Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build United States of America flag

Consumer Real-Time Pharmacy Benefit Check FHIR IG, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-rtpbc/ and changes regularly. See the Directory of published versions

: rtpbc-bundle-request-03-price-source - XML Representation

Raw xml | Download


<Bundle xmlns="http://hl7.org/fhir">
  <id value="rtpbc-bundle-request-03-price-source"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-bundle"/>
  </meta>
  <type value="message"/>
  <timestamp value="2019-11-15T13:10:13-05:00"/>
  <entry>
    <fullUrl
             value="http://example.org/my-app/MessageHeader/rtpbc-messageheader-request-03"/>
    <resource>
      <MessageHeader>
        <id value="rtpbc-messageheader-request-03"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-messageheader"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="MessageHeader_rtpbc-messageheader-request-03"> </a><p class="res-header-id"><b>Generated Narrative: MessageHeader rtpbc-messageheader-request-03</b></p><a name="rtpbc-messageheader-request-03"> </a><a name="hcrtpbc-messageheader-request-03"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-request-messageheader.html">RTPBC Request MessageHeader</a></p></div><p><b>event</b>: <a href="CodeSystem-rtpbc-event-type.html#rtpbc-event-type-rtpbc-request">RTPBC Event Type Code System rtpbc-request</a>: RTPBC Request</p><h3>Sources</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style="display: none">*</td><td>MyPatientApp</td><td><a href="http://example.org/MyPatientApp">http://example.org/MyPatientApp</a></td></tr></table><p><b>focus</b>: <a href="Claim-rtpbc-claim-03.html">Claim: identifier = rtpbc-03; status = active; type = Pharmacy; use = predetermination; created = 2019-11-01 11:20:54-0500; priority = Normal</a></p><p><b>definition</b>: <a href="MessageDefinition-rtpbc-request.html">RTPBC Request Message Definition</a></p></div>
        </text>
        <eventCoding>
          <system
                  value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type"/>
          <code value="rtpbc-request"/>
          <display value="RTPBC Request"/>
        </eventCoding>
        <source>
          <name value="MyPatientApp"/>
          <endpoint value="http://example.org/MyPatientApp"/>
        </source>
        <focus>🔗 
          <reference value="Claim/rtpbc-claim-03"/>
        </focus>
        <definition
                    value="http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-request"/>
      </MessageHeader>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/my-app/Claim/rtpbc-claim-03"/>
    <resource>
      <Claim>
        <id value="rtpbc-claim-03"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Claim_rtpbc-claim-03"> </a><p class="res-header-id"><b>Generated Narrative: Claim rtpbc-claim-03</b></p><a name="rtpbc-claim-03"> </a><a name="hcrtpbc-claim-03"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-request-claim.html">RTPBC Request Using Claim</a></p></div><p><b>identifier</b>: rtpbc-03</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}">Pharmacy</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href="Patient-rtpbc-patient-03.html">Jane Doe  Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)</a></p><p><b>created</b>: 2019-11-01 11:20:54-0500</p><p><b>provider</b>: <a href="Organization-rtpbc-organization-03.html">Organization Hometown Drug</a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><p><b>prescription</b>: <a href="MedicationRequest-rtpbc-medicationrequest-03.html">MedicationRequest: status = draft; intent = proposal; reported[x] = true; medication[x] = PROzac 10 MG Oral Capsule; authoredOn = 2019-11-01</a></p><h3>CareTeams</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><a href="Practitioner-rtpbc-practitioner-03.html">Practitioner Johnson </a></td></tr></table><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td>Identifier: GOODPRICING</td></tr></table><h3>Items</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>ProductOrService</b></td><td><b>Quantity</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>1</td><td><span title="Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 205535}">PROzac 10 MG Oral Capsule</span></td><td>60 {Each}</td></tr></table></div>
        </text>
        <identifier>
          <value value="rtpbc-03"/>
        </identifier>
        <status value="active"/>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
            <code value="pharmacy"/>
            <display value="Pharmacy"/>
          </coding>
        </type>
        <use value="predetermination"/>
        <patient>🔗 
          <reference value="Patient/rtpbc-patient-03"/>
        </patient>
        <created value="2019-11-01T11:20:54-05:00"/>
        <provider>🔗 
          <reference value="Organization/rtpbc-organization-03"/>
        </provider>
        <priority>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/processpriority"/>
            <code value="normal"/>
            <display value="Normal"/>
          </coding>
        </priority>
        <prescription>🔗 
          <reference value="MedicationRequest/rtpbc-medicationrequest-03"/>
        </prescription>
        <careTeam>
          <sequence value="1"/>
          <provider>🔗 
            <reference value="Practitioner/rtpbc-practitioner-03"/>
          </provider>
        </careTeam>
        <insurance>
          <sequence value="1"/>
          <focal value="true"/>
          <coverage>
            <identifier>
              <value value="GOODPRICING"/>
            </identifier>
          </coverage>
        </insurance>
        <item>
          <sequence value="1"/>
          <careTeamSequence value="1"/>
          <productOrService>
            <coding>
              <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
              <code value="205535"/>
              <display value="PROzac 10 MG Oral Capsule"/>
            </coding>
          </productOrService>
          <quantity>
            <value value="60"/>
            <unit value="{Each}"/>
          </quantity>
        </item>
      </Claim>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://example.org/my-app/Patient/rtpbc-patient-03"/>
    <resource>
      <Patient>
        <id value="rtpbc-patient-03"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_rtpbc-patient-03"> </a><p class="res-header-id"><b>Generated Narrative: Patient rtpbc-patient-03</b></p><a name="rtpbc-patient-03"> </a><a name="hcrtpbc-patient-03"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-patient.html">RTPBC Patient</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Jane Doe  Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3">100 Oak Court Madison WI 53510 US </td></tr></table></div>
