Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot

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-ballot 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-01

Raw json | Download

    {
      "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" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_rtpbc-messageheader-request-01\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader rtpbc-messageheader-request-01</b></p><a name=\"rtpbc-messageheader-request-01\"> </a><a name=\"hcrtpbc-messageheader-request-01\"> </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=\"Bundle-rtpbc-bundle-request-01.html#http-//example.org/my-app/Claim/rtpbc-claim-01\">Claim: identifier = rtpbc-01; 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>"
            },
            "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" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_rtpbc-claim-01\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim rtpbc-claim-01</b></p><a name=\"rtpbc-claim-01\"> </a><a name=\"hcrtpbc-claim-01\"> </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-01</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-01.html\">Jane Doe  Female, DoB: 1975-12-05 ( Patient internal identifier:\u00a030455)</a></p><p><b>created</b>: 2019-11-01 11:20:54-0500</p><p><b>provider</b>: <a href=\"Organization-rtpbc-organization-01.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-01.html\">MedicationRequest: status = draft; intent = proposal; reported[x] = true; medication[x] = fluoxetine 10 MG Oral Capsule [Prozac]; 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-01.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><a href=\"Coverage-rtpbc-coverage-01.html\">Coverage: status = active; subscriberId = 121212; relationship = Self</a></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}\">fluoxetine 10 MG Oral Capsule [Prozac]</span></td><td>60 {Each}</td></tr></table></div>"
            },
            "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" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_rtpbc-patient-01\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient rtpbc-patient-01</b></p><a name=\"rtpbc-patient-01\"> </a><a name=\"hcrtpbc-patient-01\"> </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:\u00a030455)</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>"
            },
            "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" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_rtpbc-coverage-01\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage rtpbc-coverage-01</b></p><a name=\"rtpbc-coverage-01\"> </a><a name=\"hcrtpbc-coverage-01\"> </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-coverage.html\">RTPBC Coverage</a></p></div><p><b>status</b>: Active</p><p><b>subscriberId</b>: 121212</p><p><b>beneficiary</b>: <a href=\"Patient-rtpbc-patient-01.html\">Jane Doe  Female, DoB: 1975-12-05 ( Patient internal identifier:\u00a030455)</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>payor</b>: Identifier: Pharmacy Plans US</p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxbin}\">RX BIN</span></p><p><b>value</b>: BIN001</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxpcn}\">RX PCN</span></p><p><b>value</b>: PCN002</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxgroup}\">RX Group</span></p><p><b>value</b>: GROUP0001</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxid}\">RX Id</span></p><p><b>value</b>: MEMBER000001</p></blockquote></div>"
            },
            "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" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MedicationRequest_rtpbc-medicationrequest-01\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MedicationRequest rtpbc-medicationrequest-01</b></p><a name=\"rtpbc-medicationrequest-01\"> </a><a name=\"hcrtpbc-medicationrequest-01\"> </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}\">fluoxetine 10 MG Oral Capsule [Prozac]</span></p><p><b>subject</b>: <a href=\"Patient-rtpbc-patient-01.html\">Jane Doe  Female, DoB: 1975-12-05 ( Patient internal identifier:\u00a030455)</a></p><p><b>authoredOn</b>: 2019-11-01</p><p><b>requester</b>: <a href=\"Practitioner-rtpbc-practitioner-01.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<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code1 = '1')</span></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/5.5.0/CodeSystem-v3-ucum.html\">http://unitsofmeasure.org</a></td><td>d</td></tr></table><p><b>performer</b>: <a href=\"Organization-rtpbc-organization-01.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>"
            },
            "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" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_rtpbc-practitioner-01\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner rtpbc-practitioner-01</b></p><a name=\"rtpbc-practitioner-01\"> </a><a name=\"hcrtpbc-practitioner-01\"> </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/STU8.0.1/StructureDefinition-us-core-practitioner.html\">US Core Practitioner Profile</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893</p><p><b>name</b>: Johnson </p></div>"
            },
            "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" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_rtpbc-organization-01\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization rtpbc-organization-01</b></p><a name=\"rtpbc-organization-01\"> </a><a name=\"hcrtpbc-organization-01\"> </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/5.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/9876543213</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>"
            },
            "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"
              }
            ]
          }
        }
      ]
    }