NHDR Implementation Guide Release 1.0
0.1.0 - ci-build
NHDR Implementation Guide Release 1.0, published by NHDR. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/PROJ-PHILHEALTH-EA-NHDR/nhdr-fhir-ig-review-project-2/ and changes regularly. See the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="ClaimsForm2"/>
<identifier>
<system value="http://nhdr.gov.ph/fhir/ValueSet-form-type"/>
<value value="CF2"/>
</identifier>
<type value="transaction"/>
<entry>
<fullUrl value="urn:uuid:patient"/>
<resource>
<Patient>
<id value="CF2-Patient"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Patient"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_CF2-Patient"> </a><p class="res-header-id"><b>Generated Narrative: Patient CF2-Patient</b></p><a name="CF2-Patient"> </a><a name="hcCF2-Patient"> </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-PH-Patient.html">PH Patient</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">John Harris Doe (no stated gender), DoB Unknown</p><hr/></div>
</text>
<name>
<family value="Doe"/>
<given value="John"/>
<given value="Harris"/>
<suffix value="Mr."/>
</name>
</Patient>
</resource>
<request>
<method value="POST"/>
<url value="Patient"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:relatedperson"/>
<resource>
<RelatedPerson>
<id value="CF2-RelatedPerson"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-RelatedPerson"/>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH_RelatedPerson"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="RelatedPerson_CF2-RelatedPerson"> </a><p class="res-header-id"><b>Generated Narrative: RelatedPerson CF2-RelatedPerson</b></p><a name="CF2-RelatedPerson"> </a><a name="hcCF2-RelatedPerson"> </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">Profiles: <a href="StructureDefinition-PH-RelatedPerson.html">PH RelatedPerson</a>, <code>https://nhdr.gov.ph/fhir/StructureDefinition/PH_RelatedPerson</code></p></div><p><b>patient</b>: <a href="Bundle-ClaimsForm2.html#Patient_CF2-Patient">Patient</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode MTH}">mother</span></p><p><b>name</b>: Maria Dela Cruz </p></div>
</text>
<patient>
<reference value="Patient/CF2-Patient"/>
<display value="Patient"/>
</patient>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="MTH"/>
<display value="mother"/>
</coding>
</relationship>
<name>
<family value="Dela Cruz"/>
<given value="Maria"/>
</name>
</RelatedPerson>
</resource>
<request>
<method value="POST"/>
<url value="RelatedPerson"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:organization"/>
<resource>
<Organization>
<id value="CF2-Organization"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Organization"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_CF2-Organization"> </a><p class="res-header-id"><b>Generated Narrative: Organization CF2-Organization</b></p><a name="CF2-Organization"> </a><a name="hcCF2-Organization"> </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-PH-Organization.html">PH Organization</a></p></div><p><b>identifier</b>: PhilHealth Accreditation Number (PAN)/AN199513893</p><p><b>name</b>: 6th General Hospital</p><p><b>address</b>: </p><ul><li>San Roque </li><li>Tarlac City </li><li>Tarlac </li></ul><h3>Contacts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Name</b></td></tr><tr><td style="display: none">*</td><td>Dr. Maria Santos</td></tr></table></div>
</text>
<identifier>
<type>
<coding>
<code value="AN"/>
</coding>
<text value="PhilHealth Accreditation Number (PAN)"/>
</type>
<value value="AN199513893"/>
</identifier>
<name value="6th General Hospital"/>
<address>
<line value="San Roque"/>
</address>
<address>
<line value="Tarlac City"/>
</address>
<address>
<extension
url="https://nhdr.gov.ph/fhir/StructureDefinition/Barangay">
<valueCoding>
<code value="036916001"/>
<display value="San Roque"/>
</valueCoding>
</extension>
<extension
url="https://nhdr.gov.ph/fhir/StructureDefinition/CityMunicipality">
<valueCoding>
<code value="036916000"/>
<display value="Tarlac City"/>
</valueCoding>
</extension>
<extension
url="https://nhdr.gov.ph/fhir/StructureDefinition/Province">
<valueCoding>
<code value="036900000"/>
<display value="Tarlac"/>
</valueCoding>
</extension>
<line value="Tarlac"/>
</address>
<contact>
<name>
<text value="Dr. Maria Santos"/>
</name>
</contact>
</Organization>
</resource>
<request>
<method value="POST"/>
<url value="Organization"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:encounter"/>
<resource>
<Encounter>
