{ "resourceType" : "Bundle", "id" : "ClaimsForm1-1", "identifier" : { "system" : "http://nhdr.gov.ph/fhir/ValueSet-form-type", "value" : "CF1" }, "type" : "transaction", "entry" : [{ "fullUrl" : "urn:uuid:relatedperson", "resource" : { "resourceType" : "RelatedPerson", "id" : "CF1-RelatedPerson", "meta" : { "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-RelatedPerson"] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: RelatedPerson CF1-RelatedPerson

Profile: PH RelatedPerson

Sex at birth: F

identifier: PhilHealth Identification Number/PH54321

patient: Patient

name: Lorna Mae Santos Bautista

telecom: ph: 912-00-00, ph: 0927-000-0000, lmbautista@email.com

birthDate: 1971-02-11

address: Fordham Road 1110 PH

" }, "extension" : [{ "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/Sex", "valueCode" : "F" }], "identifier" : [{ "type" : { "coding" : [{ "code" : "NIIP" }], "text" : "PhilHealth Identification Number" }, "value" : "PH54321" }], "patient" : { "reference" : "Patient/CF1-Patient-2", "display" : "Patient" }, "name" : [{ "family" : "Bautista", "given" : ["Lorna Mae", "Santos"], "suffix" : ["Mrs."] }], "telecom" : [{ "system" : "phone", "value" : "912-00-00" }, { "system" : "phone", "value" : "0927-000-0000" }, { "system" : "email", "value" : "lmbautista@email.com" }], "birthDate" : "1971-02-11", "address" : [{ "extension" : [{ "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/Barangay", "valueCoding" : { "code" : "0123456789", "display" : "Blue Ridge" } }, { "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/CityMunicipality", "valueCoding" : { "code" : "0123456", "display" : "Quezon City" } }, { "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/Province", "valueCoding" : { "code" : "01234", "display" : "Metro Manila" } }], "line" : ["Fordham Road"], "postalCode" : "1110", "country" : "PH" }] }, "request" : { "method" : "POST", "url" : "RelatedPerson" } }, { "fullUrl" : "urn:uuid:organization", "resource" : { "resourceType" : "Organization", "id" : "CF1-Organization", "meta" : { "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-Organization"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization CF1-Organization

Profile: PH Organization

identifier: PhilHealth Employer Number (PEN)/EN15243

name: PhilHealth

telecom: 080-00-00

" }, "identifier" : [{ "type" : { "coding" : [{ "code" : "EN" }], "text" : "PhilHealth Employer Number (PEN)" }, "value" : "EN15243" }], "name" : "PhilHealth", "telecom" : [{ "value" : "080-00-00" }] }, "request" : { "method" : "POST", "url" : "Organization" } }, { "fullUrl" : "urn:uuid:questionnaire", "resource" : { "resourceType" : "Questionnaire", "id" : "CF1-Questionnaire", "meta" : { "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-Questionnaire"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Questionnaire CF1-Questionnaire

Profile: PH Questionnaire

\r\n\r\n
LinkIDTextCardinalityTypeDescription & Constraints\"doco\"
\".\"\".\" Questionnaire
\".\"\".\"\".\" CF1-Q1Patient is the member?0..1boolean

\"doco\" Documentation for this format
" }, "status" : "active", "item" : [{ "linkId" : "CF1-Q1", "text" : "Patient is the member?", "type" : "boolean" }] }, "request" : { "method" : "POST", "url" : "Questionnaire" } }, { "fullUrl" : "urn:uuid:questionnaireresponse", "resource" : { "resourceType" : "QuestionnaireResponse", "id" : "CF1-QuestionnaireResponse", "meta" : { "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-QuestionnaireResponse"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: QuestionnaireResponse CF1-QuestionnaireResponse

Profile: PH QuestionnaireResponse

\r\n\r\n
LinkIDTextDefinitionAnswer\"doco\"
\".\"\".\" CF1-QuestionnaireResponseQuestionnaire:None specified
\".\"\".\"\".\" CF1-Q1true

