Patient Cost Transparency Implementation Guide
2.0.2 - STU 2 United States of America flag

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 2.0.2 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-AEOB-DocumentReference-1

Page standards status: Informative

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <http://loinc.org/rdf#> .
@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 -------------------------------------------------------------------

<http://hl7.org/fhir/DocumentReference/PCT-AEOB-DocumentReference-1> a fhir:DocumentReference ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "PCT-AEOB-DocumentReference-1"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-documentreference" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-documentreference>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ] ;
     fhir:Narrative.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: #fbffeb; 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\">Umbrella Insurance Company (Payer) (Electronic Transmitter Identification Number: ETIN-3200002)</a></li><li><a href=\"Organization-Submitter-Org-1.html\">GFE Service Help INC. (Non-Healthcare Business or Corporation) (Electronic Transmitter Identification Number: ETIN-10010301)</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>"
  ] ;
  fhir:DomainResource.extension [
     fhir:index -1 ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/requestInitiationTime" ] ;
     fhir:Extension.valueInstant [ fhir:value "2025-01-08T09:01:00+05:00"^^xsd:dateTime ]
  ], [
     fhir:index -1 ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimateProcedureOrService" ] ;
     fhir:Extension.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://www.ama-assn.org/go/cpt" ] ;
         fhir:Coding.code [ fhir:value "70551" ] ;
         fhir:Coding.display [ fhir:value "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ]
       ]
     ]
  ], [
     fhir:index -1 ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimateCondition" ] ;
     fhir:Extension.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index -1 ;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ] ;
         fhir:Coding.code [ fhir:value "S06.30" ] ;
         fhir:Coding.display [ fhir:value "Unspecified focal traumatic brain injury" ]
       ]
     ]
  ] ;
  fhir:DocumentReference.status [ fhir:value "current"] ;
  fhir:DocumentReference.docStatus [ fhir:value "final"] ;
  fhir:DocumentReference.type [
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       a loinc:111479-2 ;
       fhir:Coding.system [ fhir:value "http://loinc.org" ] ;
       fhir:Coding.code [ fhir:value "111479-2" ] ;
       fhir:Coding.display [ fhir:value "Advanced explanation of benefits" ]
     ]
  ] ;
  fhir:DocumentReference.category [
     fhir:index -1 ;
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentTypeTemporaryTrialUse" ] ;
       fhir:Coding.code [ fhir:value "estimate" ]
     ]
  ] ;
  fhir:DocumentReference.subject [
     fhir:link <http://hl7.org/fhir/Patient/patient1001> ;
     fhir:Reference.reference [ fhir:value "Patient/patient1001" ]
  ] ;
  fhir:DocumentReference.date [ fhir:value "2025-01-10T11:01:00+05:00"^^xsd:dateTime] ;
  fhir:DocumentReference.author [
     fhir:index -1 ;
     fhir:link <http://hl7.org/fhir/Organization/org1001> ;
     fhir:Reference.reference [ fhir:value "Organization/org1001" ]
  ], [
     fhir:index -1 ;
     fhir:link <http://hl7.org/fhir/Organization/Submitter-Org-1> ;
     fhir:Reference.reference [ fhir:value "Organization/Submitter-Org-1" ]
  ] ;
  fhir:DocumentReference.content [
     fhir:index -1 ;
     fhir:DocumentReference.content.attachment [
       fhir:Attachment.url [ fhir:value "http://example.org/fhir/Bundle/PCT-AEOB-Packet-1" ]
     ]
  ] .

<http://hl7.org/fhir/Patient/patient1001> a fhir:Patient .

<http://hl7.org/fhir/Organization/org1001> a fhir:Organization .

<http://hl7.org/fhir/Organization/Submitter-Org-1> a fhir:Organization .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/DocumentReference/PCT-AEOB-DocumentReference-1.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/DocumentReference/PCT-AEOB-DocumentReference-1.ttl> .