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 2.2.0-ballot 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
{
"extension" : {
"davinci-crd.configuration" : {
"coverage-info" : false,
"cost" : false,
"claim" : false,
"appropriate-use" : false,
"max-cards" : 5
}
},
"hook" : "order-dispatch",
"hookInstance" : "urn:uuid:1372e258-5ae2-4dd3-b716-dd0b1e7a8728",
"fhirServer" : "http://example.org/some-payer/fhir/crd",
"fhirAuthorization" : {
"accessToken" : "some-opaque-fhir-access-token",
"tokenType" : "Bearer",
"expiresIn" : 300,
"scope" : "user/Patient.read user/Observation.read",
"subject" : "cds-service4",
"patient" : "123"
},
"context" : {
"patientId" : "123",
"dispatchedOrders" : {
"resourceType" : "Bundle",
"type" : "collection",
"entry" : [
{
"fullUrl" : "http://example.org/someEHR/fhir/MedicationRequest/1111",
"resource" : {
"resourceType" : "MedicationRequest",
"id" : "1111",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Diclofenac potassium 50 MG Oral Tablet prescription for Amy V. Baxter by Dr. Jones, Feb 15, 2019<br/>1 50mg tablet, 3 times per day<br/>Dispense 90 tablets, 5 refills</div>"
},
"status" : "active",
"intent" : "order",
"medicationReference" : {
"reference" : "http://example.org/someEHR/fhir/Patient/MED1"
},
"subject" : {
"reference" : "http://example.org/someEHR/fhir/Patient/123"
},
"encounter" : {
"reference" : "http://example.org/someEHR/fhir/Encounter/987"
},
"authoredOn" : "2015-11-01",
"requester" : {
"reference" : "http://example.org/someEHR/fhir/PractitionerRole/ABC"
},
"dosageInstruction" : [
{
"text" : "1 50mg tablet, 3 times per day",
"timing" : {
"repeat" : {
"boundsPeriod" : {
"start" : "2015-11-01",
"end" : "2016-05-01"
},
"frequency" : 3,
"period" : 1,
"periodUnit" : "d"
}
},
"doseAndRate" : [
{
"doseQuantity" : {
"value" : 1,
"unit" : "Tablet",
"system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code" : "TAB"
}
}
]
}
],
"dispenseRequest" : {
"numberOfRepeatsAllowed" : 5,
"quantity" : {
"value" : 90,
"unit" : "Tablet",
"system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code" : "TAB"
}
}
}
},
{
"fullUrl" : "http://example.org/someEHR/fhir/MedicationRequest/2222",
"resource" : {
"resourceType" : "MedicationRequest",
"id" : "2222",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Abuse-Deterrent 12 HR oxycodone hydrochloride 10 MG Extended Release Oral Tablet [Oxycontin] prescription for Amy V. Baxter by Dr. Jones, Feb 15, 2019<br/>1 10mg tablet, every 12 hours<br/>Dispense 28 tablets, 0 refills</div>"
},
"status" : "active",
"intent" : "order",
"medicationReference" : {
"reference" : "http://example.org/someEHR/fhir/Patient/MED2"
},
"subject" : {
"reference" : "http://example.org/someEHR/fhir/Patient/123"
},
"encounter" : {
"reference" : "http://example.org/someEHR/fhir/Encounter/987"
},
"authoredOn" : "2015-11-01",
"requester" : {
"reference" : "http://example.org/someEHR/fhir/PractitionerRole/ABC"
},
"dosageInstruction" : [
{
"text" : "1 10mg tablet, every 12 hours",
"timing" : {
"repeat" : {
"boundsPeriod" : {
"start" : "2015-11-01",
"end" : "2015-11-15"
},
"frequency" : 1,
"period" : 12,
"periodUnit" : "h"
}
},
"doseAndRate" : [
{
"doseQuantity" : {
"value" : 1,
"unit" : "Tablet",
"system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code" : "TAB"
}
}
]
}
],
"dispenseRequest" : {
"numberOfRepeatsAllowed" : 0,
"quantity" : {
"value" : 28,
"unit" : "Tablet",
"system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code" : "TAB"
}
}
}
}
]
},
"performer" : "Organization/pharm1",
"fulfillmentTasks" : {
"resourceType" : "Bundle",
"type" : "collection",
"entry" : [
{
"fullUrl" : "http://example.org/someEHR/fhir/Task/A",
"resource" : {
"resourceType" : "Task",
"id" : "A",
"text" : {
"status" : "empty",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">No narrative provided</div>"
},
"status" : "requested",
"intent" : "order",
"code" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/CodeSystem/task-code",
"code" : "fulfill"
}
]
},
"focus" : {
"reference" : "http://example.org/someEHR/fhir/MedicationRequest/1111"
},
"for" : {
"reference" : "http://example.org/someEHR/fhir/Patient/123"
},
"owner" : {
"reference" : "http://example.org/someEHR/fhir/Practitioner/987"
},
"restriction" : {
"repetitions" : 1
}
}
}
]
}
},
"prefetch" : {
"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:\u00a01032702\u00a0(use:\u00a0USUAL))</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.org\">amy.shaw@example.org</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://example.org/NamingSystem/mrn",
"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.org"
}
],
"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"
}
}
]
},
"value" : {
"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:\u00a01032702\u00a0(use:\u00a0USUAL))</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.org\">amy.shaw@example.org</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://example.org/NamingSystem/mrn",
"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.org"
}
],
"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" : {
"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 "example-1" Updated "2017-05-26 11:56:57-0400" </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> " SHAW"</p><p><b>period</b>: 2015-11-01 17:00:14-0500 --> 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> "Holy Family Hospital"</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"
}
}
]
},
"value" : {
"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 "example-1" Updated "2017-05-26 11:56:57-0400" </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> " SHAW"</p><p><b>period</b>: 2015-11-01 17:00:14-0500 --> 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> "Holy Family Hospital"</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"
