Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot
Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot
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
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @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-GFE-Collection-Bundle-2"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-collection-bundle"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-collection-bundle> ] ) ] ; # fhir:identifier [ fhir:system [ fhir:v "http://example.com/identifiers/bundle"^^xsd:anyURI ] ; fhir:value [ fhir:v "59688475-2324-3242-2347384711" ] ] ; # fhir:type [ fhir:v "collection"] ; # fhir:timestamp [ fhir:v "2024-03-29T11:01:00+05:00"^^xsd:dateTime] ; # fhir:entry ( [ fhir:id [ fhir:v "patient1001" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Patient/patient1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Patient/patient1001> ) ] [ fhir:id [ fhir:v "coverage1001" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Coverage/coverage1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Coverage/coverage1001> ) ] [ fhir:id [ fhir:v "Submitter-Practitioner-1" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Practitioner/Submitter-Practitioner-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Practitioner/Submitter-Practitioner-1> ) ] [ fhir:id [ fhir:v "org1001" ] ; 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-GFE-Bundle-Prof-1" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Bundle/PCT-GFE-Bundle-Prof-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Bundle/PCT-GFE-Bundle-Prof-1> ) ] [ fhir:id [ fhir:v "PCT-GFE-Missing-Bundle-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/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/davinci-hrex/StructureDefinition/hrex-patient-demographics"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics> ] ) ] ; # fhir:text [ 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>" ], [ 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>" ], [ 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>" ] ; # 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"^^xsd:boolean ] ] [ 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"^^xsd:boolean ] ] [ 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"^^xsd:boolean ] ] ) . # <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 "additional" ] ; fhir: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 "coverage1001"</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> " BETTERHALF"</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 --> 2022-01-01</p><p><b>payor</b>: <a href=\"Organization-org1001.html\">Organization/org1001</a> "Umbrella Insurance Company"</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>" ], [ fhir:status [ fhir:v "additional" ] ; fhir: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 "coverage1001"</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> " BETTERHALF"</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 --> 2022-01-01</p><p><b>payor</b>: <a href=\"Organization-org1001.html\">Organization/org1001</a> "Umbrella Insurance Company"</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>" ], [ fhir:status [ fhir:v "additional" ] ; fhir: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 "coverage1001"</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> " BETTERHALF"</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 --> 2022-01-01</p><p><b>payor</b>: <a href=\"Organization-org1001.html\">Organization/org1001</a> "Umbrella Insurance Company"</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>" ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind"^^xsd:anyURI ] ; fhir:value [ fhir:v "insurance" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared"^^xsd:anyURI ] ; fhir:value [ fhir:v "false"^^xsd:boolean ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind"^^xsd:anyURI ] ; fhir:value [ fhir:v "insurance" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared"^^xsd:anyURI ] ; fhir:value [ fhir:v "false"^^xsd:boolean ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind"^^xsd:anyURI ] ; fhir:value [ fhir:v "insurance" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/selfPayDeclared"^^xsd:anyURI ] ; fhir:value [ fhir:v "false"^^xsd:boolean ] ] ) ; # 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/Practitioner/Submitter-Practitioner-1> a fhir:Practitioner, fhir:Practitioner ; fhir:id [ fhir:v "Submitter-Practitioner-1"], [ fhir:v "Submitter-Practitioner-1"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner> ] ) ], [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_Submitter-Practitioner-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner Submitter-Practitioner-1</b></p><a name=\"Submitter-Practitioner-1\"> </a><a name=\"hcSubmitter-Practitioner-1\"> </a><a name=\"Submitter-Practitioner-1-en-US\"> </a><p><b>identifier</b>: National provider identifier/6456789016, Electronic Transmitter Identification Number/ETIN-20020001</p><p><b>active</b>: true</p><p><b>name</b>: Nora Ologist</p><p><b>telecom</b>: ph: 860-547-3301(Work), <a href=\"mailto:csender@GFEServiceHelp.com\">csender@GFEServiceHelp.com</a></p></div>" ] ; # fhir:identifier ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "NPI" ] ] ) ] ; fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ; fhir:value [ fhir:v "6456789016" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgIdentifierTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "ETIN" ] ] ) ] ; fhir:system [ fhir:v "http://example.com/us-etin"^^xsd:anyURI ] ; fhir:value [ fhir:v "ETIN-20020001" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "NPI" ] ] ) ] ; fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ; fhir:value [ fhir:v "6456789016" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgIdentifierTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "ETIN" ] ] ) ] ; fhir:system [ fhir:v "http://example.com/us-etin"^^xsd:anyURI ] ; fhir:value [ fhir:v "ETIN-20020001" ] ] ) ; # fhir:active [ fhir:v "true"^^xsd:boolean], [ fhir:v "true"^^xsd:boolean] ; # fhir:name ( [ fhir:text [ fhir:v "Nora Ologist" ] ; fhir:family [ fhir:v "Ologist" ] ; ( fhir:given [ fhir:v "Nora" ] ) ] [ fhir:text [ fhir:v "Nora Ologist" ] ; fhir:family [ fhir:v "Ologist" ] ; ( fhir:given [ fhir:v "Nora" ] ) ] ) ; # fhir:telecom ( [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "860-547-3301" ] ; fhir:use [ fhir:v "work" ] ] [ fhir:system [ fhir:v "email" ] ; fhir:value [ fhir:v "csender@GFEServiceHelp.com" ] ; fhir:use [ fhir:v "work" ] ] [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "860-547-3301" ] ; 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/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 "additional" ] ; fhir: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 "org1001"</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>" ], [ fhir:status [ fhir:v "additional" ] ; fhir: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 "org1001"</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>" ], [ fhir:status [ fhir:v "additional" ] ; fhir: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 "org1001"</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>" ] ; # fhir:identifier ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgIdentifierTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "ETIN" ] ] ) ] ; fhir:value [ fhir:v "ETIN-3200002" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgIdentifierTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "ETIN" ] ] ) ] ; fhir:value [ fhir:v "ETIN-3200002" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgIdentifierTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "ETIN" ] ] ) ] ; fhir:value [ fhir:v "ETIN-3200002" ] ] ) ; # fhir:active [ fhir:v "true"^^xsd:boolean], [ fhir:v "true"^^xsd:boolean], [ fhir:v "true"^^xsd:boolean] ; # 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:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/countrySubdivisionCode"^^xsd:anyURI ] ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "urn:iso:std:iso:3166:-2"^^xsd:anyURI ] ; fhir:code [ fhir:v "US-CT" ] ] ] ) ; ( 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:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/countrySubdivisionCode"^^xsd:anyURI ] ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "urn:iso:std:iso:3166:-2"^^xsd:anyURI ] ; fhir:code [ fhir:v "US-CT" ] ] ] ) ; ( 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:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/countrySubdivisionCode"^^xsd:anyURI ] ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "urn:iso:std:iso:3166:-2"^^xsd:anyURI ] ; fhir:code [ fhir:v "US-CT" ] ] ] ) ; ( 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/Bundle/PCT-GFE-Bundle-Prof-1> a fhir:Bundle ; fhir:id [ fhir:v "PCT-GFE-Bundle-Prof-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:id [ fhir:v "PCT-GFE-Summary-MRI" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Claim/PCT-GFE-Summary-MRI"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Claim/PCT-GFE-Summary-MRI> ) ] [ fhir:id [ fhir:v "PCT-GFE-Professional-MRI" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Claim/PCT-GFE-Professional-MRI"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Claim/PCT-GFE-Professional-MRI> ) ] [ fhir:id [ fhir:v "Submitter-Practitioner-1" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Practitioner/Submitter-Practitioner-1"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Practitioner/Submitter-Practitioner-1> ) ] [ fhir:id [ fhir:v "org1001" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/org1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/org1001> ) ] [ fhir:id [ fhir:v "patient1001" ] ; 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-MRI> a fhir:Claim ; fhir:id [ fhir:v "PCT-GFE-Summary-MRI"] ; # 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: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 [ 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/ex-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"^^xsd:boolean ] ; 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-Professional-MRI> a fhir:Claim ; fhir:id [ fhir:v "PCT-GFE-Professional-MRI"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional> ] ) ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology"^^xsd:anyURI ] ; fhir:value [ fhir:v "EEMM1022" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "linkingIdentifier"^^xsd:anyURI ] ; fhir:value [ fhir:v "223452-2342-2435-008001" ] ] [ fhir:url [ fhir:v "plannedPeriodOfService"^^xsd:anyURI ] ; fhir:value [ 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 "GFEProviderAssignedID0002" ] ] ) ; # 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 "professional" ] ; fhir:display [ fhir:v "Professional" ] ] ) ] ; # 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:reference [ fhir:v "Practitioner/Submitter-Practitioner-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 [ fhir:v "REF12022002-122" ] ] ) ; fhir:display [ fhir:v "Referral Number" ] ] ; # 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/ex-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"^^xsd:boolean ] ; 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 [ fhir:v "Imaging" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum"^^xsd:anyURI ] ; fhir:value [ a fhir:Identifier ; fhir:value [ fhir:v "GFEBillingProviderLineItemCtrlNum-0001" ] ] ] ) ; fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; 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 [ fhir:v "2021-10-31"^^xsd:date ] ; fhir:location [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ; fhir:code [ fhir:v "21" ] ; fhir:display [ fhir:v "Inpatient Hospital" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "1"^^xsd:decimal ] ] ; fhir:unitPrice [ fhir:value [ fhir:v "200"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; 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:type [ fhir:v "collection"] ; # fhir:timestamp [ fhir:v "2024-03-27T11:01:00+05:00"^^xsd:dateTime] ; # fhir:entry ( [ fhir:id [ fhir:v "org1002" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/org1002"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Organization/org1002> ) ] [ fhir:id [ fhir:v "patient1001" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Patient/patient1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Patient/patient1001> ) ] [ fhir:id [ fhir:v "coverage1001" ] ; fhir:fullUrl [ fhir:v "http://example.org/fhir/Coverage/coverage1001"^^xsd:anyURI ] ; ( fhir:resource <http://example.org/fhir/Coverage/coverage1001> ) ] [ fhir:id [ fhir:v "org1001" ] ; 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/Organization/org1002> a fhir:Organization ; fhir:id [ 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:text [ fhir:status [ fhir:v "additional" ] ; fhir: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 "org1002"</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>" ] ; # fhir:identifier ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "NPI" ] ] ) ] ; fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ; fhir:value [ fhir:v "1234568095" ] ] [ 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"^^xsd:boolean] ; # 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:name [ 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:address ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/countrySubdivisionCode"^^xsd:anyURI ] ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "urn:iso:std:iso:3166:-2"^^xsd:anyURI ] ; fhir:code [ fhir:v "US-MA" ] ] ] ) ; ( 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/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:text [ fhir:status [ fhir:v "additional" ] ; fhir: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 "PCT-DeviceRequest-1"</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> " BETTERHALF"</p></div>" ] ; # 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 © 2023+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pct#2.0.0-ballot based on FHIR 4.0.1. Generated 2024-11-20
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