<id value="CF2-Encounter"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Encounter"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Encounter_CF2-Encounter"> </a><p class="res-header-id"><b>Generated Narrative: Encounter CF2-Encounter</b></p><a name="CF2-Encounter"> </a><a name="hcCF2-Encounter"> </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-PH-Encounter.html">PH Encounter</a></p></div><p><b>status</b>: booked</p><p><b>class</b>: <a href="http://terminology.hl7.org/7.1.0/CodeSystem-v3-ActCode.html#v3-ActCode-AMB">ActCode: AMB</a> (ambulatory)</p><p><b>period</b>: 2024-07-18 08:00:00+0800 --> 2024-07-18 10:00:00+0800</p><h3>Hospitalizations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>DischargeDisposition</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/discharge-disposition home}">Discharged to home</span></td></tr></table><p><b>serviceProvider</b>: <a href="Bundle-ClaimsForm2.html#Organization_CF2-Organization">Organization</a></p></div>
</text>
<status value="booked"/>
<class>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="AMB"/>
</class>
<period>
<start value="2024-07-18T08:00:00+08:00"/>
<end value="2024-07-18T10:00:00+08:00"/>
</period>
<hospitalization>
<dischargeDisposition>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/discharge-disposition"/>
<code value="home"/>
<display value="Discharged to home"/>
</coding>
</dischargeDisposition>
</hospitalization>
<serviceProvider>
<reference value="Organization/CF2-Organization"/>
<display value="Organization"/>
</serviceProvider>
</Encounter>
</resource>
<request>
<method value="POST"/>
<url value="Encounter"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:procedure"/>
<resource>
<Procedure>
<id value="CF2-Procedure"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Procedure"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Procedure_CF2-Procedure"> </a><p class="res-header-id"><b>Generated Narrative: Procedure CF2-Procedure</b></p><a name="CF2-Procedure"> </a><a name="hcCF2-Procedure"> </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-PH-Procedure.html">PH Procedure</a></p></div><p><b>status</b>: Completed</p><p><b>code</b>: <span title="Codes:{https://nhdr.gov.ph/fhir/ValueSet/ProcedureCodeVS 10060}">INCISION AND DRAINAGE OF ABSCESS (E.G., CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA)</span></p><p><b>subject</b>: <a href="Bundle-ClaimsForm2.html#Patient_CF2-Patient">Patient</a></p><p><b>bodySite</b>: <span title="Codes:{http://snomed.info/sct 66754008}">Appendix structure</span></p></div>
</text>
<status value="completed"/>
<code>
<coding>
<system
value="https://nhdr.gov.ph/fhir/ValueSet/ProcedureCodeVS"/>
<code value="10060"/>
<display
value="INCISION AND DRAINAGE OF ABSCESS (E.G., CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA)"/>
</coding>
</code>
<subject>
<reference value="Patient/CF2-Patient"/>
<display value="Patient"/>
</subject>
<bodySite>
<coding>
<system value="http://snomed.info/sct"/>
<code value="66754008"/>
<display value="Appendix structure"/>
</coding>
</bodySite>
</Procedure>
</resource>
<request>
<method value="POST"/>
<url value="Procedure"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:servicerequest"/>
<resource>
<ServiceRequest>
<id value="CF2-ServiceRequest"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-ServiceRequest"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="ServiceRequest_CF2-ServiceRequest"> </a><p class="res-header-id"><b>Generated Narrative: ServiceRequest CF2-ServiceRequest</b></p><a name="CF2-ServiceRequest"> </a><a name="hcCF2-ServiceRequest"> </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-PH-ServiceRequest.html">PH ServiceRequest</a></p></div><p><b>status</b>: Completed</p><p><b>intent</b>: Order</p><p><b>subject</b>: <a href="Bundle-ClaimsForm2.html#Patient_CF2-Patient">Patient</a></p><p><b>requester</b>: <a href="Bundle-ClaimsForm3.html#Organization_CF3-Organization">Organization</a></p><p><b>performer</b>: <a href="Bundle-ClaimsForm2.html#Organization_CF2-Organization">Organization</a></p><p><b>reasonReference</b>: <a href="Bundle-ClaimsForm2.html#Observation_CF2-Observation">Observation</a></p></div>
</text>
<status value="completed"/>
<intent value="order"/>
<subject>
<reference value="Patient/CF2-Patient"/>
<display value="Patient"/>
</subject>
<requester>
<reference value="Organization/CF3-Organization"/>
<display value="Organization"/>
</requester>
<performer>
<reference value="Organization/CF2-Organization"/>
<display value="Organization"/>
</performer>
<reasonReference>
<reference value="Observation/CF2-Observation"/>
<display value="Observation"/>
</reasonReference>
</ServiceRequest>
</resource>
<request>
