{ "resourceType" : "Bundle", "id" : "PCT-GFE-Information-Bundle-1", "meta" : { "profile" : ["http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-information-bundle"] }, "identifier" : { "system" : "http://example.com/identifiers/bundle", "value" : "59688475-2324-3242-2347384711" }, "type" : "collection", "timestamp" : "2024-03-27T11:01:00+05:00", "entry" : [{ "fullUrl" : "http://example.org/fhir/Patient/patient1001", "resource" : { "resourceType" : "Patient", "id" : "patient1001", "meta" : { "profile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0"] }, "text" : { "status" : "additional", "div" : "

Eve Betterhalf female, DoB: 1955-07-23 ( http://example.com/identifiers/patient/1001)

Marital Status:unmarried
Contact Details:
  • ph: 781-949-4949(MOBILE)
  • 222 Burlington Road, Bedford MA 01730
Language:English (United States) (preferred)
" }, "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 }] } }, { "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" : "extensions", "div" : "

Generated Narrative: Coverage coverage1001

Profile: PCT Coverage

Extension Definition for Coverage.kind for Version 5.0: insurance

status: Active

subscriberId: PFP123450000

beneficiary: Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)

relationship: Self

period: 2021-01-01 --> 2022-01-01

payor: Organization Umbrella Insurance Company

Classes

-TypeValueName
*PlanPremim Family PlusPremim Family Plus Plan

CostToBeneficiaries

-TypeValue[x]
*Copay Percentage20
" }, "extension" : [{ "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind", "valueCode" : "insurance" }], "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 } }] } }, { "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" : "generated", "div" : "

Generated Narrative: Organization org1001

Profile: PCT Organization

identifier: Electronic Transmitter Identification Number/ETIN-3200002

active: true

type: Payer

name: Umbrella Insurance Company

telecom: ph: 860-547-5001(Work)

address: 680 Asylum Street Hartford CT 06155 US

" }, "identifier" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "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" : [{ "line" : ["680 Asylum Street"], "city" : "Hartford", "state" : "CT", "postalCode" : "06155", "country" : "US" }] } }, { "id" : "PCT-ServiceLocation-1", "fullUrl" : "http://example.org/fhir/Location/PCT-ServiceLocation-1", "resource" : { "resourceType" : "Location", "id" : "PCT-ServiceLocation-1", "meta" : { "profile" : ["http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-service-location"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Location PCT-ServiceLocation-1

Profile: PCT Service Location

status: Active

name: Hospital

type: Hospital

" }, "status" : "active", "name" : "Hospital", "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "code" : "HOSP", "display" : "Hospital" }] }] } }, { "id" : "PCT-ServiceRequest-1", "fullUrl" : "http://example.org/fhir/ServiceRequest/PCT-ServiceRequest-1", "resource" : { "resourceType" : "ServiceRequest", "id" : "PCT-ServiceRequest-1", "meta" : { "profile" : ["http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-servicerequest"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: ServiceRequest PCT-ServiceRequest-1

Profile: PCT GFE ServiceRequest

status: Active

intent: Proposal

code: Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)

subject: Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)

" }, "status" : "active", "intent" : "proposal", "code" : { "coding" : [{ "system" : "http://www.ama-assn.org/go/cpt", "code" : "73722", "display" : "Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)" }] }, "subject" : { "reference" : "Patient/patient1001" } } }, { "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" : "generated", "div" : "

Generated Narrative: DeviceRequest PCT-DeviceRequest-1

Profile: PCT GFE DeviceRequest

status: Active

intent: Proposal

code: otherwise customized to fit a specific patient by an individual with expertise

subject: Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)

" }, "status" : "active", "intent" : "proposal", "codeCodeableConcept" : { "coding" : [{ "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets", "code" : "L1820" }] }, "subject" : { "reference" : "Patient/patient1001" } } }] }