Patient Cost Transparency Implementation Guide
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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-ballot 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

: PCT-GFE-Collection-Bundle-1 - JSON Representation

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{
  "resourceType" : "Bundle",
  "id" : "PCT-GFE-Collection-Bundle-1",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-collection-bundle"
    ]
  },
  "identifier" : {
    "system" : "http://example.com/identifiers/bundle",
    "value" : "59688475-2324-3242-2347384711"
  },
  "type" : "collection",
  "timestamp" : "2024-03-29T11:01:00+05:00",
  "entry" : [
    {
      "id" : "patient1001",
      "fullUrl" : "http://example.org/fhir/Patient/patient1001",
      "resource" : {
        "resourceType" : "Patient",
        "id" : "patient1001",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics"
          ]
        },
        "text" : {
          "status" : "additional",
          "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>"
        },
        "identifier" : [
          {
            "system" : "http://example.com/identifiers/patient",
            "value" : "1001"
          }
        ],
        "name" : [
          {
            "text" : "Eve Betterhalf",
            "family" : "Betterhalf",
            "given" : [
              "Eve"
            ]
          }
        ],
        "telecom" : [
          {
            "system" : "phone",
            "value" : "781-949-4949",
            "use" : "mobile"
          }
        ],
        "gender" : "female",
        "birthDate" : "1955-07-23",
        "address" : [
          {
            "text" : "222 Burlington Road, Bedford MA 01730"
          }
        ],
        "maritalStatus" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
              "code" : "U",
              "display" : "unmarried"
            }
          ]
        },
        "communication" : [
          {
            "language" : {
              "coding" : [
                {
                  "system" : "urn:ietf:bcp:47",
                  "code" : "en-US",
                  "display" : "English (United States)"
                }
              ]
            },
            "preferred" : true
          }
        ]
      }
    },
    {
      "id" : "coverage1001",
      "fullUrl" : "http://example.org/fhir/Coverage/coverage1001",
      "resource" : {
        "resourceType" : "Coverage",
        "id" : "coverage1001",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"
          ]
        },
        "text" : {
          "status" : "additional",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"coverage1001\"></a><a name=\"hccoverage1001\"></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 Coverage &quot;coverage1001&quot;</p><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\">Patient/patient1001</a> &quot; BETTERHALF&quot;</p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2021-01-01 --&gt; 2022-01-01</p><p><b>payor</b>: <a href=\"Organization-org1001.html\">Organization/org1001</a> &quot;Umbrella Insurance Company&quot;</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>Plan <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)</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>Copay Percentage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-copay-type.html\">Coverage Copay Type Codes</a>#copaypct)</span></td><td>20</td></tr></table></div>"
        },
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind",
            "valueCode" : "insurance"
          },
          {
            "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared",
            "valueBoolean" : false
          }
        ],
        "status" : "active",
        "subscriberId" : "PFP123450000",
        "beneficiary" : {
          🔗 "reference" : "Patient/patient1001"
        },
        "relationship" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
              "code" : "self",
              "display" : "Self"
            }
          ]
        },
        "period" : {
          "start" : "2021-01-01",
          "end" : "2022-01-01"
        },
        "payor" : [
          {
            🔗 "reference" : "Organization/org1001"
          }
        ],
        "class" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                  "code" : "plan",
                  "display" : "Plan"
                }
              ]
            },
            "value" : "Premim Family Plus",
            "name" : "Premim Family Plus Plan"
          }
        ],
        "costToBeneficiary" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
                  "code" : "copaypct",
                  "display" : "Copay Percentage"
                }
              ]
            },
            "valueQuantity" : {
              "value" : 20
            }
          }
        ]
      }
    },
    {
      "id" : "Submitter-Org-1",
      "fullUrl" : "http://example.org/fhir/Organization/Submitter-Org-1",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "Submitter-Org-1",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"
          ]
        },
        "text" : {
          "status" : "additional",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"Submitter-Org-1\"></a><a name=\"hcSubmitter-Org-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 Organization &quot;Submitter-Org-1&quot;</p><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>: Non-Healthcare Business or Corporation <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>#bus)</span></p><p><b>name</b>: GFE Service Help INC.</p><h3>Contacts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Purpose</b></td><td><b>Name</b></td><td><b>Telecom</b></td></tr><tr><td style=\"display: none\">*</td><td>GFE-related <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"CodeSystem-PCTOrgContactPurposeType.html\">PCT Organization Contact Purpose Type Code System</a>#GFERELATED)</span></td><td>Clara Sender</td><td>ph: 781-632-3209(WORK), <a href=\"mailto:csender@GFEServiceHelp.com\">csender@GFEServiceHelp.com</a></td></tr></table></div>"
        },
        "identifier" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgIdentifierTypeCS",
                  "code" : "ETIN"
                }
              ]
            },
            "value" : "ETIN-10010301"
          }
        ],