<method value="POST"/>
<url value="ServiceRequest"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:observation"/>
<resource>
<Observation>
<id value="CF2-Observation"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_CF2-Observation"> </a><p class="res-header-id"><b>Generated Narrative: Observation CF2-Observation</b></p><a name="CF2-Observation"> </a><a name="hcCF2-Observation"> </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-PH-Observation.html">PH Observation</a></p></div><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 81247-9}">Preoperative assessment</span></p><p><b>subject</b>: <a href="Bundle-ClaimsForm2.html#Patient_CF2-Patient">Patient</a></p><p><b>value</b>: <span title="Codes:">Subject for Surgery</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="81247-9"/>
<display value="Preoperative assessment"/>
</coding>
</code>
<subject>
<reference value="Patient/CF2-Patient"/>
<display value="Patient"/>
</subject>
<valueCodeableConcept>
<text value="Subject for Surgery"/>
</valueCodeableConcept>
</Observation>
</resource>
<request>
<method value="POST"/>
<url value="Observation"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:practitioner"/>
<resource>
<Practitioner>
<id value="CF2-Practitioner"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Practitioner"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_CF2-Practitioner"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner CF2-Practitioner</b></p><a name="CF2-Practitioner"> </a><a name="hcCF2-Practitioner"> </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-PH-Practitioner.html">PH Practitioner</a></p></div><p><b>identifier</b>: <code>https://prc.gov.ph</code>/1234567</p><p><b>name</b>: Maria Santos </p></div>
</text>
<identifier>
<system value="https://prc.gov.ph"/>
<value value="1234567"/>
</identifier>
<name>
<family value="Santos"/>
<given value="Maria"/>
<suffix value="MD"/>
</name>
</Practitioner>
</resource>
<request>
<method value="POST"/>
<url value="Practitioner"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:coverage"/>
<resource>
<Coverage>
<id value="CF2-Coverage"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Coverage"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Coverage_CF2-Coverage"> </a><p class="res-header-id"><b>Generated Narrative: Coverage CF2-Coverage</b></p><a name="CF2-Coverage"> </a><a name="hcCF2-Coverage"> </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-PH-Coverage.html">PH Coverage</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode EHCPOL}">extended healthcare</span></p><p><b>beneficiary</b>: <a href="Bundle-ClaimsForm2.html#Patient_CF2-Patient">Patient</a></p><p><b>payor</b>: <a href="Bundle-ClaimsForm2.html#Organization_CF2-Organization">Organization</a></p><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 copay}">Copayment</span></td><td><span title="Philippine Peso">₱500.00</span> (PHP)</td></tr></table></div>
</text>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="EHCPOL"/>
<display value="extended healthcare"/>
</coding>
</type>
<beneficiary>
<reference value="Patient/CF2-Patient"/>
<display value="Patient"/>
</beneficiary>
<payor>
<reference value="Organization/CF2-Organization"/>
<display value="Organization"/>
</payor>
<costToBeneficiary>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/coverage-copay-type"/>
<code value="copay"/>
<display value="Copayment"/>
</coding>
</type>
<valueMoney>
<value value="500"/>
<currency value="PHP"/>
</valueMoney>
</costToBeneficiary>
</Coverage>
</resource>
<request>
<method value="POST"/>
<url value="Coverage"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:questionnaire"/>
<resource>
<Questionnaire>
<id value="CF2-Questionnaire"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Questionnaire"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Questionnaire_CF2-Questionnaire"> </a><p class="res-header-id"><b>Generated Narrative: Questionnaire CF2-Questionnaire</b></p><a name="CF2-Questionnaire"> </a><a name="hcCF2-Questionnaire"> </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-PH-Questionnaire.html">PH Questionnaire</a></p></div><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description & Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> </td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" id="item.CF2-Q1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="boolean" class="hierarchy"/> CF2-Q1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">A. Certification of Consumption of Benefits (Y/N)</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
</text>
<status value="active"/>
