Patient Cost Transparency Implementation Guide
2.0.1 - 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 2.0.1 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-Bundle-Inst-1 - TTL Representation

Raw ttl | Download

    @prefix fhir: <http://hl7.org/fhir/> .
    @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-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:l <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:l <http://example.com/identifiers/bundle>     ] ;
    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:l <http://example.org/fhir/Claim/PCT-GFE-Summary-1>     ] ;
        ( 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:l <http://example.org/fhir/Claim/PCT-GFE-Institutional-1>     ] ;
        ( 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:l <http://example.org/fhir/Organization/Submitter-Org-1>     ] ;
        ( fhir:resource <http://example.org/fhir/Organization/Submitter-Org-1> )
      ] [
    fhir:fullUrl [
    fhir:v "http://example.org/fhir/Organization/org1001"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/Organization/org1001>     ] ;
        ( fhir:resource <http://example.org/fhir/Organization/org1001> )
      ] [
    fhir:fullUrl [
    fhir:v "http://example.org/fhir/Patient/patient1001"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/Patient/patient1001>     ] ;
        ( fhir:resource <http://example.org/fhir/Patient/patient1001> )
      ] [
    fhir:fullUrl [
    fhir:v "http://example.org/fhir/Coverage/coverage1001"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/Coverage/coverage1001>     ] ;
        ( 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:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-summary>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_PCT-GFE-Summary-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim PCT-GFE-Summary-1</b></p><a name=\"PCT-GFE-Summary-1\"> </a><a name=\"hcPCT-GFE-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-gfe-summary.html\">PCT Good Faith Estimate  Summary</a></p></div><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>: 2021-10-31 --&gt; 2021-10-31</p><p><b>created</b>: 2021-10-05</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><p><b>provider</b>: ?rref?</p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td><td><b>PackageCode</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm S06.30}\">Unspecified focal traumatic brain injury</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/diagnosistype principal}\">Principal Diagnosis</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup 400}\">Head trauma - concussion</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --&gt; 2022-01-01</a></td></tr></table><h3>Totals</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></div>"^^rdf:XMLLiteral ]
      ] ; #
      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:l <http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse>       ] ;
    fhir:code [ fhir:v "estimate-summary" ] ;
    fhir:display [ fhir:v "Estimate Summary" ]     ] )
      ] ; #
      fhir:use [ fhir:v "predetermination"] ; #
      fhir:patient [
    fhir:l fhir:Patient/patient1001 ;
    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:l fhir:Organization/org1001 ;
    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:l <http://hl7.org/fhir/StructureDefinition/data-absent-reason>       ] ;
    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:l <http://terminology.hl7.org/CodeSystem/processpriority>       ] ;
    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:l <http://hl7.org/fhir/sid/icd-10-cm>         ] ;
    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:l <http://terminology.hl7.org/CodeSystem/diagnosistype>         ] ;
    fhir:code [ fhir:v "principal" ]       ] )     ] ) ;
    fhir:packageCode [
          ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup>         ] ;
    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:l fhir:Coverage/coverage1001 ;
    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:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_PCT-GFE-Institutional-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim PCT-GFE-Institutional-1</b></p><a name=\"PCT-GFE-Institutional-1\"> </a><a name=\"hcPCT-GFE-Institutional-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-gfe-institutional.html\">PCT Good Faith Estimate Institutional</a></p></div><p><b>ProviderEventMethodology</b>: EEMM1021</p><p><b>GFEDisclaimer</b>: For estimation purposes only</p><blockquote><p><b>GFEServiceLinkingInfo</b></p><ul><li>linkingIdentifier: <code>http://example.org/Claim/identifiers</code>/223452-2342-2435-008001</li><li>plannedPeriodOfService: 2021-10-31</li></ul></blockquote><p><b>identifier</b>: Placer Identifier/GFEProviderAssignedID0001</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>: 2021-10-05</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><p><b>provider</b>: <a href=\"Organization-Submitter-Org-1.html\">Organization GFE Service Help INC.</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td></tr></table><p><b>referral</b>: Referral Number</p><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType typeofbill}\">Type of Bill</span></td><td><span title=\"Codes:{https://www.nubc.org/CodeSystem/TypeOfBill 011X}\">Hospital Inpatient (Part A)</span></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td><td><b>PackageCode</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm S06.30}\">Unspecified focal traumatic brain injury</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/diagnosistype principal}\">Principal Diagnosis</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup 400}\">Head trauma - concussion</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --&gt; 2022-01-01</a></td></tr></table><blockquote><p><b>item</b></p><p><b>Service Description</b>: Imaging</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>: 2021-10-31</p><p><b>quantity</b>: 1</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></blockquote><h3>Totals</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></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:extension ( [
    fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology>     ] ;
    fhir:value [
    a fhir:String ;
    fhir:v "EEMM1021"     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer>     ] ;
    fhir:value [
    a fhir:String ;
    fhir:v "For estimation purposes only"     ]
      ] [
        ( fhir:extension [
    fhir:url [
    fhir:v "linkingIdentifier"^^xsd:anyURI ;
    fhir:l fhir:linkingIdentifier       ] ;
    fhir:value [
    a fhir:Identifier ;
    fhir:system [
    fhir:v "http://example.org/Claim/identifiers"^^xsd:anyURI ;
    fhir:l <http://example.org/Claim/identifiers>         ] ;
    fhir:value [ fhir:v "223452-2342-2435-008001" ]       ]     ] [
    fhir:url [
    fhir:v "plannedPeriodOfService"^^xsd:anyURI ;
    fhir:l fhir:plannedPeriodOfService       ] ;
    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:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo>     ]
      ] ) ; #
      fhir:identifier ( [
    fhir:type [
          ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203>         ] ;
    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:l <http://terminology.hl7.org/CodeSystem/v2-0203>     ] ;
    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:l <http://terminology.hl7.org/CodeSystem/claim-type>       ] ;
    fhir:code [ fhir:v "institutional" ] ;
    fhir:display [ fhir:v "Institutional" ]     ] )
      ] ; #
      fhir:use [ fhir:v "predetermination"] ; #
      fhir:patient [
    fhir:l fhir:Patient/patient1001 ;
    fhir:reference [ fhir:v "Patient/patient1001" ]
      ] ; #
      fhir:created [ fhir:v "2021-10-05"^^xsd:date] ; #
      fhir:insurer [
    fhir:l fhir:Organization/org1001 ;
    fhir:reference [ fhir:v "Organization/org1001" ]
      ] ; #
      fhir:provider [
    fhir:l fhir:Organization/Submitter-Org-1 ;
        ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy>       ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [
    fhir:v "http://nucc.org/provider-taxonomy"^^xsd:anyURI ;
    fhir:l <http://nucc.org/provider-taxonomy>           ] ;
    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:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling>       ] ;
    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:l <http://terminology.hl7.org/CodeSystem/processpriority>       ] ;
    fhir:code [ fhir:v "normal" ]     ] )
      ] ; #
      fhir:payee [
    fhir:type [
          ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/payeetype>         ] ;
    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:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber>       ] ;
    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:l <http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType>         ] ;
    fhir:code [ fhir:v "typeofbill" ]       ] )     ] ;
    fhir:code [
          ( fhir:coding [
    fhir:system [
    fhir:v "https://www.nubc.org/CodeSystem/TypeOfBill"^^xsd:anyURI ;
    fhir:l <https://www.nubc.org/CodeSystem/TypeOfBill>         ] ;
    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:l <http://hl7.org/fhir/sid/icd-10-cm>         ] ;
    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:l <http://terminology.hl7.org/CodeSystem/diagnosistype>         ] ;
    fhir:code [ fhir:v "principal" ]       ] )     ] ) ;
    fhir:packageCode [
          ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup>         ] ;
    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:l fhir:Coverage/coverage1001 ;
    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:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription>       ] ;
    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:l <https://www.nubc.org/CodeSystem/RevenueCodes>         ] ;
    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:l <http://www.ama-assn.org/go/cpt>         ] ;
    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:l <http://www.ama-assn.org/go/cpt>         ] ;
    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/Organization/Submitter-Org-1> a fhir:Organization ;
      fhir:id [ 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:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<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:l <http://terminology.hl7.org/CodeSystem/v2-0203>         ] ;
    fhir:code [ fhir:v "ETIN" ]       ] )     ] ;
    fhir:value [ fhir:v "ETIN-10010301" ]
      ] ) ; #
      fhir:active [ fhir:v true] ; #
      fhir:type ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/organization-type>       ] ;
    fhir:code [ fhir:v "bus" ]     ] )
      ] ) ; #
      fhir:name [ 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:l <http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTOrgContactPurposeType>         ] ;
    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/org1001> a fhir:Organization ;
      fhir:id [ fhir:v "org1001"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<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:l <http://terminology.hl7.org/CodeSystem/v2-0203>         ] ;
    fhir:code [ fhir:v "ETIN" ]       ] )     ] ;
    fhir:value [ fhir:v "ETIN-3200002" ]
      ] ) ; #
      fhir:active [ fhir:v true] ; #
      fhir:type ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/organization-type>       ] ;
    fhir:code [ fhir:v "pay" ] ;
    fhir:display [ fhir:v "Payer" ]     ] )
      ] ) ; #
      fhir:name [ 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: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" ]
      ] ) . #