}
}
]
},
"coverage" : {
"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 "preferred provider organization policy")</span></p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Patient/example</a> " SHAW"</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 --> (ongoing)</p><p><b>payor</b>: <a href=\"Organization-acme-payer.html\">Organization/acme-payer: Acme Health Plan</a> "Acme Health Plan"</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 "Group")</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 "Plan")</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"
}
}
]
},
"value" : {
"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 "preferred provider organization policy")</span></p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Patient/example</a> " SHAW"</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 --> (ongoing)</p><p><b>payor</b>: <a href=\"Organization-acme-payer.html\">Organization/acme-payer: Acme Health Plan</a> "Acme Health Plan"</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 "Group")</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 "Plan")</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"
}
}
]
},
"device" : {
},
"medication" : {
"type" : "searchset",
"total" : 1,
"link" : [
{
"relation" : "self",
"url" : "http://example.org/someEHR/fhir/r4/Medication?_id=MED1,MED2"
}
],
"entry" : [
{
"fullUrl" : "http://example.org/someEHR/fhir/Medication/MED1",
"resource" : {
"resourceType" : "Medication",
"id" : "MED1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>code</b>: Diclofenac Potassium (product)</p><p><b>status</b>: active</p></div>"
},
"code" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/ndc",
"code" : "0093-0948",
"display" : "Diclofenac Potassium (product)"
}
]
},
"status" : "active"
},
"search" : {
"mode" : "match"
}
},
{
"fullUrl" : "http://example.org/someEHR/fhir/Medication/MED2",
"resource" : {
"resourceType" : "Medication",
"id" : "MED2",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>code</b>: OxyContin (product)</p><p><b>status</b>: active</p></div>"
},
"code" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/ndc",
"code" : "59011-410",
"display" : "OxyContin (product)"
}
]
},
"status" : "active"
},
"search" : {
"mode" : "match"
}
}
]
},
"value" : {
"resourceType" : "Bundle",
"type" : "searchset",
"total" : 1,
"link" : [
{
"relation" : "self",
"url" : "http://example.org/someEHR/fhir/r4/Medication?_id=MED1,MED2"
}
],
"entry" : [
{
"fullUrl" : "http://example.org/someEHR/fhir/Medication/MED1",
"resource" : {
"resourceType" : "Medication",
"id" : "MED1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>code</b>: Diclofenac Potassium (product)</p><p><b>status</b>: active</p></div>"
},
"code" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/ndc",
"code" : "0093-0948",
"display" : "Diclofenac Potassium (product)"
}
]
},
"status" : "active"
},
"search" : {
"mode" : "match"
}
},
{
"fullUrl" : "http://example.org/someEHR/fhir/Medication/MED2",
"resource" : {
"resourceType" : "Medication",
"id" : "MED2",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>code</b>: OxyContin (product)</p><p><b>status</b>: active</p></div>"
},
"code" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/ndc",
"code" : "59011-410",
"display" : "OxyContin (product)"
}
]
},
"status" : "active"
},
"search" : {
"mode" : "match"
}
}
]
},
"practitioners" : {
"type" : "searchset",
"total" : 1,
"link" : [
{
"relation" : "self",
"url" : "http://example.org/someEHR/fhir/r4/Practitioner?_id=DEF"
}
],
"entry" : [
{
"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" : "match"
}
}
]
},
"value" : {
"resourceType" : "Bundle",
"type" : "searchset",
"total" : 1,
"link" : [
{
"relation" : "self",
"url" : "http://example.org/someEHR/fhir/r4/Practitioner?_id=DEF"
}
],
"entry" : [
{
"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" : "match"
}
}
]
},
"practitionerRoles" : {
"type" : "searchset",
"total" : 1,
"link" : [
{
"relation" : "self",
"url" : "http://example.org/someEHR/fhir/r4/PractitionerRole?_id=ABC"
}
],
"entry" : [
{
"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" : "match"
}
}
]
},
"value" : {
"resourceType" : "Bundle",
"type" : "searchset",
"total" : 1,
"link" : [
{
"relation" : "self",
"url" : "http://example.org/someEHR/fhir/r4/PractitionerRole?_id=ABC"
}
],
"entry" : [
{
"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" : "match"
}
}
]
},
"organizations" : {
"type" : "searchset",
"total" : 1,
"link" : [
{
"relation" : "self",
"url" : "http://example.org/someEHR/fhir/r4/Organization?_id=GHI"
}
],
"entry" : [
{
"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" : "match"
}
}
]
},
"value" : {
"resourceType" : "Bundle",
"type" : "searchset",
"total" : 1,
"link" : [
{
"relation" : "self",
"url" : "http://example.org/someEHR/fhir/r4/Organization?_id=GHI"
}
],
"entry" : [
{
"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" : "match"
}
}
]
},
"locations" : {
"type" : "searchset",
"total" : 1,
"link" : [
{
"relation" : "self",
"url" : "http://example.org/someEHR/fhir/r4/Location?_id=hospital"
}
],
"entry" : [
{
"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><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"
}
}
]
},
"value" : {
"resourceType" : "Bundle",
"type" : "searchset",
"total" : 1,
"link" : [
{
"relation" : "self",
"url" : "http://example.org/someEHR/fhir/r4/Location?_id=hospital"
}
],
"entry" : [
{
"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><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"
}
}
]
}
}
}
IG © 2019+ HL7 International / Financial Management.
Package hl7.fhir.us.davinci-crd#2.2.0-ballot based on FHIR 4.0.1.
Generated 2025-10-30
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