Patient Cost Transparency Implementation Guide
2.0.0 - STU 2
Patient Cost Transparency Implementation Guide
2.0.0 - STU 2
Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions
@prefix fhir: <http://hl7.org/fhir/> . @prefix loinc: <https://loinc.org/rdf/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- a fhir:Bundle ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "PCT-AEOB-Packet-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-packet"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-packet> ] ) ] ; # fhir:identifier [ fhir:system [ fhir:v "http://example.com/identifiers/bundle"^^xsd:anyURI ] ; fhir:value [ fhir:v "59688475-2324-3242-1234568" ] ] ; # fhir:type [ fhir:v "document"] ; # fhir:timestamp [ fhir:v "2025-01-10T11:01:00+05:00"^^xsd:dateTime] ; # fhir:entry ( [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Composition/PCT-AEOB-Composition-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Composition/PCT-AEOB-Composition-1> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/ExplanationOfBenefit/PCT-AEOB-Summary-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/ExplanationOfBenefit/PCT-AEOB-Summary-1> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/ExplanationOfBenefit/PCT-AEOB-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/ExplanationOfBenefit/PCT-AEOB-1> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Patient/patient1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Patient/patient1001> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Coverage/coverage1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Coverage/coverage1001> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/org1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/org1001> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/Submitter-Org-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/Submitter-Org-1> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/org1002"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/org1002> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Bundle/PCT-GFE-Bundle-Inst-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Bundle/PCT-GFE-Bundle-Inst-1> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Bundle/PCT-GFE-Missing-Bundle-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Bundle/PCT-GFE-Missing-Bundle-1> ) ] ) . # <http://example.org/fhir/Composition/PCT-AEOB-Composition-1> a fhir:Composition ; fhir:id [ fhir:v "PCT-AEOB-Composition-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-composition"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-composition> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Composition_PCT-AEOB-Composition-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Composition PCT-AEOB-Composition-1</b></p><a name=\"PCT-AEOB-Composition-1\"> </a><a name=\"hcPCT-AEOB-Composition-1\"> </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-davinci-pct-aeob-composition.html\">PCT AEOB Composition</a></p></div><p><b>Request Initiation Time</b>: 2025-01-08 09:01:00+0500</p><p><b>identifier</b>: <code>http://www.example.org/identifiers/composition</code>/019283475</p><p><b>status</b>: Final</p><p><b>type</b>: <span title=\"Codes:{http://loinc.org 111479-2}\">Advanced explanation of benefits</span></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentTypeTemporaryTrialUse estimate}\">Estimation Packet</span></p><p><b>date</b>: 2025-01-10 11:01:00+0500</p><p><b>author</b>: </p><ul><li><a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></li><li><a href=\"Organization-Submitter-Org-1.html\">Organization GFE Service Help INC.</a></li></ul><p><b>title</b>: Advanced Explanation of Benefit Packet for Eve Betterhalf - 2025-01-10</p></div>"^^rdf:XMLLiteral ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/requestInitiationTime"^^xsd:anyURI ] ; fhir:value [ a fhir:instant ; fhir:v "2025-01-08T09:01:00+05:00"^^xsd:dateTime ] ] ) ; # fhir:identifier [ fhir:system [ fhir:v "http://www.example.org/identifiers/composition"^^xsd:anyURI ] ; fhir:value [ fhir:v "019283475" ] ] ; # fhir:status [ fhir:v "final"] ; # fhir:type [ ( fhir:coding [ a loinc:111479-2 ; fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ] ; fhir:code [ fhir:v "111479-2" ] ; fhir:display [ fhir:v "Advanced explanation of benefits" ] ] ) ] ; # fhir:category ( [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentTypeTemporaryTrialUse"^^xsd:anyURI ] ; fhir:code [ fhir:v "estimate" ] ] ) ] ) ; # fhir:subject [ fhir:reference [ fhir:v "Patient/patient1001" ] ] ; # fhir:date [ fhir:v "2025-01-10T11:01:00+05:00"^^xsd:dateTime] ; # fhir:author ( [ fhir:reference [ fhir:v "Organization/org1001" ] ] [ fhir:reference [ fhir:v "Organization/Submitter-Org-1" ] ] ) ; # fhir:title [ fhir:v "Advanced Explanation of Benefit Packet for Eve Betterhalf - 2025-01-10"] ; # fhir:section ( [ fhir:code [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentSection"^^xsd:anyURI ] ; fhir:code [ fhir:v "aeob-summary-section" ] ] ) ] ; fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ExplanationOfBenefit PCT-AEOB-Summary-1</b></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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-aeob-summary.html\">PCT Advanced EOB Summary</a></p></div><p><b>Service Description</b>: Example service</p><p><b>In Network Provider Options Link</b>: <a href=\"http://example.org/out-of-network.html\">http://example.org/out-of-network.html</a></p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse estimate-summary}\">Estimate Summary</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>billablePeriod</b>: 2022-01-01 --> 2022-01-01</p><p><b>created</b>: 2021-10-12</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><p><b>provider</b>: ?rref?