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-Information-Bundle-1 - TTL Representation

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    @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-Information-Bundle-1"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-information-bundle"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-information-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 "59688475-2324-3242-2347384711" ]
      ] ; #
      fhir:type [ fhir:v "collection"] ; #
      fhir:timestamp [ fhir:v "2024-03-27T11:01:00+05:00"^^xsd:dateTime] ; #
      fhir:entry ( [
    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> )
      ] [
    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:id [ fhir:v "PCT-ServiceLocation-1" ] ;
    fhir:fullUrl [
    fhir:v "http://example.org/fhir/Location/PCT-ServiceLocation-1"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/Location/PCT-ServiceLocation-1>     ] ;
        ( fhir:resource <http://example.org/fhir/Location/PCT-ServiceLocation-1> )
      ] [
    fhir:id [ fhir:v "PCT-ServiceRequest-1" ] ;
    fhir:fullUrl [
    fhir:v "http://example.org/fhir/ServiceRequest/PCT-ServiceRequest-1"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/ServiceRequest/PCT-ServiceRequest-1>     ] ;
        ( fhir:resource <http://example.org/fhir/ServiceRequest/PCT-ServiceRequest-1> )
      ] [
    fhir:id [ fhir:v "PCT-DeviceRequest-1" ] ;
    fhir:fullUrl [
    fhir:v "http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1>     ] ;
        ( fhir:resource <http://example.org/fhir/DeviceRequest/PCT-DeviceRequest-1> )
      ] ) . #

    <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 ]     ]
      ] ) . #

    <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/Location/PCT-ServiceLocation-1> a fhir:Location ;
      fhir:id [ fhir:v "PCT-ServiceLocation-1"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-service-location"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-service-location>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Location_PCT-ServiceLocation-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Location PCT-ServiceLocation-1</b></p><a name=\"PCT-ServiceLocation-1\"> </a><a name=\"hcPCT-ServiceLocation-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-service-location.html\">PCT Service Location</a></p></div><p><b>status</b>: Active</p><p><b>name</b>: Hospital</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode HOSP}\">Hospital</span></p></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:name [ fhir:v "Hospital"] ; #
      fhir:type ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v3-RoleCode"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v3-RoleCode>       ] ;
    fhir:code [ fhir:v "HOSP" ] ;
    fhir:display [ fhir:v "Hospital" ]     ] )
      ] ) . #

    <http://example.org/fhir/ServiceRequest/PCT-ServiceRequest-1> a fhir:ServiceRequest ;
      fhir:id [ fhir:v "PCT-ServiceRequest-1"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-servicerequest"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-servicerequest>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ServiceRequest_PCT-ServiceRequest-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ServiceRequest PCT-ServiceRequest-1</b></p><a name=\"PCT-ServiceRequest-1\"> </a><a name=\"hcPCT-ServiceRequest-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-servicerequest.html\">PCT GFE ServiceRequest</a></p></div><p><b>status</b>: Active</p><p><b>intent</b>: Proposal</p><p><b>code</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 73722}\">Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)</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></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:intent [ fhir:v "proposal"] ; #
      fhir:code [
        ( 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 "73722" ] ;
    fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)" ]     ] )
      ] ; #
      fhir:subject [
    fhir:l fhir:Patient/patient1001 ;
    fhir:reference [ fhir:v "Patient/patient1001" ]
      ] . #

    <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:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-devicerequest>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"DeviceRequest_PCT-DeviceRequest-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: DeviceRequest PCT-DeviceRequest-1</b></p><a name=\"PCT-DeviceRequest-1\"> </a><a name=\"hcPCT-DeviceRequest-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-devicerequest.html\">PCT GFE DeviceRequest</a></p></div><p><b>status</b>: Active</p><p><b>intent</b>: Proposal</p><p><b>code</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets L1820}\">otherwise customized to fit a specific patient by an individual with expertise</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></div>"^^rdf:XMLLiteral ]
      ] ; #
      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:l <http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets>       ] ;
    fhir:code [ fhir:v "L1820" ]     ] )
      ] ; #
      fhir:subject [
    fhir:l fhir:Patient/patient1001 ;
    fhir:reference [ fhir:v "Patient/patient1001" ]
      ] . #