        "active" : true,
        "type" : [
          {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                "code" : "bus"
              }
            ]
          }
        ],
        "name" : "GFE Service Help INC.",
        "contact" : [
          {
            "purpose" : {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgContactPurposeType",
                  "code" : "GFERELATED"
                }
              ]
            },
            "name" : {
              "text" : "Clara Sender"
            },
            "telecom" : [
              {
                "system" : "phone",
                "value" : "781-632-3209",
                "use" : "work"
              },
              {
                "system" : "email",
                "value" : "csender@GFEServiceHelp.com",
                "use" : "work"
              }
            ]
          }
        ]
      }
    },
    {
      "id" : "org1001",
      "fullUrl" : "http://example.org/fhir/Organization/org1001",
      "resource" : {
        "resourceType" : "Organization",
        "id" : "org1001",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"
          ]
        },
        "text" : {
          "status" : "additional",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"org1001\"></a><a name=\"hcorg1001\"></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 Organization &quot;org1001&quot;</p><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>: Payer <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>#pay)</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>"
        },
        "identifier" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgIdentifierTypeCS",
                  "code" : "ETIN"
                }
              ]
            },
            "value" : "ETIN-3200002"
          }
        ],
        "active" : true,
        "type" : [
          {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                "code" : "pay",
                "display" : "Payer"
              }
            ]
          }
        ],
        "name" : "Umbrella Insurance Company",
        "telecom" : [
          {
            "system" : "phone",
            "value" : "860-547-5001",
            "use" : "work"
          }
        ],
        "address" : [
          {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/countrySubdivisionCode",
                "valueCoding" : {
                  "system" : "urn:iso:std:iso:3166:-2",
                  "code" : "US-CT"
                }
              }
            ],
            "line" : [
              "680 Asylum Street"
            ],
            "city" : "Hartford",
            "state" : "CT",
            "postalCode" : "06155",
            "country" : "US"
          }
        ]
      }
    },
    {
      "id" : "PCT-GFE-Missing-Bundle-1",
      "fullUrl" : "http://example.org/fhir/Bundle/PCT-GFE-Missing-Bundle-1",
      "resource" : {
        "resourceType" : "Bundle",
        "id" : "PCT-GFE-Missing-Bundle-1",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-missing-bundle"
          ]
        },
        "type" : "collection",
        "timestamp" : "2024-03-27T11:01:00+05:00",
        "entry" : [
          {
            "id" : "org1002",
            "fullUrl" : "http://example.org/fhir/Organization/org1002",
            "resource" : {
              "resourceType" : "Organization",
              "id" : "org1002",
              "meta" : {
                "profile" : [
                  🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"
                ]
              },
              "text" : {
                "status" : "additional",
                "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"org1002\"></a><a name=\"hcorg1002\"></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 Organization &quot;org1002&quot;</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-organization.html\">PCT Organization</a></p></div><p><b>identifier</b>: National provider identifier/1234568095, Tax ID number/TAX-3211001</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>: 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>"
              },
              "identifier" : [
                {
                  "type" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code" : "NPI"
                      }
                    ]
                  },
                  "system" : "http://hl7.org/fhir/sid/us-npi",
                  "value" : "1234568095"
                },
                {
                  "type" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code" : "TAX"
                      }
                    ]
                  },
                  "system" : "urn:oid:2.16.840.1.113883.4.4",
                  "value" : "TAX-3211001"
                }
              ],
              "active" : true,
              "type" : [
                {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                      "code" : "prov",
                      "display" : "Healthcare Provider"
                    }
                  ]
                }
              ],
              "name" : "Boston Radiology Center",
              "telecom" : [
                {
                  "system" : "phone",
                  "value" : "781-232-3200",
                  "use" : "work"
                }
              ],
              "address" : [
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/countrySubdivisionCode",
                      "valueCoding" : {
                        "system" : "urn:iso:std:iso:3166:-2",
                        "code" : "US-MA"
                      }
                    }
                  ],
                  "line" : [
                    "32 Fruit Street"
                  ],
                  "city" : "Boston",
                  "state" : "MA",
                  "postalCode" : "02114",
                  "country" : "US"
                }
              ]
            }
          },
          {
            "id" : "patient1001",
            "fullUrl" : "http://example.org/fhir/Patient/patient1001",
            "resource" : {
              "resourceType" : "Patient",
              "id" : "patient1001",
              "meta" : {
                "profile" : [
                  🔗 "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics"
                ]
              },
              "text" : {
