Da Vinci - Coverage Requirements Discovery
2.1.0-preview - STU 2 United States of America flag

Da Vinci - Coverage Requirements Discovery, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-crd/ and changes regularly. See the Directory of published versions

Binary: Example CRD Service Requestion with MedicationRequests

    
{
  "hookInstance": "d5a80646-7ef5-4edf-ade9-72407ca28c76",
  "fhirServer": "http://example.org/some-payer/fhir/crd",
  "hook": "order-sign",
  "fhirAuthorization": {
    "access_token": "some-opaque-fhir-access-token",
    "token_type": "Bearer",
    "expires_in": 300,
    "scope": "user/Patient.read user/Observation.read",
    "subject": "cds-service4"
  },
  "context": {
    "userId": "Practitioner/ABC",
    "patientId": "123",
    "encounterId": "987",
    "draftOrders": {
      "resourceType": "Bundle",
      "type": "collection",
      "entry": [
        {
          "fullUrl": "http://example.org/someEHR/fhir/ServiceRequest/1357",
          "resource": {
            "resourceType": "ServiceRequest",
            "id": "1357",
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Contrast enhanced spectral mammography (Procedure) for Amy V. Baxter<br/>Requested by Dr. Jones, Feb 15, 2019</div>"
            },
            "status": "draft",
            "intent": "original-order",
            "code": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "726551006",
                  "display": "Contrast enhanced spectral mammography (Procedure)"
                }
              ]
            },
            "subject": {
              "reference": "http://example.org/fhir/Patient/123"
            },
            "encounter": {
              "reference": "http://example.org/fhir/Encounter/987"
            },
            "authoredOn": "2019-02-15",
            "requester": {
              "reference": "http://example.org/fhir/PractitionerRole/ABC",
              "display": "Dr. Jones"
            }
          }
        },
        {
          "fullUrl": "http://example.org/someEHR/fhir/ServiceRequest/2468",
          "resource": {
            "resourceType": "ServiceRequest",
            "id": "2468",
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing for Amy V. Baxter<br/>Requested by Dr. Jones, Feb 15, 2019</div>"
            },
            "status": "draft",
            "intent": "original-order",
            "code": {
              "coding": [
                {
                  "system": "https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                  "code": "E0431",
                  "display": "Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing"
                }
              ]
            },
            "subject": {
              "reference": "http://example.org/fhir/Patient/123"
            },
            "encounter": {
              "reference": "http://example.org/fhir/Encounter/987"
            },
            "authoredOn": "2019-02-15",
            "requester": {
              "reference": "http://example.org/fhir/PractitionerRole/ABC",
              "display": "Dr. Jones"
            }
          }
        }
      ]
    }
  },
  "prefetch": {
    "patient": {
      "resourceType": "Patient",
      "id": "123",
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\"><b>Amy V. Baxter </b> female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: USUAL))</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Record is active\">Active:</td><td colspan=\"3\">true</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Alternate names (see the one above)\">Alt. Name:</td><td colspan=\"3\">Amy V. Shaw (OLD)</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Details:</td><td colspan=\"3\"><ul><li>ph: 555-555-5555(HOME)</li><li><a href=\"mailto:amy.shaw@example.com\">amy.shaw@example.com</a></li><li>49 MEADOW ST MOUNDS OK 74047 US (OLD)</li><li>183 MOUNTAIN VIEW ST MOUNDS OK 74048 US </li></ul></td></tr></table></div>"
      },
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
          "valueCode": "F"
        },
        {
          "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex",
          "valueCode": "248152002"
        },
        {
          "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                "code": "UNK",
                "display": "Unknown"
              }
            ],
            "text": "Unknown"
          }
        }
      ],
      "identifier": [
        {
          "use": "usual",
          "type": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code": "MR",
                "display": "Medical Record Number"
              }
            ],
            "text": "Medical Record Number"
          },
          "system": "http://hospital.smarthealthit.org",
          "value": "1032702"
        }
      ],
      "active": true,
      "name": [
        {
          "use": "old",
          "family": "Shaw",
          "given": [
            "Amy",
            "V."
          ],
          "period": {
            "start": "2016-12-06",
            "end": "2020-07-22"
          }
        },
        {
          "family": "Baxter",
          "given": [
            "Amy",
            "V."
