{ "resourceType" : "Bundle", "id" : "rtpbc-bundle-request-01", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-bundle"] }, "language" : "en", "type" : "message", "timestamp" : "2019-11-15T13:10:13-05:00", "entry" : [{ "fullUrl" : "http://example.org/my-app/MessageHeader/rtpbc-messageheader-request-01", "resource" : { "resourceType" : "MessageHeader", "id" : "rtpbc-messageheader-request-01", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-messageheader"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: MessageHeader rtpbc-messageheader-request-01

Profile: RTPBC Request MessageHeader

event: RTPBC Event Type Code System: rtpbc-request (RTPBC Request)

Sources

-NameEndpoint
*MyPatientApphttp://example.org/MyPatientApp

focus: Claim: identifier = rtpbc-01; status = active; type = Pharmacy; use = predetermination; created = 2019-11-01 11:20:54-0500; priority = Normal

definition: RTPBC Request Message Definition

" }, "eventCoding" : { "system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type", "code" : "rtpbc-request", "display" : "RTPBC Request" }, "source" : { "name" : "MyPatientApp", "endpoint" : "http://example.org/MyPatientApp" }, "focus" : [{ "reference" : "http://example.org/my-app/Claim/rtpbc-claim-01" }], "definition" : "http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-request" } }, { "fullUrl" : "http://example.org/my-app/Claim/rtpbc-claim-01", "resource" : { "resourceType" : "Claim", "id" : "rtpbc-claim-01", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Claim rtpbc-claim-01

Profile: RTPBC Request Using Claim

identifier: rtpbc-01

status: Active

type: Pharmacy

use: Predetermination

patient: Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier:\u00a030455)

created: 2019-11-01 11:20:54-0500

provider: Organization Hometown Drug

priority: Normal

prescription: MedicationRequest: status = draft; intent = proposal; reported[x] = true; medication[x] = fluoxetine 10 MG Oral Capsule [Prozac]; authoredOn = 2019-11-01

CareTeams

-SequenceProvider
*1Practitioner Johnson

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active; subscriberId = 121212; relationship = Self

Items

-SequenceCareTeamSequenceProductOrServiceQuantity
*11fluoxetine 10 MG Oral Capsule [Prozac]60 {Each}
" }, "identifier" : [{ "value" : "rtpbc-01" }], "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy", "display" : "Pharmacy" }] }, "use" : "predetermination", "patient" : { "reference" : "Patient/rtpbc-patient-01" }, "created" : "2019-11-01T11:20:54-05:00", "provider" : { "reference" : "Organization/rtpbc-organization-01" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal", "display" : "Normal" }] }, "prescription" : { "reference" : "MedicationRequest/rtpbc-medicationrequest-01" }, "careTeam" : [{ "sequence" : 1, "provider" : { "reference" : "Practitioner/rtpbc-practitioner-01" } }], "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "reference" : "Coverage/rtpbc-coverage-01" } }], "item" : [{ "sequence" : 1, "careTeamSequence" : [1], "productOrService" : { "coding" : [{ "system" : "http://www.nlm.nih.gov/research/umls/rxnorm", "code" : "205535", "display" : "fluoxetine 10 MG Oral Capsule [Prozac]" }] }, "quantity" : { "value" : 60, "unit" : "{Each}" } }] } }, { "fullUrl" : "http://example.org/my-app/Patient/rtpbc-patient-01", "resource" : { "resourceType" : "Patient", "id" : "rtpbc-patient-01", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Patient rtpbc-patient-01

Profile: RTPBC Patient

Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier:\u00a030455)

Contact Detail100 Oak Court Madison WI 53510 US
" }, "identifier" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "PI", "display" : "Patient internal identifier" }], "text" : "Patient internal identifier" }, "system" : "http://example.org/MyPatientApp", "value" : "30455" }], "name" : [{ "family" : "Doe", "given" : ["Jane"] }], "gender" : "female", "birthDate" : "1975-12-05", "address" : [{ "line" : ["100 Oak Court"], "city" : "Madison", "state" : "WI", "postalCode" : "53510", "country" : "US" }] } }, { "fullUrl" : "http://example.org/my-app/Coverage/rtpbc-coverage-01", "resource" : { "resourceType" : "Coverage", "id" : "rtpbc-coverage-01", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Coverage rtpbc-coverage-01