                "status" : "additional",
                "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>"
              },
              "identifier" : [
                {
                  "system" : "http://example.com/identifiers/patient",
                  "value" : "1001"
                }
              ],
              "name" : [
                {
                  "text" : "Eve Betterhalf",
                  "family" : "Betterhalf",
                  "given" : [
                    "Eve"
                  ]
                }
              ],
              "telecom" : [
                {
                  "system" : "phone",
                  "value" : "781-949-4949",
                  "use" : "mobile"
                }
              ],
              "gender" : "female",
              "birthDate" : "1955-07-23",
              "address" : [
                {
                  "text" : "222 Burlington Road, Bedford MA 01730"
                }
              ],
              "maritalStatus" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code" : "U",
                    "display" : "unmarried"
                  }
                ]
              },
              "communication" : [
                {
                  "language" : {
                    "coding" : [
                      {
                        "system" : "urn:ietf:bcp:47",
                        "code" : "en-US",
                        "display" : "English (United States)"
                      }
                    ]
                  },
                  "preferred" : true
                }
              ]
            }
          },
          {
            "id" : "coverage1001",
            "fullUrl" : "http://example.org/fhir/Coverage/coverage1001",
            "resource" : {
              "resourceType" : "Coverage",
              "id" : "coverage1001",
              "meta" : {
                "profile" : [
                  🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"
                ]
              },
              "text" : {
                "status" : "additional",
                "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"coverage1001\"></a><a name=\"hccoverage1001\"></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 Coverage &quot;coverage1001&quot;</p><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\">Patient/patient1001</a> &quot; BETTERHALF&quot;</p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2021-01-01 --&gt; 2022-01-01</p><p><b>payor</b>: <a href=\"Organization-org1001.html\">Organization/org1001</a> &quot;Umbrella Insurance Company&quot;</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>Plan <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)</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>Copay Percentage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-copay-type.html\">Coverage Copay Type Codes</a>#copaypct)</span></td><td>20</td></tr></table></div>"
              },
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind",
                  "valueCode" : "insurance"
                },
                {
                  "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared",
                  "valueBoolean" : false
                }
              ],
              "status" : "active",
              "subscriberId" : "PFP123450000",
              "beneficiary" : {
                🔗 "reference" : "Patient/patient1001"
              },
              "relationship" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code" : "self",
                    "display" : "Self"
                  }
                ]
              },
              "period" : {
                "start" : "2021-01-01",
                "end" : "2022-01-01"
              },
              "payor" : [
                {
                  🔗 "reference" : "Organization/org1001"
                }
              ],
              "class" : [
                {
                  "type" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code" : "plan",
                        "display" : "Plan"
                      }
                    ]
                  },
                  "value" : "Premim Family Plus",
                  "name" : "Premim Family Plus Plan"
                }
              ],
              "costToBeneficiary" : [
                {
                  "type" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
                        "code" : "copaypct",
                        "display" : "Copay Percentage"
                      }
                    ]
                  },
                  "valueQuantity" : {
                    "value" : 20
                  }
                }
              ]
            }
          },
          {
            "id" : "PCT-DeviceRequest-1",
            "fullUrl" : "http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1",
            "resource" : {
              "resourceType" : "DeviceRequest",
              "id" : "PCT-DeviceRequest-1",
              "meta" : {
                "profile" : [
                  🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-devicerequest"
                ]
              },
              "text" : {
                "status" : "additional",
                "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><a name=\"PCT-DeviceRequest-1\"></a><a name=\"hcPCT-DeviceRequest-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 DeviceRequest &quot;PCT-DeviceRequest-1&quot;</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-devicerequest.html\">PCT GFE DeviceRequest</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: proposal</p><p><b>code</b>: KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">(HCPCSReleaseCodeSets#L1820)</span></p><p><b>subject</b>: <a href=\"Patient-patient1001.html\">Patient/patient1001</a> &quot; BETTERHALF&quot;</p></div>"
              },
              "status" : "active",
              "intent" : "proposal",
              "codeCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                    "code" : "L1820",
                    "display" : "KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT"
                  }
                ]
              },
              "subject" : {
                🔗 "reference" : "Patient/patient1001"
              }
            }
          }
        ]
      }
    }
  ]
}