<item>
<linkId value="CF2-Q1"/>
<text value="A. Certification of Consumption of Benefits (Y/N)"/>
<type value="boolean"/>
</item>
</Questionnaire>
</resource>
<request>
<method value="POST"/>
<url value="Questionnaire"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:questionnaireResponse"/>
<resource>
<QuestionnaireResponse>
<id value="CF2-QuestionnaireResponse"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-QuestionnaireResponse"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="QuestionnaireResponse_CF2-QuestionnaireResponse"> </a><p class="res-header-id"><b>Generated Narrative: QuestionnaireResponse CF2-QuestionnaireResponse</b></p><a name="CF2-QuestionnaireResponse"> </a><a name="hcCF2-QuestionnaireResponse"> </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-PH-QuestionnaireResponse.html">PH QuestionnaireResponse</a></p></div><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Definition</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Answer</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireResponseRoot" class="hierarchy"/> CF2-QuestionnaireResponse</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire:None specified</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> CF2-Q1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td></tr>
<tr><td colspan="4" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
</text>
<status value="completed"/>
<item>
<linkId value="CF2-Q1"/>
<answer>
<valueBoolean value="true"/>
</answer>
</item>
</QuestionnaireResponse>
</resource>
<request>
<method value="POST"/>
<url value="QuestionnaireResponse"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:provenance"/>
<resource>
<Provenance>
<id value="CF2-Provenance"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Provenance"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Provenance_CF2-Provenance"> </a><p class="res-header-id"><b>Generated Narrative: Provenance CF2-Provenance</b></p><a name="CF2-Provenance"> </a><a name="hcCF2-Provenance"> </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-PH-Provenance.html">PH Provenance</a></p></div><p>Provenance for <a href="Bundle-ClaimsForm2.html#Claim_CF2-Claim">Claim</a></p><p>Summary</p><table class="grid"><tr><td>Recorded</td><td>2026-02-03 09:00:00+0800</td></tr></table><p><b>Agents</b></p><table class="grid"><tr><td><b>who</b></td></tr><tr><td><a href="Bundle-ClaimsForm2.html#Practitioner_CF2-Practitioner">Practitioner</a></td></tr></table></div>
</text>
<target>
<reference value="Claim/CF2-Claim"/>
<display value="Claim"/>
</target>
<recorded value="2026-02-03T09:00:00+08:00"/>
<agent>
<who>
<reference value="Practitioner/CF2-Practitioner"/>
<display value="Practitioner"/>
</who>
</agent>
<signature>
<extension
url="https://nhdr.gov.ph/fhir/StructureDefinition/SignaturePosition">
<valueString value="Attending Physician"/>
</extension>
<type>
<system value="urn:iso-astm:E1762-95:2013"/>
<code value="1.2.840.10065.1.12.1.20"/>
<display value="Electronic Signature"/>
</type>
<when value="2026-02-03T10:30:00+08:00"/>
<who>
<reference value="Practitioner/CF2-Practitioner"/>
<display value="Practitioner"/>
</who>
<data value="U1VCTUlUU0lPTl9QUkFDVElUSU9ORVJfU0lHTg=="/>
</signature>
<signature>
<type>
<system value="urn:iso-astm:E1762-95:2013"/>
<code value="1.2.840.10065.1.12.1.20"/>
<display value="Electronic Signature"/>
</type>
<when value="2026-02-03T10:30:00+08:00"/>
<who>
<reference value="Patient/CF2-Patient"/>
<display value="Patient"/>
</who>
<data value="U1VCTUlUU0lPTl9QQVRJRU5UX1NJR04="/>
</signature>
<signature>
<type>
<system value="urn:iso-astm:E1762-95:2013"/>
<code value="1.2.840.10065.1.12.1.20"/>
<display value="Electronic Signature"/>
</type>
<when value="2026-02-03T10:30:00+08:00"/>
<who>
<reference value="RelatedPerson/CF2-RelatedPerson"/>
<display value="RelatedPerson"/>
</who>
<data value="U1VCTUlUU0lPTl9SRUxBVEVEX1NJR04="/>
</signature>
</Provenance>
</resource>
<request>
<method value="POST"/>
<url value="Provenance"/>
</request>
</entry>
<entry>
<fullUrl value="urn:uuid:claim"/>
<resource>
<Claim>
<id value="CF2-Claim"/>
<meta>
<profile