</p><p><b>outcome</b>: Processing Complete</p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --> 2022-01-01</a></td></tr></table><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS memberliability}\">Member liability</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>190</td><td>United States dollar</td></tr></table></blockquote><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>processNote disclaimer text</td></tr></table><p><b>benefitPeriod</b>: 2022-01-01 --> 2022-01-01</p><blockquote><p><b>benefitBalance</b></p><p><b>category</b>: <span title=\"Codes:{https://x12.org/codes/service-type-codes 1}\">Medical Care</span></p><p><b>unit</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-unit individual}\">Individual</span></p><p><b>term</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-term annual}\">Annual</span></p><h3>Financials</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType allowed}\">Allowed</span></td><td><span title=\"US Dollar\">$1.00</span> (USD)</td><td><span title=\"US Dollar\">$1.00</span> (USD)</td></tr></table></blockquote></div>"^^rdf:XMLLiteral ] ; ( fhir:entry [ fhir:reference [ fhir:v "ExplanationOfBenefit/PCT-AEOB-Summary-1" ] ] ) ] [ fhir:code [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentSection"^^xsd:anyURI ] ; fhir:code [ fhir:v "aeob-section" ] ] ) ] ; fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ExplanationOfBenefit PCT-AEOB-Summary-1</b></p><a name=\"PCT-AEOB-Summary-1\"/><a name=\"hcPCT-AEOB-Summary-1\"/><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-davinci-pct-aeob-summary.html\">PCT Advanced EOB Summary</a></p></div><p><b>Service Description</b>: Example service</p><p><b>In Network Provider Options Link</b>: <a href=\"http://example.org/out-of-network.html\">http://example.org/out-of-network.html</a></p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse estimate-summary}\">Estimate Summary</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>billablePeriod</b>: 2022-01-01 --> 2022-01-01</p><p><b>created</b>: 2021-10-12</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><p><b>provider</b>: ?rref?</p><p><b>outcome</b>: Processing Complete</p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --> 2022-01-01</a></td></tr></table><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS memberliability}\">Member liability</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>190</td><td>United States dollar</td></tr></table></blockquote><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>processNote disclaimer text</td></tr></table><p><b>benefitPeriod</b>: 2022-01-01 --> 2022-01-01</p><blockquote><p><b>benefitBalance</b></p><p><b>category</b>: <span title=\"Codes:{https://x12.org/codes/service-type-codes 1}\">Medical Care</span></p><p><b>unit</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-unit individual}\">Individual</span></p><p><b>term</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-term annual}\">Annual</span></p><h3>Financials</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType allowed}\">Allowed</span></td><td><span title=\"US Dollar\">$1.00</span> (USD)</td><td><span title=\"US Dollar\">$1.00</span> (USD)</td></tr></table></blockquote></div>"^^rdf:XMLLiteral ] ; ( fhir:entry [ fhir:reference [ fhir:v "ExplanationOfBenefit/PCT-AEOB-1" ] ] ) ] [ fhir:code [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentSection"^^xsd:anyURI ] ; fhir:code [ fhir:v "gfe-section" ] ] ) ] ; ( fhir:author [ fhir:reference [ fhir:v "Organization/Submitter-Org-1" ] ] ) ; fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: PCT-GFE-Missing-Bundle-1</b></p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 (http://example.com/identifiers/patient#1001)</a></p><p><b>coverage</b>: <a href=\"Patient-patient1001.html\">Coverage_coverage1001, period: 2021-01-01 --> 2022-01-01</a></p><p><b>organization</b>: <a href=\"Organization-org1001.html\">Umbrella Insurance Company</a></p><h3>Requested Services</h3><ul><li><b>device request</b>: KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT</li></ul></div>"^^rdf:XMLLiteral ] ; ( fhir:entry [ fhir:reference [ fhir:v "Bundle/PCT-GFE-Bundle-Inst-1" ] ] ) ] [ fhir:code [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentSection"^^xsd:anyURI ] ; fhir:code [ fhir:v "gfe-section" ] ] ) ] ; ( fhir:author [ fhir:reference [ fhir:v "Organization/Submitter-Org-1" ] ] ) ; ( fhir:entry [ fhir:reference [ fhir:v "Bundle/PCT-GFE-Missing-Bundle-1" ] ] ) ] ) . # <http://example.org/fhir/ExplanationOfBenefit/PCT-AEOB-Summary-1> a fhir:ExplanationOfBenefit ; fhir:id [ fhir:v "PCT-AEOB-Summary-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-summary"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-summary> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ExplanationOfBenefit_PCT-AEOB-Summary-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ExplanationOfBenefit PCT-AEOB-Summary-1</b></p><a name=\"PCT-AEOB-Summary-1\"> </a><a name=\"hcPCT-AEOB-Summary-1\"> </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-davinci-pct-aeob-summary.html\">PCT Advanced EOB Summary</a></p></div><p><b>Service Description</b>: Example service</p><p><b>In Network Provider Options Link</b>: <a href=\"http://example.org/out-of-network.html\">http://example.org/out-of-network.html</a></p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse estimate-summary}\">Estimate Summary</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>billablePeriod</b>: 2022-01-01 --> 2022-01-01</p><p><b>created</b>: 2021-10-12</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><p><b>provider</b>: ?rref?</p><p><b>outcome</b>: Processing Complete</p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --> 2022-01-01</a></td></tr></table><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS memberliability}\">Member liability</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>190</td><td>United States dollar</td></tr></table></blockquote><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>processNote disclaimer text</td></tr></table><p><b>benefitPeriod</b>: 2022-01-01 --> 2022-01-01</p><blockquote><p><b>benefitBalance</b></p><p><b>category</b>: <span title=\"Codes:{https://x12.org/codes/service-type-codes 1}\">Medical Care</span></p><p><b>unit</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-unit individual}\">Individual</span></p><p><b>term</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-term annual}\">Annual</span></p><h3>Financials</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType allowed}\">Allowed</span></td><td><span title=\"US Dollar\">$1.00</span> (USD)</td><td><span title=\"US Dollar\">$1.00</span> (USD)</td></tr></table></blockquote></div>"^^rdf:XMLLiteral ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Example service" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink"^^xsd:anyURI ] ; fhir:value [ a fhir:url ; fhir:v "http://example.org/out-of-network.html"^^xsd:anyURI ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse"^^xsd:anyURI ] ; fhir:code [ fhir:v "estimate-summary" ] ; fhir:display [ fhir:v "Estimate Summary" ] ] ) ] ; # fhir:use [ fhir:v "predetermination"] ; # fhir:patient [ fhir:reference [ fhir:v "Patient/patient1001" ] ] ; # fhir:billablePeriod [ fhir:start [ fhir:v "2022-01-01"^^xsd:date ] ; fhir:end [ fhir:v "2022-01-01"^^xsd:date ] ] ; # fhir:created [ fhir:v "2021-10-12"^^xsd:date] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/org1001" ] ] ; # fhir:provider [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/data-absent-reason"^^xsd:anyURI ] ; fhir:value [ a fhir:code ; fhir:v "not-applicable" ] ] ) ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:insurance ( [ fhir:focal [ fhir:v true ] ; fhir:coverage [ fhir:reference [ fhir:v "Coverage/coverage1001" ] ] ] ) ; # fhir:total ( [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:version [ fhir:v "1.0.1" ] ; fhir:code [ fhir:v "submitted" ] ; fhir:display [ fhir:v "Submitted Amount" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "200"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "memberliability" ] ; fhir:display [ fhir:v "Member liability" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "20"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:version [ fhir:v "1.0.1" ] ; fhir:code [ fhir:v "eligible" ] ; fhir:display [ fhir:v "Eligible Amount" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "190"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; # fhir:processNote ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAEOBProcessNoteCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "disclaimer" ] ; fhir:display [ fhir:v "Disclaimer" ] ] ) ] ] ) ; fhir:text [ fhir:v "processNote disclaimer text" ] ] ) ; # fhir:benefitPeriod [ fhir:start [ fhir:v "2022-01-01"^^xsd:date ] ; fhir:end [ fhir:v "2022-01-01"^^xsd:date ] ] ; # fhir:benefitBalance ( [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "https://x12.org/codes/service-type-codes"^^xsd:anyURI ] ; fhir:code [ fhir:v "1" ] ; fhir:display [ fhir:v "Medical Care" ] ] ) ; fhir:text [ fhir:v "Medical Care" ] ] ; fhir:unit [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "individual" ] ] ) ] ; fhir:term [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ; fhir:code [ fhir:v "annual" ] ] ) ] ; ( fhir:financial [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit"^^xsd:anyURI ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType"^^xsd:anyURI ] ; fhir:code [ fhir:v "allowed" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "1"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "1"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] ) . # <http://example.org/fhir/ExplanationOfBenefit/PCT-AEOB-1> a fhir:ExplanationOfBenefit ; fhir:id [ fhir:v "PCT-AEOB-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ExplanationOfBenefit_PCT-AEOB-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ExplanationOfBenefit PCT-AEOB-1</b></p><a name=\"PCT-AEOB-1\"> </a><a name=\"hcPCT-AEOB-1\"> </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-davinci-pct-aeob.html\">PCT Advanced EOB</a></p></div><p><b>GFE Reference</b>: <a href=\"Bundle-PCT-GFE-Bundle-Inst-1.html\">Bundle: identifier = http://example.com/identifiers/bundle#59688475-2324-3242-23473847; type = collection; timestamp = 2021-11-09 11:01:00+0500</a></p><p><b>Service Description</b>: Example service</p><p><b>In Network Provider Options Link</b>: <a href=\"http://example.org/out-of-network.html\">http://example.org/out-of-network.html</a></p><p><b>identifier</b>: Unique Claim Identifier/?ngen-9?</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>created</b>: 2021-10-12</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><p><b>provider</b>: <a href=\"Organization-org1002.html\">Organization Boston Radiology Center</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><p><b>claim</b>: Identifier: <code>http://example.com/identifiers/bundle</code>/59688475-2324-3242-23473847</p><p><b>outcome</b>: Processing Complete</p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --> 2022-01-01</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>revenue</b>: <span title=\"Codes:{https://www.nubc.org/CodeSystem/RevenueCodes 0611}\">Magnetic Resonance Technology (MRT) - Brain/brain stem</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 70551}\">Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material</span></p><p><b>modifier</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 70551}\">Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material</span></p><p><b>serviced</b>: 2022-01-01</p><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS medicalmanagement}\">Medical Management</span></td></tr></table></blockquote><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS medicalmanagement}\">Medical Management</span></td></tr><tr><td style=\"display: none\">*</td><td> </td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr><tr><td style=\"display: none\">*</td><td> </td><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS memberliability}\">Member Liability</span></td></tr></table><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS memberliability}\">Member liability</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>190</td><td>United States dollar</td></tr></table></blockquote><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>processNote disclaimer text</td></tr></table><p><b>benefitPeriod</b>: 2022-01-01 --> 2023-01-01</p><blockquote><p><b>benefitBalance</b></p><p><b>category</b>: <span title=\"Codes:{https://x12.org/codes/service-type-codes 1}\">Medical Care</span></p><p><b>unit</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-unit individual}\">Individual</span></p><p><b>term</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-term annual}\">Annual</span></p><h3>Financials</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType allowed}\">Allowed</span></td><td><span title=\"US Dollar\">$1.00</span> (USD)</td><td><span title=\"US