ClaimsForm3
type: Bundle
node role: treeRoot
id:
  v: ClaimsForm3
identifier:
  system:
    v: http://nhdr.gov.ph/fhir/ValueSet-form-type
    l: ValueSet-form-type
  value:
    v: CF3
type:
  v: transaction
entry:
  full url:
    v: urn:uuid:patient
    l: patient
  resource: patient
  request:
    method:
      v: POST
    url:
      v: Patient
      l: Patient
entry:
  full url:
    v: urn:uuid:organization
    l: organization
  resource: organization
  request:
    method:
      v: POST
    url:
      v: Organization
      l: Organization
entry:
  full url:
    v: urn:uuid:encounter
    l: encounter
  resource: encounter
  request:
    method:
      v: POST
    url:
      v: Encounter
      l: Encounter
entry:
  full url:
    v: urn:uuid:observation
    l: observation
  resource: observation
  request:
    method:
      v: POST
    url:
      v: Observation
      l: Observation
entry:
  full url:
    v: urn:uuid:observation
    l: observation
  resource: observation
  request:
    method:
      v: POST
    url:
      v: Observation
      l: Observation
entry:
  full url:
    v: urn:uuid:observation
    l: observation
  resource: observation
  request:
    method:
      v: POST
    url:
      v: Observation
      l: Observation
entry:
  full url:
    v: urn:uuid:observation
    l: observation
  resource: observation
  request:
    method:
      v: POST
    url:
      v: Observation
      l: Observation
entry:
  full url:
    v: urn:uuid:observation
    l: observation
  resource: observation
  request:
    method:
      v: POST
    url:
      v: Observation
      l: Observation
entry:
  full url:
    v: urn:uuid:observation
    l: observation
  resource: observation
  request:
    method:
      v: POST
    url:
      v: Observation
      l: Observation
entry:
  full url:
    v: urn:uuid:observation
    l: observation
  resource: observation
  request:
    method:
      v: POST
    url:
      v: Observation
      l: Observation
entry:
  full url:
    v: urn:uuid:observation
    l: observation
  resource: observation
  request:
    method:
      v: POST
    url:
      v: Observation
      l: Observation
entry:
  full url:
    v: urn:uuid:observation
    l: observation
  resource: observation
  request:
    method:
      v: POST
    url:
      v: Observation
      l: Observation
entry:
  full url:
    v: urn:uuid:clinicalimpression
    l: clinicalimpression
  resource: clinicalimpression
  request:
    method:
      v: POST
    url:
      v: ClinicalImpression
      l: ClinicalImpression
entry:
  full url:
    v: urn:uuid:diagnosticreport
    l: diagnosticreport
  resource: diagnosticreport
  request:
    method:
      v: POST
    url:
      v: DiagnosticReport
      l: DiagnosticReport
entry:
  full url:
    v: urn:uuid:provenance
    l: provenance
  resource: provenance
  request:
    method:
      v: POST
    url:
      v: Provenance
      l: Provenance
entry:
  full url:
    v: urn:uuid:questionnaire
    l: questionnaire
  resource: questionnaire
  request:
    method:
      v: POST
    url:
      v: Questionnaire
      l: Questionnaire
entry:
  full url:
    v: urn:uuid:questionnaireresponse
    l: questionnaireresponse
  resource: questionnaireresponse
  request:
    method:
      v: POST
    url:
      v: QuestionnaireResponse
      l: QuestionnaireResponse
entry:
  full url:
    v: urn:uuid:claim
    l: claim
  resource: claim

patient
type: Patient
id:
  v: CF3-Patient
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Patient
    l: PH-Patient
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Patient CF3-Patient Profile: PH Patient John Mark Apilyido (no stated gender), DoB Unknown
name:
  family:
    v: Apilyido
  given:
    v: John
  given:
    v: Mark
  suffix:
    v: Mr.