\"doco\" Documentation for this format
" }, "status" : "completed", "item" : [{ "linkId" : "CF1-Q1", "answer" : [{ "valueBoolean" : true }] }] }, "request" : { "method" : "POST", "url" : "QuestionnaireResponse" } }, { "fullUrl" : "urn:uuid:provenance", "resource" : { "resourceType" : "Provenance", "id" : "CF1-Provenance", "meta" : { "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-Provenance"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Provenance CF1-Provenance

Profile: PH Provenance

Provenance for Claim

Summary

Recorded2026-02-03 09:00:00+0800

Agents

who
Organization
" }, "target" : [{ "reference" : "Claim/CF1-Claim", "display" : "Claim" }], "recorded" : "2026-02-03T09:00:00+08:00", "agent" : [{ "who" : { "reference" : "Organization/CF1-Organization", "display" : "Organization" } }], "signature" : [{ "extension" : [{ "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/SignatureReason", "valueString" : "Claim Approval" }], "type" : [{ "system" : "urn:iso-astm:E1762-95:2013", "code" : "1.2.840.10065.1.12.1.20", "display" : "Electronic Signature" }], "when" : "2026-02-03T10:30:00+08:00", "who" : { "reference" : "RelatedPerson/CF1-RelatedPerson", "display" : "Related Person" }, "data" : "QkFTRTY0X1NJR05BVFVSRV9QQVRJRU5U" }, { "type" : [{ "system" : "urn:iso-astm:E1762-95:2013", "code" : "1.2.840.10065.1.12.1.20", "display" : "Electronic Signature" }], "when" : "2026-02-03T10:30:00+08:00", "who" : { "reference" : "Organization/CF1-Organization", "display" : "PhilHealth Regional Office" }, "data" : "QkFTRTY0X1NJR05BVFVSRV9PUkdBTklaVElPTg==" }] }, "request" : { "method" : "POST", "url" : "Provenance" } }, { "fullUrl" : "urn:uuid:coverage", "resource" : { "resourceType" : "Coverage", "id" : "CF1-Coverage", "meta" : { "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-Coverage"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Coverage CF1-Coverage

Profile: PH Coverage

status: Active

policyHolder: Organization

beneficiary: Patient

payor: Organization

" }, "status" : "active", "policyHolder" : { "reference" : "Organization/CF1-Organization", "display" : "Organization" }, "beneficiary" : { "reference" : "Patient/CF1-Patient-2", "display" : "Patient" }, "payor" : [{ "reference" : "Organization/CF1-Organization", "display" : "Organization" }] }, "request" : { "method" : "POST", "url" : "Coverage" } }, { "fullUrl" : "urn:uuid:claim", "resource" : { "resourceType" : "Claim", "id" : "CF1-Claim", "meta" : { "profile" : ["https://nhdr.gov.ph/fhir/StructureDefinition/PH-Claim"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Claim CF1-Claim

Profile: PH Claim

identifier: https://philhealth.gov.ph/claim/CF1-CLM-00001

status: Active

type: Institutional

use: Claim

patient: Patient

created: 2026-02-03 08:00:00+0800

provider: Organization

priority: Normal

Payees

-TypeParty
*SubscriberRelatedPerson

Insurances

-SequenceFocalCoverage
*1trueCoverage
" }, "identifier" : [{ "system" : "https://philhealth.gov.ph/claim", "value" : "CF1-CLM-00001" }], "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "institutional", "display" : "Institutional" }] }, "use" : "claim", "patient" : { "reference" : "Patient/CF1-Patient-2", "display" : "Patient" }, "created" : "2026-02-03T08:00:00+08:00", "provider" : { "reference" : "Organization/CF1-Organization", "display" : "Organization" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal", "display" : "Normal" }] }, "payee" : { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/payeetype", "code" : "subscriber", "display" : "Subscriber" }] }, "party" : { "reference" : "RelatedPerson/CF1-RelatedPerson", "display" : "RelatedPerson" } }, "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "reference" : "Coverage/CF1-Coverage", "display" : "Coverage" } }] }, "request" : { "method" : "POST", "url" : "Claim" } }] }