          ],
          "suffix": [
            "PharmD"
          ],
          "period": {
            "start": "2020-07-22"
          }
        }
      ],
      "telecom": [
        {
          "system": "phone",
          "value": "555-555-5555",
          "use": "home"
        },
        {
          "system": "email",
          "value": "amy.shaw@example.com"
        }
      ],
      "gender": "female",
      "birthDate": "1987-02-20",
      "address": [
        {
          "use": "old",
          "line": [
            "49 MEADOW ST"
          ],
          "city": "MOUNDS",
          "state": "OK",
          "postalCode": "74047",
          "country": "US",
          "period": {
            "start": "2016-12-06",
            "end": "2020-07-22"
          }
        },
        {
          "line": [
            "183 MOUNTAIN VIEW ST"
          ],
          "city": "MOUNDS",
          "state": "OK",
          "postalCode": "74048",
          "country": "US",
          "period": {
            "start": "2020-07-22"
          }
        }
      ]
    },
    "encounter": {
      "resourceType": "Bundle",
      "type": "searchset",
      "total": 1,
      "link": [
        {
          "relation": "self",
          "url": "Encounter?_id=987&_include=Encounter:service-provider&_include=Encounter:practitioner&_include=Encounter:location"
        }
      ],
      "entry": [
        {
          "fullUrl": "http://example.org/someEHR/fhir/Encounter/987",
          "resource": {
            "resourceType": "Encounter",
            "id": "987",
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Encounter</b><a name=\"example-1\"> </a></p><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\">Resource Encounter &quot;example-1&quot; Updated &quot;2017-05-26 11:56:57-0400&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-us-core-encounter.html\">US Core Encounter Profile (version 7.0.0-ballot)</a></p></div><p><b>status</b>: finished</p><p><b>class</b>: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')</p><p><b>type</b>: Office Visit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT®)</a>#99211)</span></p><p><b>subject</b>: <a href=\"Patient-example.html\">Patient/example</a> &quot; SHAW&quot;</p><p><b>period</b>: 2015-11-01 17:00:14-0500 --&gt; 2015-11-01 18:00:14-0500</p><h3>Locations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Location</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Location-hospital.html\">Location/hospital: Holy Family Hospital</a> &quot;Holy Family Hospital&quot;</td></tr></table></div>"
      },
            "status": "finished",
            "class": {
              "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code": "AMB",
              "display": "ambulatory"
            },
            "type": [
              {
                "coding": [
                  {
                    "system": "http://www.ama-assn.org/go/cpt",
                    "code": "99211"
                  }
                ],
                "text": "Office Visit"
              }
            ],
            "subject": {
              "reference": "http://example.org/someEHR/fhir/Patient/123"
            },
            "period": {
              "start": "2015-11-01T17:00:14-05:00",
              "end": "2015-11-01T18:00:14-05:00"
            },
            "location": [
              {
                "location": {
                  "reference": "http://example.org/someEHR/fhir/Location/hospital",
                  "display": "Holy Family Hospital"
                }
              }
            ]
          },
          "search": {
            "mode": "match"
          }
        },
        {
          "fullUrl": "http://example.org/someEHR/fhir/Location/hospital",
          "resource": {
            "resourceType": "Location",
            "id": "hospital",
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>name</b>: Acme Clinic</p><p></p><p><b>address</b>: 3300 WASHTENAW AVE STE 227 AMHERST MA 01002 USA </p></div>"
            },
            "address": {
              "line": [
                "3300 WASHTENAW AVE STE 227"
              ],
              "city": "AMHERST",
              "state": "MA",
              "postalCode": "01002",
              "country": "USA"
            },
            "managingOrganization": {
              "reference": "http://example.org/someEHR/fhir/Organization/GHI"
            }
          },
          "search": {
            "mode": "include"
          }
        }
      ]
    },
    "coverage": {
      "resourceType": "Bundle",
      "type": "searchset",
      "total": 1,
      "link": [
        {
          "relation": "self",
          "url": "http://example.org/someEHR/fhir/r4/Coverage?patient=123&status=active"
        }
      ],
      "entry": [
        {
          "fullUrl": "http://example.org/someEHR/fhir/Coverage/COV1",
          "resource": {
            "resourceType": "Coverage",
            "id": "COV1",