organization
type: Organization
id:
  v: CF3-Organization
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Organization
    l: PH-Organization
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Organization CF3-Organization Profile: PH Organization identifier: PhilHealth Accreditation Number (PAN)/AN55555 name: Pasig General Hospital
identifier:
  type:
    coding:
      code:
        v: AN
    text:
      v: PhilHealth Accreditation Number (PAN)
  value:
    v: AN55555
name:
  v: Pasig General Hospital

encounter
type: Encounter
id:
  v: CF3-Encounter
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Encounter
    l: PH-Encounter
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Encounter CF3-Encounter Profile: PH Encounter status: booked class: ActCode: AMB (ambulatory) period: 2024-07-18 08:00:00+0800 --> 2024-07-18 10:00:00+0800 reasonReference: Observation Hospitalizations - DischargeDisposition * Discharged to home
status:
  v: booked
class:
  system:
    v: http://terminology.hl7.org/CodeSystem/v3-ActCode
    l: v3-ActCode
  code:
    v: AMB
period:
  start:
    v: 2024-07-18T08:00:00+08:00
  end:
    v: 2024-07-18T10:00:00+08:00
reason reference:
  l: CF3-Observation-Physical-Examination
  reference:
    v: Observation/CF3-Observation-Physical-Examination
  display:
    v: Observation
hospitalization:
  discharge disposition:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/discharge-disposition
        l: discharge-disposition
      code:
        v: home
      display:
        v: Discharged to home

observation
type: Observation
id:
  v: CF3-Observation-Physical-Examination
id:
  v: CF3-Observation-Pertinent-Laboratory
id:
  v: CF3-Observation-Pregnancy-Risk-Assessment
id:
  v: CF3-Observation-Obstetric-Risk-Factors
id:
  v: CF3-Observation-Estimated-Delivery-Date
id:
  v: CF3-Observation-Age-of-Gestation
id:
  v: CF3-Observation-Weight-and-Vital-Signs
id:
  v: CF3-Observation-Pregnancy-status-panel
id:
  v: CF3-Observation-Birth-Outcome-Panel
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation
    l: PH-Observation
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation
    l: PH-Observation
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation
    l: PH-Observation
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation
    l: PH-Observation
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation
    l: PH-Observation
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation
    l: PH-Observation
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation
    l: PH-Observation
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation
    l: PH-Observation
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation
    l: PH-Observation
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Observation CF3-Observation-Physical-Examination Profile: PH Observation status: Final code: Physical examination value: Patient complains of severe headache component code: General Survey value: Patient appears weak component code: Vital Signs - BP value: 120/80 mmHg component code: Vital Signs - CR value: 78 bpm component code: Vital Signs - RR value: 18 breaths/min component code: Vital Signs - Temperature value: 36.8°C component code: Abdomen value: Soft, non-tender, no organomegaly component code: HEENT value: Pupils equal, round, reactive to light; oropharynx clear component code: GU (IE) value: Normal external genitalia; no masses or tenderness component code: Chest/Lungs value: Clear to auscultation bilaterally; no wheezes or crackles component code: Skin/Extremities value: Skin warm and dry; no rashes; peripheral pulses palpable component code: CVS value: Heart sounds normal; regular rate and rhythm; no murmurs component code: Neuro Examination value: Alert, cranial nerves II-XII intact; motor and sensory exam normal
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Observation CF3-Observation-Pertinent-Laboratory Profile: PH Observation status: Final code: Pertinent Laboratory Components - Code Value[x] * CBC Normal
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Observation CF3-Observation-Pregnancy-Risk-Assessment Profile: PH Observation status: Final code: Pregnancy risk assessment component code: Vital signs interpretation: Normal component code: Pregnancy Low Risk value: true component code: Menstrual History - Last Menstrual Period (LMP) value: 2026-02-10 component code: Menstrual History - Age of Menarche value: 13 component code: Obstetric History (G) value: 2 component code: Obstetric History (P) value: 1 component code: Obstetric History (P)[T] value: 1 component code: Obstetric History (P)[P] value: 0 component code: Obstetric History (P)[A] value: 0 component code: Obstetric History (P)[L] value: 1
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Observation CF3-Observation-Obstetric-Risk-Factors Profile: PH Observation status: Final code: Obstetric risk factors component code: Multiple pregnancy value: false component code: Ovarian cyst value: true component code: Myoma uteri value: false component code: Placenta previa value: false component code: History of 3 miscarriages value: true component code: History of stillbirth value: false component code: History of pre-eclampsia value: true component code: History of eclampsia value: false component code: Premature contraction value: true
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Observation CF3-Observation-Estimated-Delivery-Date Profile: PH Observation status: Final code: Delivery date Estimated effective: 2026-03-10
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Observation CF3-Observation-Age-of-Gestation Profile: PH Observation status: Final code: Age of Gestation value: 20 weeks
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Observation CF3-Observation-Weight-and-Vital-Signs Profile: PH Observation status: Final code: Vital signs panel component code: Weight value: 65 kg component code: Cardiac Rate value: 80 beats/minute component code: Respiratory Rate value: 18 breaths/minute component code: Blood Pressure value: 120/80 mmHg component code: Temperature value: 36.8 °C
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Observation CF3-Observation-Pregnancy-status-panel Profile: PH Observation status: Final code: Pregnancy status panel component code: Maternal Outcome - Obstetric Index value: G2P1 (1-0-0-1) component code: Pregnancy Uterine - AOG by LMP value: 20 weeks component code: Pregnancy Uterine - Manner of Delivery value: Normal Spontaneous Vaginal Delivery component code: Pregnancy Uterine - Presentation value: Cephalic
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Observation CF3-Observation-Birth-Outcome-Panel Profile: PH Observation status: Final code: Birth outcome panel component code: Birth Outcome - Fetal Outcome value: Live birth component code: Birth Outcome - Sex value: Male component code: Birth Outcome - Birth Weight (grm) value: 3200 g component code: Birth Outcome - APGAR Score value: 9
status:
  v: final
status:
  v: final
status:
  v: final
status:
  v: final
status:
  v: final
status:
  v: final
status:
  v: final
status:
  v: final
status:
  v: final
code:
  coding: https://loinc.org/rdf/29545-1
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 29545-1
    display:
      v: Physical examination
code:
  coding: https://loinc.org/rdf/26436-6
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 26436-6
    display:
      v: Pertinent Laboratory
code:
  coding: https://loinc.org/rdf/82810-3
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 82810-3
    display:
      v: Pregnancy risk assessment
code:
  coding: https://loinc.org/rdf/82801-8
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 82801-8
    display:
      v: Obstetric risk factors
code:
  coding: https://loinc.org/rdf/11778-8
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 11778-8
    display:
      v: Delivery date Estimated
code:
  coding: https://loinc.org/rdf/18185-9
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 18185-9
    display:
      v: Age of Gestation
code:
  coding: https://loinc.org/rdf/85353-1
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 85353-1
    display:
      v: Vital signs panel
code:
  coding: https://loinc.org/rdf/57075-4
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 57075-4
    display:
      v: Pregnancy status panel
code:
  coding: https://loinc.org/rdf/57076-2
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 57076-2
    display:
      v: Birth outcome panel
value: String
  v: Patient complains of severe headache
value: Quantity
effective: DateTime