value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Claim"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Claim_CF2-Claim"> </a><p class="res-header-id"><b>Generated Narrative: Claim CF2-Claim</b></p><a name="CF2-Claim"> </a><a name="hcCF2-Claim"> </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-PH-Claim.html">PH Claim</a></p></div><p><b>Encounter (Extension)</b>: <a href="Bundle-ClaimsForm2.html#Encounter_CF2-Encounter">Encounter</a></p><p><b>identifier</b>: <code>https://philhealth.gov.ph/claim</code>/CLM-2026-00001</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>: Claim</p><p><b>patient</b>: <a href="Bundle-ClaimsForm2.html#Patient_CF2-Patient">Patient</a></p><p><b>created</b>: 2026-02-03 08:00:00+0800</p><p><b>provider</b>: <a href="Bundle-ClaimsForm2.html#Organization_CF2-Organization">Organization</a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><p><b>referral</b>: <a href="Bundle-ClaimsForm2.html#ServiceRequest_CF2-ServiceRequest">ServiceRequest</a></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>Value[x]</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/claiminformationcategory information}">Supporting Information</span></td><td><a href="Bundle-ClaimsForm2.html#Practitioner_CF2-Practitioner">Practitioner</a></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></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{http://hl7.org/fhir/sid/icd-10 I10}">Essential (primary) hypertension</span></td></tr></table><h3>Procedures</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Date</b></td><td><b>Procedure[x]</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>2026-02-03 09:00:00+0800</td><td><a href="Bundle-ClaimsForm2.html#Procedure_CF2-Procedure">Procedure</a></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="Bundle-ClaimsForm2.html#Coverage_CF2-Coverage">Coverage</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/service-uscls 80146002}">Appendectomy</span></p><p><b>serviced</b>: 2026-02-03</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>15000</td><td>Philippine piso</td></tr></table><blockquote><p><b>detail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/service-uscls 80146002}">Appendectomy Procedure Fee</span></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>15000</td><td>Philippine piso</td></tr></table></blockquote></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>15000</td><td>Philippine piso</td></tr></table></div>
</text>
<extension
url="https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension">
<valueReference>
<reference value="Encounter/CF2-Encounter"/>
<display value="Encounter"/>
</valueReference>
</extension>
<identifier>
<system value="https://philhealth.gov.ph/claim"/>
<value value="CLM-2026-00001"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="institutional"/>
<display value="Institutional"/>
</coding>
</type>
<use value="claim"/>
<patient>
<reference value="Patient/CF2-Patient"/>
<display value="Patient"/>
</patient>
<created value="2026-02-03T08:00:00+08:00"/>
<provider>
<reference value="Organization/CF2-Organization"/>
<display value="Organization"/>
</provider>
<priority>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/processpriority"/>
<code value="normal"/>
<display value="Normal"/>
</coding>
</priority>
<referral>
<reference value="ServiceRequest/CF2-ServiceRequest"/>
<display value="ServiceRequest"/>
</referral>
<supportingInfo>
<sequence value="1"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
<code value="information"/>
<display value="Supporting Information"/>
</coding>
</category>
<valueReference>
<reference value="Practitioner/CF2-Practitioner"/>
<display value="Practitioner"/>
</valueReference>
</supportingInfo>
<diagnosis>
<sequence value="1"/>
<diagnosisCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/sid/icd-10"/>
<code value="I10"/>
<display value="Essential (primary) hypertension"/>
</coding>
</diagnosisCodeableConcept>
</diagnosis>
<procedure>
<sequence value="1"/>
<date value="2026-02-03T09:00:00+08:00"/>
<procedureReference>
<reference value="Procedure/CF2-Procedure"/>
<display value="Procedure"/>
</procedureReference>
</procedure>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>
<reference value="Coverage/CF2-Coverage"/>
<display value="Coverage"/>
</coverage>
</insurance>
<item>
<sequence value="1"/>
<productOrService>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/service-uscls"/>
<code value="80146002"/>
<display value="Appendectomy"/>
</coding>
</productOrService>
<servicedDate value="2026-02-03"/>
<net>
<value value="15000"/>
<currency value="PHP"/>
</net>
<detail>
<sequence value="1"/>
<productOrService>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/service-uscls"/>
<code value="80146002"/>
<display value="Appendectomy Procedure Fee"/>
</coding>
</productOrService>
<net>
<value value="15000"/>
<currency value="PHP"/>
</net>
</detail>
</item>
<total>
<value value="15000"/>
<currency value="PHP"/>
</total>
</Claim>
</resource>
<request>
<method value="POST"/>
<url value="Claim"/>
</request>
</entry>
</Bundle>