fullUrl = https://hl7.org/fhir/Condition/need1

Resource Condition:

Generated Narrative: Condition
Resource Condition "need1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Condition_eltss
clinicalStatus: Active (Condition Clinical Status Codes#active)
verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)
category: Health Concern (US Core Condition Category Extension Codes#health-concern), Assessed Need (eLTSS Condition Category Codes#assessed-need), SDOH (US Core Category#sdoh)
code: Needs transportation (SNOMED CT#713458007 "Lack of access to transportation (finding)")
subject: See on this page: Patient/patientBSJ1

Entry 26 - fullUrl = https://hl7.org/fhir/Condition/need2

Resource Condition:

Generated Narrative: Condition
Resource Condition "need2" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Condition_eltss
clinicalStatus: Active (Condition Clinical Status Codes#active)
verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)
category: Health Concern (US Core Condition Category Extension Codes#health-concern), Assessed Need (eLTSS Condition Category Codes#assessed-need)
code: Needs health / nutrition education for diabetes (SNOMED CT#734920002 "Diabetes mellitus education service")
subject: See on this page: Patient/patientBSJ1

Entry 27 - fullUrl = https://hl7.org/fhir/Condition/need3

Resource Condition:

Generated Narrative: Condition
Resource Condition "need3" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Condition_eltss
clinicalStatus: Active (Condition Clinical Status Codes#active)
verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)
category: Health Concern (US Core Condition Category Extension Codes#health-concern), Assessed Need (eLTSS Condition Category Codes#assessed-need), Cognitive Status (US Core Category#cognitive-status)
code: Depression (on treatment) (SNOMED CT#35489007 "Depressive disorder (disorder)")
subject: See on this page: Patient/patientBSJ1

Entry 28 - fullUrl = https://hl7.org/fhir/Condition/need4

Resource Condition:

Generated Narrative: Condition
Resource Condition "need4" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Condition_eltss
ELTSS-dueTo: See on this page: Condition/need3
clinicalStatus: Active (Condition Clinical Status Codes#active)
verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)
category: Health Concern (US Core Condition Category Extension Codes#health-concern), Assessed Need (eLTSS Condition Category Codes#assessed-need), SDOH (US Core Category#sdoh)
code: Needs physical exercises (SNOMED CT#183301007 "Physical exercises (regime/therapy)")
subject: See on this page: Patient/patientBSJ1

Entry 29 - fullUrl = https://hl7.org/fhir/Observation/pref1

Resource Observation:

Generated Narrative: Observation
Resource Observation "pref1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Observation_eltss
status: FINAL
category: Social History (Observation Category Codes#social-history)
code: Care experience preference (LOINC#95541-9)
subject: See on this page: Patient/patientBSJ1
effective: 2013-04-02 10:30:10+0100
issued: Apr 3, 2013, 2:30:10 PM
performer: See on this page: Practitioner/caremgr1: Care Manager
value: Accessing the ICWP Waiver for her current service needs, and would like to remain on ICWP and continue with her current services.

Entry 30 - fullUrl = https://hl7.org/fhir/Organization/provider2a

Resource Organization:

Generated Narrative: Organization
Resource Organization "provider2a" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: US Core Organization Profile
identifier: United States National Provider Identifier/1144221847, Clinical Laboratory Improvement Amendments/12D4567890
active: true
name: The Transporter, Inc.
Contacts
- Telecom Address
* ph: (210) 555 1313 111 Business Street, San Antonio, TX 78212

Entry 31 - fullUrl = https://hl7.org/fhir/Practitioner/provider2b

Resource Practitioner:

Generated Narrative: Practitioner
Resource Practitioner "provider2b" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Practitioner_eltss
identifier: http://www.acme.org/practitioners/11223344
name: Bill Driver
telecom: ph: (210) 111 2222

Entry 32 - fullUrl = https://hl7.org/fhir/Practitioner/provider3

Resource Practitioner:

Generated Narrative: Practitioner
Resource Practitioner "provider3" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Practitioner_eltss
identifier: http://www.acme.org/practitioners/987654
name: Lisa Educator
telecom: ph: (210) 555 1213

Entry 33 - fullUrl = https://hl7.org/fhir/Practitioner/provider4

Resource Practitioner:

Generated Narrative: Practitioner
Resource Practitioner "provider4" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Practitioner_eltss
identifier: http://www.acme.org/practitioners/987657
name: Norma Trainer
telecom: ph: (210) 555 1214