clinicalimpression
type: ClinicalImpression
id:
  v: CF3-ClinicalImpression
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-ClinicalImpression
    l: PH-ClinicalImpression
text:
  status:
    v: generated
  div:
    v: Generated Narrative: ClinicalImpression CF3-ClinicalImpression Profile: PH ClinicalImpression status: Completed description: Patient admitted for observation and management of hypertension. During the ward stay, vital signs stabilized, medications were adjusted, and patient responded well to treatment. No complications noted. Discharged in stable condition. subject: John Mark Apilyido (no stated gender), DoB Unknown
status:
  v: completed
description:
  v: Patient admitted for observation and management of hypertension. During the ward stay, vital signs stabilized, medications were adjusted, and patient responded well to treatment. No complications noted. Discharged in stable condition.
subject:
  l: CF3-Patient
  reference:
    v: Patient/CF3-Patient

diagnosticreport
type: DiagnosticReport
id:
  v: CF3-DiagnosticReport
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-DiagnosticReport
    l: PH-DiagnosticReport
text:
  status:
    v: generated
  div:
    v: Generated Narrative: DiagnosticReport CF3-DiagnosticReport Profile: PH DiagnosticReport Anemia, unspecified Report Details Patient shows mild anemia with hemoglobin slightly below normal range; other CBC parameters within normal limits.
status:
  v: final
code:
  coding:
    system:
      v: http://hl7.org/fhir/sid/icd-10
      l: icd-10
    code:
      v: D64.9
    display:
      v: Anemia, unspecified
conclusion:
  v: Patient shows mild anemia with hemoglobin slightly below normal range; other CBC parameters within normal limits.