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>identifier</b>: Member Number:\u00a088800933501</p><p><b>status</b>: active</p><p><b>type</b>: PPO <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://nahdo.org/sopt\">Source of Payment Typology</a>#3712; <a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-ActCode.html\">ActCode</a>#PPO &quot;preferred provider organization policy&quot;)</span></p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Patient/example</a> &quot; SHAW&quot;</p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2020-01-01 --&gt; (ongoing)</p><p><b>payor</b>: <a href=\"Organization-acme-payer.html\">Organization/acme-payer: Acme Health Plan</a> &quot;Acme Health Plan&quot;</p><blockquote><p><b>class</b></p><p><b>type</b>: An employee group <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#group &quot;Group&quot;)</span></p><p><b>value</b>: xyz</p><p><b>name</b>: XYZ employee Group Plan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: A specific suite of benefits. <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#plan &quot;Plan&quot;)</span></p><p><b>value</b>: gold</p><p><b>name</b>: Acme Gold Plan</p></blockquote></div>"
},
            "identifier": [
              {
                "type": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                      "code": "MB",
                      "display": "Member Number"
                    }
                  ]
                },
                "system": "http://example.org/fhir/memberidentifier",
                "value": "88800933501"
              }
            ],
            "status": "active",
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                  "code": "PPO",
                  "display": "preferred provider organization policy"
                }
              ],
              "text": "PPO"
            },
            "subscriberId": "888009335",
            "beneficiary": {
              "reference": "http://example.org/someEHR/fhir/Patient/123"
            },
            "relationship": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                  "code": "self"
                }
              ],
              "text": "Self"
            },
            "period": {
              "start": "2020-01-01"
            },
            "payor": [
              {
                "reference": "http://example.org/someEHR/fhir/Organization/acme-payer",
                "display": "Acme Health Plan"
              }
            ],
            "class": [
              {
                "type": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                      "code": "group",
                      "display": "Group"
                    }
                  ],
                  "text": "An employee group"
                },
                "value": "xyz",
                "name": "XYZ employee Group Plan"
              },
              {
                "type": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                      "code": "plan",
                      "display": "Plan"
                    }
                  ],
                  "text": "A specific suite of benefits."
                },
                "value": "gold",
                "name": "Acme Gold Plan"
              }
            ]
          },
          "search": {
            "mode": "match"
          }
        }
      ]
    },
    "servicerequest": {
      "resourceType": "Bundle",
      "type": "searchset",
      "total": 1,
      "link": [
        {
          "relation": "self",
          "url": "http://example.org/someEHR/fhir/r4/ServiceRequest?_id=1357,2468&_include=ServiceRequest:performer&_include=ServiceRequest:requester&_include:iterate=PractitionerRole:organization&_include:iterate=PractitionerRole:practitioner"
        }
      ],
      "entry": [
        {
          "fullUrl": "http://example.org/someEHR/fhir/ServiceRequest/1357",
          "resource": {
            "resourceType": "ServiceRequest",
            "id": "1357",
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Contrast enhanced spectral mammography (Procedure) for Amy V. Baxter<br/>Requested by Dr. Jones, Feb 15, 2019</div>"
            },
            "status": "draft",
            "intent": "original-order",
            "code": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "726551006",
                  "display": "Contrast enhanced spectral mammography (Procedure)"
                }
              ]
            },
            "subject": {
              "reference": "http://example.org/fhir/Patient/123"
            },
            "encounter": {
              "reference": "http://example.org/fhir/Encounter/987"
            },
            "authoredOn": "2019-02-15",
            "requester": {
              "reference": "http://example.org/fhir/PractitionerRole/ABC",
              "display": "Dr. Jones"
            }
          },
          "search": {
            "mode": "match"
          }
        },
        {
          "fullUrl": "http://example.org/someEHR/fhir/ServiceRequest/2468",
          "resource": {
            "resourceType": "ServiceRequest",
            "id": "2468",
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing for Amy V. Baxter<br/>Requested by Dr. Jones, Feb 15, 2019</div>"
            },
            "status": "draft",
            "intent": "original-order",
            "code": {
              "coding": [
                {
                  "system": "https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                  "code": "E0430",
                  "display": "Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing"
                }
              ]
            },
            "subject": {
              "reference": "http://example.org/fhir/Patient/123"
            },
            "encounter": {
              "reference": "http://example.org/fhir/Encounter/987"
            },
            "authoredOn": "2019-02-15",
