# rtpbc-bundle-request-01 - Consumer Real-Time Pharmacy Benefit Check FHIR IG v2.0.0-ballot

## Example Bundle: rtpbc-bundle-request-01



## Resource Content

```json
{
  "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"]
      },
      "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"]
      },
      "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: 30455)</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"]
      },
      "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: 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>"
      },
      "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"]
      },
      "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: 30455)</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"]
      },
      "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: 30455)</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"]
      },
      "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"]
      },
      "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"
      }]
    }
  }]
}

```