provenance
type: Provenance
id:
  v: CF3-Provenance
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Provenance
    l: PH-Provenance
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Provenance CF3-Provenance Profile: PH Provenance Provenance for Claim: extension = ->Encounter; status = active; type = Institutional; use = claim; created = 2024-07-18; priority = Normal Summary Recorded 2026-02-03 09:00:00+0800 Agents who Practitioner
target:
  l: CF3-Claim
  reference:
    v: Claim/CF3-Claim
recorded:
  v: 2026-02-03T09:00:00+08:00
agent:
  who:
    l: K4-Practitioner
    reference:
      v: Practitioner/K4-Practitioner
    display:
      v: Practitioner
signature:
  type:
    system:
      v: urn:iso-astm:E1762-95:2013
      l: 2013
    code:
      v: 1.2.840.10065.1.12.1.20
    display:
      v: Electronic Signature
  when:
    v: 2026-02-03T10:30:00+08:00
  who:
    l: K4-Practitioner
    reference:
      v: Practitioner/K4-Practitioner
    display:
      v: Practitioner

questionnaire
type: Questionnaire
id:
  v: CF3-Questionnaire
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Questionnaire
    l: PH-Questionnaire
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH_Questionnaire
    l: PH Questionnaire
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Questionnaire CF3-Questionnaire Profiles: PH Questionnaire, https://nhdr.gov.ph/fhir/StructureDefinition/PH_Questionnaire LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Questionnaire #xD; CF3-Q1 Orientation to MCP/Availment of Benefits (Yes/No) 0..1 boolean #xD; CF3-Q2 Perineal wound care 0..1 boolean #xD; CF3-Q3 Perineal wound care - Remarks 0..1 string #xD; CF3-Q4 Signs of Maternal Postpartum Complications 0..1 boolean #xD; CF3-Q5 Signs of Maternal Postpartum Complications - Remarks 0..1 string #xD; CF3-Q6 Counselling and Education (Breastfeeding and Nutrition) 0..1 boolean #xD; CF3-Q7 Counselling and Education (Breastfeeding and Nutrition) - Remarks 0..1 string #xD; CF3-Q8 Counselling and Education (Family Planning) 0..1 boolean #xD; CF3-Q9 Counselling and Education (Family Planning) - Remarks 0..1 string #xD; CF3-Q10 Provided family planning service to patient (as requested by patient) 0..1 boolean #xD; CF3-Q11 Provided family planning service to patient (as requested by patient) - Remarks 0..1 string #xD; CF3-Q12 Referred to partner physician for Voluntary Surgical Sterilization (as requested by pt.) 0..1 boolean #xD; CF3-Q13 Referred to partner physician for Voluntary Surgical Sterilization (as requested by pt.) - Remarks 0..1 string #xD; CF3-Q14 Schedule the next postpartum follow-up 0..1 boolean #xD; CF3-Q15 Schedule the next postpartum follow-up - Remarks 0..1 string #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format
status:
  v: active
item:
  link id:
    v: CF3-Q1
  text:
    v: Orientation to MCP/Availment of Benefits (Yes/No)
  type:
    v: boolean
item:
  link id:
    v: CF3-Q2
  text:
    v: Perineal wound care
  type:
    v: boolean
item:
  link id:
    v: CF3-Q3
  text:
    v: Perineal wound care - Remarks
  type:
    v: string
item:
  link id:
    v: CF3-Q4
  text:
    v: Signs of Maternal Postpartum Complications
  type:
    v: boolean
item:
  link id:
    v: CF3-Q5
  text:
    v: Signs of Maternal Postpartum Complications - Remarks
  type:
    v: string
item:
  link id:
    v: CF3-Q6
  text:
    v: Counselling and Education (Breastfeeding and Nutrition)
  type:
    v: boolean
item:
  link id:
    v: CF3-Q7
  text:
    v: Counselling and Education (Breastfeeding and Nutrition) - Remarks
  type:
    v: string
item:
  link id:
    v: CF3-Q8
  text:
    v: Counselling and Education (Family Planning)
  type:
    v: boolean
item:
  link id:
    v: CF3-Q9
  text:
    v: Counselling and Education (Family Planning) - Remarks
  type:
    v: string
item:
  link id:
    v: CF3-Q10
  text:
    v: Provided family planning service to patient (as requested by patient)
  type:
    v: boolean
item:
  link id:
    v: CF3-Q11
  text:
    v: Provided family planning service to patient (as requested by patient) - Remarks
  type:
    v: string
item:
  link id:
    v: CF3-Q12
  text:
    v: Referred to partner physician for Voluntary Surgical Sterilization (as requested by pt.)
  type:
    v: boolean
item:
  link id:
    v: CF3-Q13
  text:
    v: Referred to partner physician for Voluntary Surgical Sterilization (as requested by pt.) - Remarks
  type:
    v: string
item:
  link id:
    v: CF3-Q14
  text:
    v: Schedule the next postpartum follow-up
  type:
    v: boolean
item:
  link id:
    v: CF3-Q15
  text:
    v: Schedule the next postpartum follow-up - Remarks
  type:
    v: string