Profile: RTPBC Coverage

status: Active

subscriberId: 121212

beneficiary: Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier:\u00a030455)

relationship: Self

payor: Identifier: Pharmacy Plans US

class

type: RX BIN

value: BIN001

class

type: RX PCN

value: PCN002

class

type: RX Group

value: GROUP0001

class

type: RX Id

value: MEMBER000001

" }, "status" : "active", "subscriberId" : "121212", "beneficiary" : { "reference" : "Patient/rtpbc-patient-01" }, "relationship" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code" : "self" }] }, "payor" : [{ "identifier" : { "value" : "Pharmacy Plans US" } }], "class" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/coverage-class", "code" : "rxbin" }] }, "value" : "BIN001" }, { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/coverage-class", "code" : "rxpcn" }] }, "value" : "PCN002" }, { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/coverage-class", "code" : "rxgroup" }] }, "value" : "GROUP0001" }, { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/coverage-class", "code" : "rxid" }] }, "value" : "MEMBER000001" }] } }, { "fullUrl" : "http://example.org/my-app/MedicationRequest/rtpbc-medicationrequest-01", "resource" : { "resourceType" : "MedicationRequest", "id" : "rtpbc-medicationrequest-01", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-medicationrequest"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: MedicationRequest rtpbc-medicationrequest-01

Profile: RTPBC Medication Request

status: Draft

intent: Proposal

reported: true

medication: fluoxetine 10 MG Oral Capsule [Prozac]

subject: Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier:\u00a030455)

authoredOn: 2019-11-01

requester: Practitioner Johnson

DosageInstructions

-Text
*Take 2 capsules once a day

dispenseRequest

quantity: 60 each (Details: UCUM code1 = '1')

ExpectedSupplyDurations

-ValueUnitSystemCode
*30dayshttp://unitsofmeasure.orgd

performer: Organization Hometown Drug

Substitutions

-Allowed[x]
*false
" }, "status" : "draft", "intent" : "proposal", "reportedBoolean" : true, "medicationCodeableConcept" : { "coding" : [{ "system" : "http://www.nlm.nih.gov/research/umls/rxnorm", "code" : "205535", "display" : "fluoxetine 10 MG Oral Capsule [Prozac]" }] }, "subject" : { "reference" : "Patient/rtpbc-patient-01" }, "authoredOn" : "2019-11-01", "requester" : { "reference" : "Practitioner/rtpbc-practitioner-01" }, "dosageInstruction" : [{ "text" : "Take 2 capsules once a day" }], "dispenseRequest" : { "quantity" : { "value" : 60, "unit" : "each", "system" : "http://unitsofmeasure.org", "code" : "1" }, "expectedSupplyDuration" : { "value" : 30, "unit" : "days", "system" : "http://unitsofmeasure.org", "code" : "d" }, "performer" : { "reference" : "Organization/rtpbc-organization-01" } }, "substitution" : { "allowedBoolean" : false } } }, { "fullUrl" : "http://example.org/my-app/Practitioner/rtpbc-practitioner-01", "resource" : { "resourceType" : "Practitioner", "id" : "rtpbc-practitioner-01", "meta" : { "profile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Practitioner rtpbc-practitioner-01

Profile: US Core Practitioner Profile

identifier: United States National Provider Identifier/1234567893

name: Johnson

" }, "identifier" : [{ "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "1234567893" }], "name" : [{ "family" : "Johnson" }] } }, { "fullUrl" : "http://example.org/my-app/Organization/rtpbc-organization-01", "resource" : { "resourceType" : "Organization", "id" : "rtpbc-organization-01", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization rtpbc-organization-01

Profile: RTPBC Pharmacy Organization

identifier: United States National Provider Identifier/9876543213

active: true

type: Retail

name: Hometown Drug

telecom: ph: 6081234567

address: 900 9th Street Madison WI 53535 US

" }, "identifier" : [{ "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "9876543213" }], "active" : true, "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType", "code" : "R", "display" : "Retail" }] }], "name" : "Hometown Drug", "telecom" : [{ "system" : "phone", "value" : "6081234567" }], "address" : [{ "line" : ["900 9th Street"], "city" : "Madison", "state" : "WI", "postalCode" : "53535", "country" : "US" }] } }] }