Dollar\">$1.00</span> (USD)</td></tr></table></blockquote></div>"^^rdf:XMLLiteral ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference"^^xsd:anyURI ] ; fhir:value [ a fhir:Reference ; fhir:reference [ fhir:v "Bundle/PCT-GFE-Bundle-Inst-1" ] ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Example service" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink"^^xsd:anyURI ] ; fhir:value [ a fhir:url ; fhir:v "http://example.org/out-of-network.html"^^xsd:anyURI ] ] ) ; # fhir:identifier ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "UCID" ] ] ) ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "institutional" ] ; fhir:display [ fhir:v "Institutional" ] ] ) ] ; # fhir:use [ fhir:v "predetermination"] ; # fhir:patient [ fhir:reference [ fhir:v "Patient/patient1001" ] ] ; # fhir:created [ fhir:v "2021-10-12"^^xsd:date] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/org1001" ] ] ; # fhir:provider [ fhir:reference [ fhir:v "Organization/org1002" ] ] ; # fhir:priority [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; fhir:code [ fhir:v "normal" ] ] ) ] ; # fhir:claim [ fhir:identifier [ fhir:system [ fhir:v "http://example.com/identifiers/bundle"^^xsd:anyURI ] ; fhir:value [ fhir:v "59688475-2324-3242-23473847" ] ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:insurance ( [ fhir:focal [ fhir:v true ] ; fhir:coverage [ fhir:reference [ fhir:v "Coverage/coverage1001" ] ] ] ) ; # fhir:item ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:revenue [ ( fhir:coding [ fhir:system [ fhir:v "https://www.nubc.org/CodeSystem/RevenueCodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "0611" ] ; fhir:display [ fhir:v "Magnetic Resonance Technology (MRT) - Brain/brain stem" ] ] ) ] ; fhir:productOrService [ ( fhir:coding [ fhir:system [ fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ] ; fhir:code [ fhir:v "70551" ] ; fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ] ] ) ] ; ( fhir:modifier [ ( fhir:coding [ fhir:system [ fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ] ; fhir:code [ fhir:v "70551" ] ; fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ] ] ) ] ) ; fhir:serviced [ a fhir:date ; fhir:v "2022-01-01"^^xsd:date ] ; fhir:net [ fhir:value [ fhir:v "200"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; ( fhir:adjudication [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/medical-management-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "concurrent-review" ] ; fhir:display [ fhir:v "Concurrent Review" ] ] ) ] ] ) ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "medicalmanagement" ] ; fhir:display [ fhir:v "Medical Management" ] ] ) ] ] ) ] ) ; # fhir:adjudication ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/medical-management-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "concurrent-review" ] ; fhir:display [ fhir:v "Concurrent Review" ] ] ) ] ] ) ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "medicalmanagement" ] ; fhir:display [ fhir:v "Medical Management" ] ] ) ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "submitted" ] ; fhir:display [ fhir:v "Submitted Amount" ] ] ) ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "memberliability" ] ; fhir:display [ fhir:v "Member Liability" ] ] ) ] ] ) ; # fhir:total ( [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:version [ fhir:v "1.0.1" ] ; fhir:code [ fhir:v "submitted" ] ; fhir:display [ fhir:v "Submitted Amount" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "200"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "memberliability" ] ; fhir:display [ fhir:v "Member liability" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "20"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:version [ fhir:v "1.0.1" ] ; fhir:code [ fhir:v "eligible" ] ; fhir:display [ fhir:v "Eligible Amount" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "190"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; # fhir:processNote ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAEOBProcessNoteCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "disclaimer" ] ; fhir:display [ fhir:v "Disclaimer" ] ] ) ] ] ) ; fhir:text [ fhir:v "processNote disclaimer text" ] ] ) ; # fhir:benefitPeriod [ fhir:start [ fhir:v "2022-01-01"^^xsd:date ] ; fhir:end [ fhir:v "2023-01-01"^^xsd:date ] ] ; # fhir:benefitBalance ( [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "https://x12.org/codes/service-type-codes"^^xsd:anyURI ] ; fhir:code [ fhir:v "1" ] ; fhir:display [ fhir:v "Medical Care" ] ] ) ; fhir:text [ fhir:v "Medical Care" ] ] ; fhir:unit [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "individual" ] ] ) ] ; fhir:term [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ; fhir:code [ fhir:v "annual" ] ] ) ] ; ( fhir:financial [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit"^^xsd:anyURI ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType"^^xsd:anyURI ] ; fhir:code [ fhir:v "allowed" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "1"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "1"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] ) . # <http://example.org/fhir/Patient/patient1001> a fhir:Patient, fhir:Patient, fhir:Patient ; fhir:id [ fhir:v "patient1001"], [ fhir:v "patient1001"], [ fhir:v "patient1001"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "additional" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_patient1001\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\"><b>Eve Betterhalf</b> female, DoB: 1955-07-23 ( <code>http://example.com/identifiers/patient</code>/1001)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Known Marital status of Patient\">Marital Status:</td><td colspan=\"3\"><span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus U}\">unmarried</span></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Details:</td><td colspan=\"3\"><ul><li>ph: 781-949-4949(MOBILE)</li><li>222 Burlington Road, Bedford MA 01730</li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Languages spoken\">Language:</td><td colspan=\"3\"><span title=\"Codes: {urn:ietf:bcp:47 en-US}\">English (United States)</span> (preferred)</td></tr></table></div>"^^rdf:XMLLiteral ], [ fhir:status [ fhir:v "additional" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\"><b>Eve