questionnaireresponse
type: QuestionnaireResponse
id:
  v: CF3-QuestionnaireResponse
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-QuestionnaireResponse
    l: PH-QuestionnaireResponse
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH_QuestionnaireResponse
    l: PH QuestionnaireResponse
text:
  status:
    v: generated
  div:
    v: Generated Narrative: QuestionnaireResponse CF3-QuestionnaireResponse Profiles: PH QuestionnaireResponse, https://nhdr.gov.ph/fhir/StructureDefinition/PH_QuestionnaireResponse LinkID Text Definition Answer<img src="[binary]" alt="doco" style="background-color: inherit"/> CF3-QuestionnaireResponse Questionnaire:None specified #xD; CF3-Q1 true #xD; CF3-Q2 true #xD; CF3-Q3 Patient instructed on proper perineal hygiene and wound care. #xD; CF3-Q4 true #xD; CF3-Q5 Patient advised to watch for fever, excessive bleeding, and severe abdominal pain. #xD; CF3-Q6 true #xD; CF3-Q7 Counselling provided on exclusive breastfeeding and balanced nutrition. #xD; CF3-Q8 true #xD; CF3-Q9 Discussed available family planning methods suitable for postpartum mothers. #xD; CF3-Q10 false #xD; CF3-Q11 Patient opted to decide on family planning method at next visit. #xD; CF3-Q12 false #xD; CF3-Q13 No referral requested by patient. #xD; CF3-Q14 true #xD; CF3-Q15 Next postpartum follow-up scheduled after 6 weeks. #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format
status:
  v: completed
item:
  link id:
    v: CF3-Q1
  answer:
    value: Boolean
      v: true
item:
  link id:
    v: CF3-Q2
  answer:
    value: Boolean
      v: true
item:
  link id:
    v: CF3-Q3
  answer:
    value: String
      v: Patient instructed on proper perineal hygiene and wound care.
item:
  link id:
    v: CF3-Q4
  answer:
    value: Boolean
      v: true
item:
  link id:
    v: CF3-Q5
  answer:
    value: String
      v: Patient advised to watch for fever, excessive bleeding, and severe abdominal pain.
item:
  link id:
    v: CF3-Q6
  answer:
    value: Boolean
      v: true
item:
  link id:
    v: CF3-Q7
  answer:
    value: String
      v: Counselling provided on exclusive breastfeeding and balanced nutrition.
item:
  link id:
    v: CF3-Q8
  answer:
    value: Boolean
      v: true
item:
  link id:
    v: CF3-Q9
  answer:
    value: String
      v: Discussed available family planning methods suitable for postpartum mothers.
item:
  link id:
    v: CF3-Q10
  answer:
    value: Boolean
      v: false
item:
  link id:
    v: CF3-Q11
  answer:
    value: String
      v: Patient opted to decide on family planning method at next visit.
item:
  link id:
    v: CF3-Q12
  answer:
    value: Boolean
      v: false
item:
  link id:
    v: CF3-Q13
  answer:
    value: String
      v: No referral requested by patient.
item:
  link id:
    v: CF3-Q14
  answer:
    value: Boolean
      v: true
item:
  link id:
    v: CF3-Q15
  answer:
    value: String
      v: Next postpartum follow-up scheduled after 6 weeks.

