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

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: PCT-AEOB-DocumentReference-1 - JSON Representation

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{
  "resourceType" : "DocumentReference",
  "id" : "PCT-AEOB-DocumentReference-1",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-documentreference"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: DocumentReference PCT-AEOB-DocumentReference-1</b></p><a name=\"PCT-AEOB-DocumentReference-1\"> </a><a name=\"hcPCT-AEOB-DocumentReference-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-documentreference.html\">PCT AEOB Packet Document Reference</a></p></div><p><b>Request Initiation Time</b>: 2025-01-08 09:01:00+0500</p><p><b>Significant Procedures and/or products involved</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>Significant condition involved</b>: <span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm S06.30}\">Unspecified focal traumatic brain injury</span></p><p><b>status</b>: Current</p><p><b>docStatus</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>subject</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></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><blockquote><p><b>content</b></p><h3>Attachments</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://example.org/fhir/Bundle/PCT-AEOB-Packet-1\">http://example.org/fhir/Bundle/PCT-AEOB-Packet-1</a></td></tr></table></blockquote></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/requestInitiationTime",
      "valueInstant" : "2025-01-08T09:01:00+05:00"
    },
    {
      "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimateProcedureOrService",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://www.ama-assn.org/go/cpt",
            "code" : "70551",
            "display" : "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material"
          }
        ]
      }
    },
    {
      "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimateCondition",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/sid/icd-10-cm",
            "code" : "S06.30",
            "display" : "Unspecified focal traumatic brain injury"
          }
        ]
      }
    }
  ],
  "status" : "current",
  "docStatus" : "final",
  "type" : {
    "coding" : [
      {
        "system" : "http://loinc.org",
        "code" : "111479-2",
        "display" : "Advanced explanation of benefits"
      }
    ]
  },
  "category" : [
    {
      "coding" : [
        {
          "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentTypeTemporaryTrialUse",
          "code" : "estimate"
        }
      ]
    }
  ],
  "subject" : {
    🔗 "reference" : "Patient/patient1001"
  },
  "date" : "2025-01-10T11:01:00+05:00",
  "author" : [
    {
      🔗 "reference" : "Organization/org1001"
    },
    {
      🔗 "reference" : "Organization/Submitter-Org-1"
    }
  ],
  "content" : [
    {
      "attachment" : {
        "url" : "http://example.org/fhir/Bundle/PCT-AEOB-Packet-1"
      }
    }
  ]
}