Betterhalf</b> female, DoB: 1955-07-23 ( <code>http://example.com/identifiers/patient</code>/1001)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Known Marital status of Patient\">Marital Status:</td><td colspan=\"3\"><span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus U}\">unmarried</span></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Details:</td><td colspan=\"3\"><ul><li>ph: 781-949-4949(MOBILE)</li><li>222 Burlington Road, Bedford MA 01730</li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Languages spoken\">Language:</td><td colspan=\"3\"><span title=\"Codes: {urn:ietf:bcp:47 en-US}\">English (United States)</span> (preferred)</td></tr></table></div>"^^rdf:XMLLiteral ], [ fhir:status [ fhir:v "additional" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\"><b>Eve Betterhalf</b> female, DoB: 1955-07-23 ( <code>http://example.com/identifiers/patient</code>/1001)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Known Marital status of Patient\">Marital Status:</td><td colspan=\"3\"><span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus U}\">unmarried</span></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Details:</td><td colspan=\"3\"><ul><li>ph: 781-949-4949(MOBILE)</li><li>222 Burlington Road, Bedford MA 01730</li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Languages spoken\">Language:</td><td colspan=\"3\"><span title=\"Codes: {urn:ietf:bcp:47 en-US}\">English (United States)</span> (preferred)</td></tr></table></div>"^^rdf:XMLLiteral ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://example.com/identifiers/patient"^^xsd:anyURI ] ; fhir:value [ fhir:v "1001" ] ] [ fhir:system [ fhir:v "http://example.com/identifiers/patient"^^xsd:anyURI ] ; fhir:value [ fhir:v "1001" ] ] [ fhir:system [ fhir:v "http://example.com/identifiers/patient"^^xsd:anyURI ] ; fhir:value [ fhir:v "1001" ] ] ) ; # fhir:name ( [ fhir:text [ fhir:v "Eve Betterhalf" ] ; fhir:family [ fhir:v "Betterhalf" ] ; ( fhir:given [ fhir:v "Eve" ] ) ] [ fhir:text [ fhir:v "Eve Betterhalf" ] ; fhir:family [ fhir:v "Betterhalf" ] ; ( fhir:given [ fhir:v "Eve" ] ) ] [ fhir:text [ fhir:v "Eve Betterhalf" ] ; fhir:family [ fhir:v "Betterhalf" ] ; ( fhir:given [ fhir:v "Eve" ] ) ] ) ; # fhir:telecom ( [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "781-949-4949" ] ; fhir:use [ fhir:v "mobile" ] ] [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "781-949-4949" ] ; fhir:use [ fhir:v "mobile" ] ] [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "781-949-4949" ] ; fhir:use [ fhir:v "mobile" ] ] ) ; # fhir:gender [ fhir:v "female"], [ fhir:v "female"], [ fhir:v "female"] ; # fhir:birthDate [ fhir:v "1955-07-23"^^xsd:date], [ fhir:v "1955-07-23"^^xsd:date], [ fhir:v "1955-07-23"^^xsd:date] ; # fhir:address ( [ fhir:text [ fhir:v "222 Burlington Road, Bedford MA 01730" ] ] [ fhir:text [ fhir:v "222 Burlington Road, Bedford MA 01730" ] ] [ fhir:text [ fhir:v "222 Burlington Road, Bedford MA 01730" ] ] ) ; # fhir:maritalStatus [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus"^^xsd:anyURI ] ; fhir:code [ fhir:v "U" ] ; fhir:display [ fhir:v "unmarried" ] ] ) ], [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus"^^xsd:anyURI ] ; fhir:code [ fhir:v "U" ] ; fhir:display [ fhir:v "unmarried" ] ] ) ], [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus"^^xsd:anyURI ] ; fhir:code [ fhir:v "U" ] ; fhir:display [ fhir:v "unmarried" ] ] ) ] ; # fhir:communication ( [ fhir:language [ ( fhir:coding [ fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ] ; fhir:code [ fhir:v "en-US" ] ; fhir:display [ fhir:v "English (United States)" ] ] ) ] ; fhir:preferred [ fhir:v true ] ] [ fhir:language [ ( fhir:coding [ fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ] ; fhir:code [ fhir:v "en-US" ] ; fhir:display [ fhir:v "English (United States)" ] ] ) ] ; fhir:preferred [ fhir:v true ] ] [ fhir:language [ ( fhir:coding [ fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ] ; fhir:code [ fhir:v "en-US" ] ; fhir:display [ fhir:v "English (United States)" ] ] ) ] ; fhir:preferred [ fhir:v true ] ] ) . # <http://example.org/fhir/Coverage/coverage1001> a fhir:Coverage, fhir:Coverage, fhir:Coverage ; fhir:id [ fhir:v "coverage1001"], [ fhir:v "coverage1001"], [ fhir:v "coverage1001"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_coverage1001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage coverage1001</b></p><a name=\"coverage1001\"> </a><a name=\"hccoverage1001\"> </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-davinci-pct-coverage.html\">PCT Coverage</a></p></div><p><b>Extension Definition for Coverage.kind for Version 5.0</b>: insurance</p><p><b>status</b>: Active</p><p><b>subscriberId</b>: PFP123450000</p><p><b>beneficiary</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2021-01-01 --> 2022-01-01</p><p><b>payor</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><h3>Classes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></td><td>Premim Family Plus</td><td>Premim Family Plus Plan</td></tr></table><h3>CostToBeneficiaries</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-copay-type copaypct}\">Copay Percentage</span></td><td>20</td></tr></table></div>"^^rdf:XMLLiteral ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind"^^xsd:anyURI ] ; fhir:value [ a fhir:code ; fhir:v "insurance" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind"^^xsd:anyURI ] ; fhir:value [ a fhir:code ; fhir:v "insurance" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind"^^xsd:anyURI ] ; fhir:value [ a fhir:code ; fhir:v "insurance" ] ] ) ; # fhir:status [ fhir:v "active"], [ fhir:v "active"], [ fhir:v "active"] ; # fhir:subscriberId [ fhir:v "PFP123450000"], [ fhir:v "PFP123450000"], [ fhir:v "PFP123450000"] ; # fhir:beneficiary [ fhir:reference [ fhir:v "Patient/patient1001" ] ], [ fhir:reference [ fhir:v "Patient/patient1001" ] ], [ fhir:reference [ fhir:v "Patient/patient1001" ] ] ; # fhir:relationship [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ; fhir:code [ fhir:v "self" ] ; fhir:display [ fhir:v "Self" ] ] ) ], [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ; fhir:code [ fhir:v "self" ] ; fhir:display [ fhir:v "Self" ] ] ) ], [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ; fhir:code [ fhir:v "self" ] ; fhir:display [ fhir:v "Self" ] ] ) ] ; # fhir:period [ fhir:start [ fhir:v "2021-01-01"^^xsd:date ] ; fhir:end [ fhir:v "2022-01-01"^^xsd:date ] ], [ fhir:start [ fhir:v "2021-01-01"^^xsd:date ] ; fhir:end [ fhir:v "2022-01-01"^^xsd:date ] ], [ fhir:start [ fhir:v "2021-01-01"^^xsd:date ] ; fhir:end [ fhir:v "2022-01-01"^^xsd:date ] ] ; # fhir:payor ( [ fhir:reference [ fhir:v "Organization/org1001" ] ] [ fhir:reference [ fhir:v "Organization/org1001" ] ] [ fhir:reference [ fhir:v "Organization/org1001" ] ] ) ; # fhir:class ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "plan" ] ; fhir:display [ fhir:v "Plan" ] ] ) ] ; fhir:value [ fhir:v "Premim Family Plus" ] ; fhir:name [ fhir:v "Premim Family Plus Plan" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "plan" ] ; fhir:display [ fhir:v "Plan" ] ] ) ] ; fhir:value [ fhir:v "Premim Family Plus" ] ; fhir:name [ fhir:v "Premim Family Plus Plan" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "plan" ] ; fhir:display [ fhir:v "Plan" ] ] ) ] ; fhir:value [ fhir:v "Premim Family Plus" ] ; fhir:name [ fhir:v "Premim Family Plus Plan" ] ] ) ; # fhir:costToBeneficiary ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-copay-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "copaypct" ] ; fhir:display [ fhir:v "Copay Percentage" ] ] ) ] ; fhir:value [ a fhir:Quantity ; fhir:value [ fhir:v "20"^^xsd:decimal ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-copay-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "copaypct" ] ; fhir:display [ fhir:v "Copay Percentage" ] ] ) ] ; fhir:value [ a fhir:Quantity ; fhir:value [ fhir:v "20"^^xsd:decimal ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-copay-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "copaypct" ] ; fhir:display [ fhir:v "Copay Percentage" ] ] ) ] ; fhir:value [ a fhir:Quantity ; fhir:value [ fhir:v "20"^^xsd:decimal ] ] ] ) . # <http://example.org/fhir/Organization/org1001> a fhir:Organization, fhir:Organization, fhir:Organization ; fhir:id [ fhir:v "org1001"], [ fhir:v "org1001"], [ fhir:v "org1001"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_org1001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization org1001</b></p><a name=\"org1001\"> </a><a name=\"hcorg1001\"> </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-davinci-pct-organization.html\">PCT Organization</a></p></div><p><b>identifier</b>: Electronic Transmitter Identification Number/ETIN-3200002</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type pay}\">Payer</span></p><p><b>name</b>: Umbrella Insurance Company</p><p><b>telecom</b>: ph: 860-547-5001(Work)</p><p><b>address</b>: 680 Asylum Street Hartford CT 06155 US </p></div>"^^rdf:XMLLiteral ] ; # fhir:identifier ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "ETIN" ] ] ) ] ; fhir:value [ fhir:v "ETIN-3200002" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "ETIN" ] ] ) ] ; fhir:value [ fhir:v "ETIN-3200002" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "ETIN" ] ] ) ] ; fhir:value [ fhir:v "ETIN-3200002" ] ] ) ; # fhir:active [ fhir:v true], [ fhir:v true], [ fhir:v true] ; # fhir:type ( [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "pay" ] ; fhir:display [ fhir:v "Payer" ] ] ) ] [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "pay" ] ; fhir:display [ fhir:v "Payer" ] ] ) ] [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "pay" ] ; fhir:display [ fhir:v "Payer" ] ] ) ] ) ; # fhir:name [ fhir:v "Umbrella Insurance Company"], [ fhir:v "Umbrella Insurance Company"], [ fhir:v "Umbrella Insurance Company"] ; # fhir:telecom ( [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "860-547-5001" ] ; fhir:use [ fhir:v "work" ] ] [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "860-547-5001" ] ; fhir:use [ fhir:v "work" ] ] [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "860-547-5001" ] ; fhir:use [ fhir:v "work" ] ] ) ; # fhir:address ( [ ( fhir:line [ fhir:v "680 Asylum Street" ] ) ; fhir:city [ fhir:v "Hartford" ] ; fhir:state [ fhir:v "CT" ] ; fhir:postalCode [ fhir:v "06155" ] ; fhir:country [ fhir:v "US" ] ] [ ( fhir:line [ fhir:v "680 Asylum Street" ] ) ; fhir:city [ fhir:v "Hartford" ] ; fhir:state [ fhir:v "CT" ] ; fhir:postalCode [ fhir:v "06155" ] ; fhir:country [ fhir:v "US" ] ] [ ( fhir:line [ fhir:v "680 Asylum Street" ] ) ; fhir:city [ fhir:v "Hartford" ] ; fhir:state [ fhir:v "CT" ] ; fhir:postalCode [ fhir:v "06155" ] ; fhir:country [ fhir:v "US" ] ] ) . # <http://example.org/fhir/Organization/Submitter-Org-1> a fhir:Organization, fhir:Organization ; fhir:id [ fhir:v "Submitter-Org-1"], [ fhir:v "Submitter-Org-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_Submitter-Org-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization Submitter-Org-1</b></p><a name=\"Submitter-Org-1\"> </a><a name=\"hcSubmitter-Org-1\"> </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-davinci-pct-organization.html\">PCT Organization</a></p></div><p><b>identifier</b>: Electronic Transmitter Identification Number/ETIN-10010301</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type bus}\">Non-Healthcare Business or Corporation</span></p><p><b>name</b>: GFE Service Help INC.</p><blockquote><p><b>contact</b></p><p><b>purpose</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgContactPurposeType GFERELATED}\">GFE-related</span></p><p><b>name</b>: Clara Sender</p><p><b>telecom</b>: ph: 781-632-3209(Work), <a href=\"mailto:csender@GFEServiceHelp.com\">csender@GFEServiceHelp.com</a></p></blockquote></div>"^^rdf:XMLLiteral ] ; # fhir:identifier ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "ETIN" ] ] ) ] ; fhir:value [ fhir:v "ETIN-10010301" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "ETIN" ] ] ) ] ; fhir:value [ fhir:v "ETIN-10010301" ] ] ) ; # fhir:active [ fhir:v true], [ fhir:v true] ; # fhir:type ( [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "bus" ] ] ) ] [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "bus" ] ] ) ] ) ; # fhir:name [ fhir:v "GFE Service Help INC."], [ fhir:v "GFE Service Help INC."] ; # fhir:contact ( [ fhir:purpose [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgContactPurposeType"^^xsd:anyURI ] ; fhir:code [ fhir:v "GFERELATED" ] ] ) ] ; fhir:name [ fhir:text [ fhir:v "Clara Sender" ] ] ; ( fhir:telecom [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "781-632-3209" ] ; fhir:use [ fhir:v "work" ] ] [ fhir:system [ fhir:v "email" ] ; fhir:value [ fhir:v "csender@GFEServiceHelp.com" ] ; fhir:use [ fhir:v "work" ] ] ) ] [ fhir:purpose [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgContactPurposeType"^^xsd:anyURI ] ; fhir:code [ fhir:v "GFERELATED" ] ] ) ] ; fhir:name [ fhir:text [ fhir:v "Clara Sender" ] ] ; ( fhir:telecom [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "781-632-3209" ] ; fhir:use [ fhir:v "work" ] ] [ fhir:system [ fhir:v "email" ] ; fhir:value [ fhir:v "csender@GFEServiceHelp.com" ] ; fhir:use [ fhir:v "work" ] ] ) ] ) . # <http://example.org/fhir/Organization/org1002> a fhir:Organization, fhir:Organization ; fhir:id [ fhir:v "org1002"], [ fhir:v "org1002"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_org1002\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization org1002</b></p><a name=\"org1002\"> </a><a name=\"hcorg1002\"> </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-davinci-pct-organization.html\">PCT Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/9941339100, Tax ID number/TAX-3211001</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: Boston Radiology Center</p><p><b>telecom</b>: ph: 781-232-3200(Work)</p><p><b>address</b>: 32 Fruit Street Boston MA 02114 US </p></div>"^^rdf:XMLLiteral ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ; fhir:value [ fhir:v "9941339100" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "TAX" ] ] ) ] ; fhir:system [ fhir:v "urn:oid:2.16.840.1.113883.4.4"^^xsd:anyURI ] ; fhir:value [ fhir:v "TAX-3211001" ] ] [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ; fhir:value [ fhir:v "9941339100" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "TAX" ] ] ) ] ; fhir:system [ fhir:v "urn:oid:2.16.840.1.113883.4.4"^^xsd:anyURI ] ; fhir:value [ fhir:v "TAX-3211001" ] ] ) ; # fhir:active [ fhir:v true], [ fhir:v true] ; # fhir:type ( [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "prov" ] ; fhir:display [ fhir:v "Healthcare Provider" ] ] ) ] [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "prov" ] ; fhir:display [ fhir:v "Healthcare Provider" ] ] ) ] ) ; # fhir:name [ fhir:v "Boston Radiology Center"], [ fhir:v "Boston Radiology Center"] ; # fhir:telecom ( [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "781-232-3200" ] ; fhir:use [ fhir:v "work" ] ] [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "781-232-3200" ] ; fhir:use [ fhir:v "work" ] ] ) ; # fhir:address ( [ ( fhir:line [ fhir:v "32 Fruit Street" ] ) ; fhir:city [ fhir:v "Boston" ] ; fhir:state [ fhir:v "MA" ] ; fhir:postalCode [ fhir:v "02114" ] ; fhir:country [ fhir:v "US" ] ] [ ( fhir:line [ fhir:v "32 Fruit Street" ] ) ; fhir:city [ fhir:v "Boston" ] ; fhir:state [ fhir:v "MA" ] ; fhir:postalCode [ fhir:v "02114" ] ; fhir:country [ fhir:v "US" ] ] ) . # <http://example.org/fhir/Bundle/PCT-GFE-Bundle-Inst-1> a fhir:Bundle ; fhir:id [ fhir:v "PCT-GFE-Bundle-Inst-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-bundle"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-bundle> ] ) ] ; # fhir:identifier [ fhir:system [ fhir:v "http://example.com/identifiers/bundle"^^xsd:anyURI ] ; fhir:value [ fhir:v "59688475-2324-3242-23473847" ] ] ; # fhir:type [ fhir:v "collection"] ; # fhir:timestamp [ fhir:v "2021-11-09T11:01:00+05:00"^^xsd:dateTime] ; # fhir:entry ( [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Claim/PCT-GFE-Summary-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Claim/PCT-GFE-Summary-1> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Claim/PCT-GFE-Institutional-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Claim/PCT-GFE-Institutional-1> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/Submitter-Org-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/Submitter-Org-1> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/org1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/org1001> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Patient/patient1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Patient/patient1001> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Coverage/coverage1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Coverage/coverage1001> ) ] ) . # <http://example.org/fhir/Claim/PCT-GFE-Summary-1> a fhir:Claim ; fhir:id [ fhir:v "PCT-GFE-Summary-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-summary"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-summary> ] ) ] ; # fhir:status [ fhir:v "active"] ; # fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse"^^xsd:anyURI ] ; fhir:code [ fhir:v "estimate-summary" ] ; fhir:display [ fhir:v "Estimate Summary" ] ] ) ] ; # fhir:use [ fhir:v "predetermination"] ; # fhir:patient [ fhir:reference [ fhir:v "Patient/patient1001" ] ] ; # fhir:billablePeriod [ fhir:start [ fhir:v "2021-10-31"^^xsd:date ] ; fhir:end [ fhir:v "2021-10-31"^^xsd:date ] ] ; # fhir:created [ fhir:v "2021-10-05"^^xsd:date] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/org1001" ] ] ; # fhir:provider [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/data-absent-reason"^^xsd:anyURI ] ; fhir:value [ a fhir:code ; fhir:v "not-applicable" ] ] ) ] ; # fhir:priority [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; fhir:code [ fhir:v "normal" ] ] ) ] ; # fhir:diagnosis ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:diagnosis [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ] ; fhir:code [ fhir:v "S06.30" ] ; fhir:display [ fhir:v "Unspecified focal traumatic brain injury" ] ] ) ] ; ( fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/diagnosistype"^^xsd:anyURI ] ; fhir:code [ fhir:v "principal" ] ] ) ] ) ; fhir:packageCode [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup"^^xsd:anyURI ] ; fhir:code [ fhir:v "400" ] ; fhir:display [ fhir:v "Head trauma - concussion" ] ] ) ] ] ) ; # fhir:insurance ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:focal [ fhir:v true ] ; fhir:coverage [ fhir:reference [ fhir:v "Coverage/coverage1001" ] ] ] ) ; # fhir:total [ fhir:value [ fhir:v "200"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] . # <http://example.org/fhir/Claim/PCT-GFE-Institutional-1> a