claim
type: Claim
id:
  v: CF3-Claim
meta:
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Claim
    l: PH-Claim
  profile:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/PH_Claim
    l: PH Claim
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: Claim CF3-Claim Profiles: PH Claim, https://nhdr.gov.ph/fhir/StructureDefinition/PH_Claim Encounter (Extension): Encounter status: Active type: Institutional use: Claim patient: Patient created: 2024-07-18 provider: Organization priority: Normal supportingInfo sequence: 1 category: Physical Examination value: Observation supportingInfo sequence: 2 category: Laboratory value: Observation supportingInfo sequence: 3 category: Pregnancy Risk Assessment value: Observation supportingInfo sequence: 4 category: Obstetric Risk Factors value: Observation supportingInfo sequence: 5 category: Estimated Delivery Date value: Observation supportingInfo sequence: 6 category: Age of Gestation value: Observation supportingInfo sequence: 7 category: Weight and Vital Signs value: Observation supportingInfo sequence: 8 category: Pregnancy Status Panel value: Observation supportingInfo sequence: 9 category: Birth Outcome Panel value: Observation diagnosis sequence: 1 diagnosis: Condition diagnosis sequence: 2 diagnosis: Moderate persistent asthma Insurances - Sequence Focal Coverage * 1 true Coverage Items - Sequence ProductOrService Serviced[x] * 1 Maternity Care Package Service 2024-07-18
extension:
  url:
    v: https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension
    l: EncounterExtension
  value: Reference
    l: CF3-Encounter
    reference:
      v: Encounter/CF3-Encounter
    display:
      v: Encounter
status:
  v: active
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/claim-type
      l: claim-type
    code:
      v: institutional
    display:
      v: Institutional
use:
  v: claim
patient:
  l: CF3-Patient
  reference:
    v: Patient/CF3-Patient
  display:
    v: Patient
created:
  v: 2024-07-18
provider:
  l: CF3-Organization
  reference:
    v: Organization/CF3-Organization
  display:
    v: Organization
priority:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/processpriority
      l: processpriority
    code:
      v: normal
supporting info:
  sequence:
    v: 1
  category:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/claiminformationcategory
        l: claiminformationcategory
      code:
        v: exam
      display:
        v: Physical Examination
  value: Reference
    l: CF3-Observation-Physical-Examination
    reference:
      v: Observation/CF3-Observation-Physical-Examination
    display:
      v: Observation
supporting info:
  sequence:
    v: 2
  category:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/claiminformationcategory
        l: claiminformationcategory
      code:
        v: lab
      display:
        v: Laboratory
  value: Reference
    l: CF3-Observation-Pertinent-Laboratory
    reference:
      v: Observation/CF3-Observation-Pertinent-Laboratory
    display:
      v: Observation
supporting info:
  sequence:
    v: 3
  category:
    text:
      v: Pregnancy Risk Assessment
  value: Reference
    l: CF3-Observation-Pregnancy-Risk-Assessment
    reference:
      v: Observation/CF3-Observation-Pregnancy-Risk-Assessment
    display:
      v: Observation
supporting info:
  sequence:
    v: 4
  category:
    text:
      v: Obstetric Risk Factors
  value: Reference
    l: CF3-Observation-Obstetric-Risk-Factors
    reference:
      v: Observation/CF3-Observation-Obstetric-Risk-Factors
    display:
      v: Observation
supporting info:
  sequence:
    v: 5
  category:
    text:
      v: Estimated Delivery Date
  value: Reference
    l: CF3-Observation-Estimated-Delivery-Date
    reference:
      v: Observation/CF3-Observation-Estimated-Delivery-Date
    display:
      v: Observation
supporting info:
  sequence:
    v: 6
  category:
    text:
      v: Age of Gestation
  value: Reference
    l: CF3-Observation-Age-of-Gestation
    reference:
      v: Observation/CF3-Observation-Age-of-Gestation
    display:
      v: Observation
supporting info:
  sequence:
    v: 7
  category:
    text:
      v: Weight and Vital Signs
  value: Reference
    l: CF3-Observation-Weight-and-Vital-Signs
    reference:
      v: Observation/CF3-Observation-Weight-and-Vital-Signs
    display:
      v: Observation
supporting info:
  sequence:
    v: 8
  category:
    text:
      v: Pregnancy Status Panel
  value: Reference
    l: CF3-Observation-Pregnancy-status-panel
    reference:
      v: Observation/CF3-Observation-Pregnancy-status-panel
    display:
      v: Observation
supporting info:
  sequence:
    v: 9
  category:
    text:
      v: Birth Outcome Panel
  value: Reference
    l: CF3-Observation-Birth-Outcome-Panel
    reference:
      v: Observation/CF3-Observation-Birth-Outcome-Panel
    display:
      v: Observation
diagnosis:
  sequence:
    v: 1
  diagnosis: Reference
    l: CF4-Condition
    reference:
      v: Condition/CF4-Condition
    display:
      v: Condition
diagnosis:
  sequence:
    v: 2
  diagnosis: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/sid/icd-10
        l: icd-10
      code:
        v: J45.4
      display:
        v: Moderate persistent asthma