        </text>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="PI"/>
              <display value="Patient internal identifier"/>
            </coding>
            <text value="Patient internal identifier"/>
          </type>
          <system value="http://example.org/MyPatientApp"/>
          <value value="30455"/>
        </identifier>
        <name>
          <family value="Doe"/>
          <given value="Jane"/>
        </name>
        <gender value="female"/>
        <birthDate value="1975-12-05"/>
        <address>
          <line value="100 Oak Court"/>
          <city value="Madison"/>
          <state value="WI"/>
          <postalCode value="53510"/>
          <country value="US"/>
        </address>
      </Patient>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://example.org/my-app/MedicationRequest/rtpbc-medicationrequest-03"/>
    <resource>
      <MedicationRequest>
        <id value="rtpbc-medicationrequest-03"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-medicationrequest"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="MedicationRequest_rtpbc-medicationrequest-03"> </a><p class="res-header-id"><b>Generated Narrative: MedicationRequest rtpbc-medicationrequest-03</b></p><a name="rtpbc-medicationrequest-03"> </a><a name="hcrtpbc-medicationrequest-03"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-medicationrequest.html">RTPBC Medication Request</a></p></div><p><b>status</b>: Draft</p><p><b>intent</b>: Proposal</p><p><b>reported</b>: true</p><p><b>medication</b>: <span title="Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 205535}">PROzac 10 MG Oral Capsule</span></p><p><b>subject</b>: <a href="Patient-rtpbc-patient-03.html">Jane Doe  Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)</a></p><p><b>authoredOn</b>: 2019-11-01</p><p><b>requester</b>: <a href="Practitioner-rtpbc-practitioner-03.html">Practitioner Johnson </a></p><h3>DosageInstructions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Text</b></td></tr><tr><td style="display: none">*</td><td>Take 2 capsules once a day</td></tr></table><blockquote><p><b>dispenseRequest</b></p><p><b>quantity</b>: 60 {Each}</p><h3>ExpectedSupplyDurations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Unit</b></td><td><b>System</b></td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td>30</td><td>days</td><td><a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ucum.html">http://unitsofmeasure.org</a></td><td>d</td></tr></table><p><b>performer</b>: <a href="Organization-rtpbc-organization-03.html">Organization Hometown Drug</a></p></blockquote><h3>Substitutions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Allowed[x]</b></td></tr><tr><td style="display: none">*</td><td>false</td></tr></table></div>
        </text>
        <status value="draft"/>
        <intent value="proposal"/>
        <reportedBoolean value="true"/>
        <medicationCodeableConcept>
          <coding>
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
            <code value="205535"/>
            <display value="PROzac 10 MG Oral Capsule"/>
          </coding>
        </medicationCodeableConcept>
        <subject>🔗 
          <reference value="Patient/rtpbc-patient-03"/>
        </subject>
        <authoredOn value="2019-11-01"/>
        <requester>🔗 
          <reference value="Practitioner/rtpbc-practitioner-03"/>
        </requester>
        <dosageInstruction>
          <text value="Take 2 capsules once a day"/>
        </dosageInstruction>
        <dispenseRequest>
          <quantity>
            <value value="60"/>
            <unit value="{Each}"/>
          </quantity>
          <expectedSupplyDuration>
            <value value="30"/>
            <unit value="days"/>
            <system value="http://unitsofmeasure.org"/>
            <code value="d"/>
          </expectedSupplyDuration>
          <performer>🔗 
            <reference value="Organization/rtpbc-organization-03"/>
          </performer>
        </dispenseRequest>
        <substitution>
          <allowedBoolean value="false"/>
        </substitution>
      </MedicationRequest>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://example.org/my-app/Practitioner/rtpbc-practitioner-03"/>
    <resource>
      <Practitioner>
        <id value="rtpbc-practitioner-03"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_rtpbc-practitioner-03"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner rtpbc-practitioner-03</b></p><a name="rtpbc-practitioner-03"> </a><a name="hcrtpbc-practitioner-03"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-practitioner.html">US Core Practitioner Profile</a></p></div><p><b>identifier</b>: <a href="http://terminology.hl7.org/6.5.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/1234567890</p><p><b>name</b>: Johnson </p></div>
        </text>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1234567890"/>
        </identifier>
        <name>
          <family value="Johnson"/>
        </name>
      </Practitioner>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://example.org/my-app/Organization/rtpbc-organization-03"/>
    <resource>
      <Organization>
        <id value="rtpbc-organization-03"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_rtpbc-organization-03"> </a><p class="res-header-id"><b>Generated Narrative: Organization rtpbc-organization-03</b></p><a name="rtpbc-organization-03"> </a><a name="hcrtpbc-organization-03"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-rtpbc-pharmacy-organization.html">RTPBC Pharmacy Organization</a></p></div><p><b>identifier</b>: <a href="http://terminology.hl7.org/6.5.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/9876543210</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType R}">Retail</span></p><p><b>name</b>: Hometown Drug</p><p><b>telecom</b>: ph: 6081234567</p><p><b>address</b>: 900 9th Street Madison WI 53535 US </p></div>
        </text>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="9876543210"/>
        </identifier>
        <active value="true"/>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType"/>
            <code value="R"/>
            <display value="Retail"/>
          </coding>
        </type>
        <name value="Hometown Drug"/>
        <telecom>
          <system value="phone"/>
          <value value="6081234567"/>
        </telecom>
        <address>
          <line value="900 9th Street"/>
          <city value="Madison"/>
          <state value="WI"/>
          <postalCode value="53535"/>
          <country value="US"/>
        </address>
      </Organization>
    </resource>
  </entry>
</Bundle>