fhir:Claim ; fhir:id [ fhir:v "PCT-GFE-Institutional-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional> ] ) ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "EEMM1021" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "For estimation purposes only" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "linkingIdentifier"^^xsd:anyURI ] ; fhir:value [ a fhir:Identifier ; fhir:system [ fhir:v "http://example.org/Claim/identifiers"^^xsd:anyURI ] ; fhir:value [ fhir:v "223452-2342-2435-008001" ] ] ] [ fhir:url [ fhir:v "plannedPeriodOfService"^^xsd:anyURI ] ; fhir:value [ a fhir:date ; fhir:v "2021-10-31"^^xsd:date ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo"^^xsd:anyURI ] ] ) ; # fhir:identifier ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "PLAC" ] ; fhir:display [ fhir:v "Placer Identifier" ] ] ) ] ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:value [ fhir:v "GFEProviderAssignedID0001" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "institutional" ] ; fhir:display [ fhir:v "Institutional" ] ] ) ] ; # fhir:use [ fhir:v "predetermination"] ; # fhir:patient [ fhir:reference [ fhir:v "Patient/patient1001" ] ] ; # fhir:created [ fhir:v "2021-10-05"^^xsd:date] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/org1001" ] ] ; # fhir:provider [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://nucc.org/provider-taxonomy"^^xsd:anyURI ] ; fhir:code [ fhir:v "2085D0003X" ] ; fhir:display [ fhir:v "Diagnostic Neuroimaging (Radiology) Physician" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling"^^xsd:anyURI ] ; fhir:value [ a fhir:boolean ; fhir:v true ] ] ) ; fhir:reference [ fhir:v "Organization/Submitter-Org-1" ] ] ; # fhir:priority [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; fhir:code [ fhir:v "normal" ] ] ) ] ; # fhir:payee [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ; fhir:code [ fhir:v "provider" ] ] ) ] ] ; # fhir:referral [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "REF12022002-121" ] ] ) ; fhir:display [ fhir:v "Referral Number" ] ] ; # fhir:supportingInfo ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType"^^xsd:anyURI ] ; fhir:code [ fhir:v "typeofbill" ] ] ) ] ; fhir:code [ ( fhir:coding [ fhir:system [ fhir:v "https://www.nubc.org/CodeSystem/TypeOfBill"^^xsd:anyURI ] ; fhir:code [ fhir:v "011X" ] ; fhir:display [ fhir:v "Hospital Inpatient (Part A)" ] ] ) ] ] ) ; # fhir:diagnosis ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:diagnosis [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ] ; fhir:code [ fhir:v "S06.30" ] ; fhir:display [ fhir:v "Unspecified focal traumatic brain injury" ] ] ) ] ; ( fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/diagnosistype"^^xsd:anyURI ] ; fhir:code [ fhir:v "principal" ] ] ) ] ) ; fhir:packageCode [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup"^^xsd:anyURI ] ; fhir:code [ fhir:v "400" ] ; fhir:display [ fhir:v "Head trauma - concussion" ] ] ) ] ] ) ; # fhir:insurance ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:focal [ fhir:v true ] ; fhir:coverage [ fhir:reference [ fhir:v "Coverage/coverage1001" ] ] ] ) ; # fhir:item ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Imaging" ] ] ) ; fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:revenue [ ( fhir:coding [ fhir:system [ fhir:v "https://www.nubc.org/CodeSystem/RevenueCodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "0611" ] ; fhir:display [ fhir:v "Magnetic Resonance Technology (MRT) - Brain/brain stem" ] ] ) ] ; fhir:productOrService [ ( fhir:coding [ fhir:system [ fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ] ; fhir:code [ fhir:v "70551" ] ; fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ] ] ) ] ; ( fhir:modifier [ ( fhir:coding [ fhir:system [ fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ] ; fhir:code [ fhir:v "70551" ] ; fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ] ] ) ] ) ; fhir:serviced [ a fhir:date ; fhir:v "2021-10-31"^^xsd:date ] ; fhir:quantity [ fhir:value [ fhir:v "1"^^xsd:decimal ] ] ; fhir:net [ fhir:value [ fhir:v "200"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; # fhir:total [ fhir:value [ fhir:v "200"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] . # <http://example.org/fhir/Bundle/PCT-GFE-Missing-Bundle-1> a fhir:Bundle ; fhir:id [ fhir:v "PCT-GFE-Missing-Bundle-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-missing-bundle"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-missing-bundle> ] ) ] ; # fhir:identifier [ fhir:system [ fhir:v "http://example.com/identifiers/bundle"^^xsd:anyURI ] ; fhir:value [ fhir:v "59688475-2324-3242-2347384376" ] ] ; # fhir:type [ fhir:v "collection"] ; # fhir:timestamp [ fhir:v "2024-03-27T11:01:00+05:00"^^xsd:dateTime] ; # fhir:entry ( [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/org1002"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/org1002> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Patient/patient1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Patient/patient1001> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Coverage/coverage1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Coverage/coverage1001> ) ] [ fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/org1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/org1001> ) ] [ fhir:id [ fhir:v "PCT-DeviceRequest-1" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1> ) ] ) . # <http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1> a fhir:DeviceRequest ; fhir:id [ fhir:v "PCT-DeviceRequest-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-devicerequest"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-devicerequest> ] ) ] ; # fhir:status [ fhir:v "active"] ; # fhir:intent [ fhir:v "proposal"] ; # fhir:code [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"^^xsd:anyURI ] ; fhir:code [ fhir:v "L1820" ] ; fhir:display [ fhir:v "KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT" ] ] ) ] ; # fhir:subject [ fhir:reference [ fhir:v "Patient/patient1001" ] ] . #
IG © 2025+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pct#2.0.0 based on FHIR 4.0.1. Generated 2025-09-09
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