    <http://example.org/fhir/Patient/patient1001> a fhir:Patient ;
      fhir:id [ 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:l <http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient?version=7.0.0>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "additional" ] ;
    fhir:div [ fhir:v "<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:identifier ( [
    fhir:system [
    fhir:v "http://example.com/identifiers/patient"^^xsd:anyURI ;
    fhir:l <http://example.com/identifiers/patient>     ] ;
    fhir:value [ fhir:v "1001" ]
      ] ) ; #
      fhir:name ( [
    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:gender [ fhir:v "female"] ; #
      fhir:birthDate [ fhir:v "1955-07-23"^^xsd:date] ; #
      fhir:address ( [
    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:l <http://terminology.hl7.org/CodeSystem/v3-MaritalStatus>       ] ;
    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:l <urn:ietf:bcp:47>         ] ;
    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:id [ fhir:v "coverage1001"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div [ fhir:v "<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 --&gt; 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:l <http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "insurance"     ]
      ] ) ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:subscriberId [ fhir:v "PFP123450000"] ; #
      fhir:beneficiary [
    fhir:l fhir: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:l <http://terminology.hl7.org/CodeSystem/subscriber-relationship>       ] ;
    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:payor ( [
    fhir:l fhir: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:l <http://terminology.hl7.org/CodeSystem/coverage-class>         ] ;
    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:l <http://terminology.hl7.org/CodeSystem/coverage-copay-type>         ] ;
    fhir:code [ fhir:v "copaypct" ] ;
    fhir:display [ fhir:v "Copay Percentage" ]       ] )     ] ;
    fhir:value [
    a fhir:Quantity ;
    fhir:value [ fhir:v "20"^^xsd:decimal ]     ]
      ] ) . #