            "requester": {
              "reference": "http://example.org/fhir/PractitionerRole/ABC",
              "display": "Dr. Jones"
            }
          },
          "search": {
            "mode": "match"
          }
        },
        {
          "fullUrl": "http://example.org/someEHR/fhir/PractitionerRole/ABC",
          "resource": {
            "resourceType": "PractitionerRole",
            "id": "ABC",
            "meta": {
              "lastUpdated": "2016-02-29T23:52:32.387Z"
            },
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Dr. Ronald Bone, primary care physician at Acme Clinic</div>"
            },
            "practitioner": {
              "reference": "http://example.org/someEHR/fhir/Practitioner/DEF",
              "display": "Dr. Ronald Bone"
            },
            "organization": {
              "reference": "http://example.org/someEHR/fhir/Organization/GHI",
              "display": "Acme Clinic"
            },
            "code": [
              {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction",
                    "code": "PCP",
                    "display": "primary care physician"
                  },
                  {
                    "system": "http://nucc.org/provider-taxonomy",
                    "code": "261QP2300X",
                    "display": "Primary Care Clinic/Center"
                  }
                ]
              }
            ]
          },
          "search": {
            "mode": "include"
          }
        },
        {
          "fullUrl": "http://example.org/someEHR/fhir/Practitioner/DEF",
          "resource": {
            "resourceType": "Practitioner",
            "id": "DEF",
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>identifier</b>: id:\u00a0<a href=\"http://terminology.hl7.org/5.3.0/NamingSystem-npi.html\">#</a>9941339100, id:\u00a025456</p><p><b>name</b>: Ronald Bone </p><p><b>address</b>: 1003 HEALTHCARE DR AMHERST MA 01002 (WORK)</p></div>"
            },
            "identifier": [
              {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "9941339100"
              },
              {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "https://www.usps.com/",
                          "code": "MA"
                        }
                      ],
                      "text": "Massachusetts"
                    }
                  }
                ],
                "system": "http://www.acme.org/practitioners",
                "value": "25456"
              }
            ],
            "name": [
              {
                "family": "Bone",
                "given": [
                  "Ronald"
                ],
                "prefix": [
                  "Dr"
                ]
              }
            ],
            "address": [
              {
                "use": "work",
                "line": [
                  "1003 HEALTHCARE DR"
                ],
                "city": "AMHERST",
                "state": "MA",
                "postalCode": "01002"
              }
            ]
          },
          "search": {
            "mode": "include"
          }
        },
        {
          "fullUrl": "http://example.org/someEHR/fhir/Organization/GHI",
          "resource": {
            "resourceType": "Organization",
            "id": "GHI",
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>identifier</b>: id:\u00a0<a href=\"http://terminology.hl7.org/5.3.0/NamingSystem-npi.html\">#</a>1407071236, id:\u00a0121111111</p><p><b>active</b>: true</p><p><b>type</b>: Healthcare Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-organization-type.html\">Organization type</a>#prov)</span></p><p><b>name</b>: Acme Clinic</p><p><b>telecom</b>: ph: (+1) 734-677-7777, <a href=\"mailto:customer-service@acme-clinic.org\">customer-service@acme-clinic.org</a></p><p><b>address</b>: 3300 WASHTENAW AVE STE 227 AMHERST MA 01002 USA </p></div>"
            },
            "identifier": [
              {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "1407071236"
              },
              {
                "system": "http://example.org/fhir/sid/us-tin",
                "value": "121111111"
              }
            ],
            "active": true,
            "type": [
              {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                    "code": "prov",
                    "display": "Healthcare Provider"
                  }
                ]
              }
            ],
            "name": "Acme Clinic",
            "telecom": [
              {
                "system": "phone",
                "value": "(+1) 734-677-7777"
              },
              {
                "system": "email",
                "value": "customer-service@acme-clinic.org"
              }
            ],
            "address": [
              {
                "line": [
                  "3300 WASHTENAW AVE STE 227"
                ],
                "city": "AMHERST",
                "state": "MA",
                "postalCode": "01002",
                "country": "USA"
              }
            ]
          },
          "search": {
            "mode": "include"
          }
        }
      ]
    }
  },
  "extension": {
    "davinci-crd.configuration": {
      "cost": false,
      "claim": false,
      "appropriate-use": false,
      "max-cards": 5
    }
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}