Entry 34 - fullUrl = https://hl7.org/fhir/PractitionerRole/PractitionerRole-1

Resource PractitionerRole:

Generated Narrative: PractitionerRole
Resource PractitionerRole "PractitionerRole-1"
Profile: eLTSS PractitionerRole Profile
practitioner: See on this page: Practitioner/caremgr1: Sam Monitor
organization: See on this page: Organization/funding1: Texas Department of Community Health
code: Community Health Worker (provider-taxonomy#172V00000X)
specialty: Case Manager/Care Coordinator (provider-taxonomy#171M00000X)
location: See on this page: Location/communitysite: Health Level Seven International

Entry 35 - fullUrl = https://hl7.org/fhir/Location/communitysite

Resource Location:

Generated Narrative: Location
Resource Location "communitysite" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: Location_eltss
name: In Home
address: 7430 Louis Pasteur Dr, San Antonio, TX 78229

Entry 36 - fullUrl = https://hl7.org/fhir/Questionnaire/questionnaire1

Resource Questionnaire:

LinkId Text Cardinality Type Description & Constraints
Questionnaire1 Questionnaire http://hl7.org/fhir/us/eltss/Questionnaire/questionnaire1

q1 Did you choose the setting in which you reside? 0..1 boolean

q2 What alternative home and community-based settings were considered? 0..1 string

q3 Were you given a choice of services outlined in the plan? 0..1 boolean

q4 Did you participate in the selection of services outlined in the plan? 0..1 boolean

q5 Do you agree to the services outlined in the plan? 0..1 boolean

q6 Were you offered a choice of providers for each service? 0..1 boolean

q7 Do you feel you made an informed choice in selecting the provider for each service? 0..1 boolean

Documentation for this format

LinkId	Text	Cardinality	Type	Description & Constraints
Questionnaire1			Questionnaire	http://hl7.org/fhir/us/eltss/Questionnaire/questionnaire1
q1	Did you choose the setting in which you reside?	0..1	boolean
q2	What alternative home and community-based settings were considered?	0..1	string
q3	Were you given a choice of services outlined in the plan?	0..1	boolean
q4	Did you participate in the selection of services outlined in the plan?	0..1	boolean
q5	Do you agree to the services outlined in the plan?	0..1	boolean
q6	Were you offered a choice of providers for each service?	0..1	boolean
q7	Do you feel you made an informed choice in selecting the provider for each service?	0..1	boolean
Documentation for this format

Entry 37 - fullUrl = https://hl7.org/fhir/QuestionnaireResponse/questionnaireresponse1

Resource QuestionnaireResponse:

LinkId Text Definition Answer
questionnaireresponse1 QuestionnaireResponse

q1

q2

q3

q4

q5

q6

q7

Documentation for this format

Entry 38 - fullUrl = https://hl7.org/fhir/RiskAssessment/risk1

Resource RiskAssessment:

Generated Narrative: RiskAssessment
Resource RiskAssessment "risk1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: RiskAssessment_eltss
RiskPlan: : This points to a management plan for any risks. This is not the backup plan, which is an alternative plan for the CarePlan. The risk management plan is meant to help avoid needing the backup plan.
status: FINAL
subject: See on this page: Patient/patientBSJ1
prediction
outcome: At risk for falls (finding) (SNOMED CT#129839007)
prediction
outcome: At risk of stroke (SNOMED CT#866240007)
mitigation: Betsy is at risk for falls and of having a stroke. Her risk is increased due to her depression medication. She has grab bars installed in the shower and is working on her balance with a trainer.

Entry 39 - fullUrl = https://hl7.org/fhir/ServiceRequest/service1

Resource ServiceRequest:

Generated Narrative: ServiceRequest
Resource ServiceRequest "service1" Version "1" Updated "2020-09-03 10:16:03-0400"
Information Source: #KZ0jzPjXDrhCiMif!
Profile: ServiceRequest_eltss
Eltss_directedBy: self ()
status: ACTIVE
intent: PLAN
code: Bath tub wall rail, each (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#E0241)
quantity: 1 install (Details: http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl code C81906 = 'Deploy')
subject: See on this page: Patient/patientBSJ1
occurrence: 2020-05-01 --> 2020-12-31
performer: See on this page: RelatedPerson/son1
supportingInfo: RiskAssessment/risk1

LinkId	Text	Definition	Answer
questionnaireresponse1		QuestionnaireResponse
q1
q2
q3
q4
q5
q6
q7
Documentation for this format