method:
  v: POST
url:
  v: Claim
  l: Claim

Quantity
value:
  v: 20
unit:
  v: weeks

code:
  text:
    v: General Survey
value: String
  v: Patient appears weak

code:
  text:
    v: Vital Signs - BP
value: String
  v: 120/80 mmHg

code:
  text:
    v: Vital Signs - CR
value: String
  v: 78 bpm

code:
  text:
    v: Vital Signs - RR
value: String
  v: 18 breaths/min

code:
  text:
    v: Vital Signs - Temperature
value: String
  v: 36.8°C

code:
  text:
    v: Abdomen
value: String
  v: Soft, non-tender, no organomegaly

code:
  text:
    v: HEENT
value: String
  v: Pupils equal, round, reactive to light; oropharynx clear

code:
  text:
    v: GU (IE)
value: String
  v: Normal external genitalia; no masses or tenderness

code:
  text:
    v: Chest/Lungs
value: String
  v: Clear to auscultation bilaterally; no wheezes or crackles

code:
  text:
    v: Skin/Extremities
value: String
  v: Skin warm and dry; no rashes; peripheral pulses palpable

code:
  text:
    v: CVS
value: String
  v: Heart sounds normal; regular rate and rhythm; no murmurs

code:
  text:
    v: Neuro Examination
value: String
  v: Alert, cranial nerves II-XII intact; motor and sensory exam normal

code:
  text:
    v: CBC
value: String
  v: Normal

code:
  text:
    v: Vital signs
interpretation:
  text:
    v: Normal

code:
  text:
    v: Pregnancy Low Risk
value: Boolean
  v: true

code:
  text:
    v: Menstrual History - Last Menstrual Period (LMP)
value: DateTime
  v: 2026-02-10

code:
  text:
    v: Menstrual History - Age of Menarche
value: Integer
  v: 13

code:
  text:
    v: Obstetric History (G)
value: Integer
  v: 2

code:
  text:
    v: Obstetric History (P)
value: Integer
  v: 1

code:
  text:
    v: Obstetric History (P)[T]
value: Integer
  v: 1

code:
  text:
    v: Obstetric History (P)[P]
value: Integer
  v: 0

code:
  text:
    v: Obstetric History (P)[A]
value: Integer
  v: 0

code:
  text:
    v: Obstetric History (P)[L]
value: Integer
  v: 1

code:
  text:
    v: Multiple pregnancy
value: Boolean
  v: false

code:
  text:
    v: Ovarian cyst
value: Boolean
  v: true

code:
  text:
    v: Myoma uteri
value: Boolean
  v: false

code:
  text:
    v: Placenta previa
value: Boolean
  v: false

code:
  text:
    v: History of 3 miscarriages
value: Boolean
  v: true

code:
  text:
    v: History of stillbirth
value: Boolean
  v: false

code:
  text:
    v: History of pre-eclampsia
value: Boolean
  v: true

code:
  text:
    v: History of eclampsia
value: Boolean
  v: false

code:
  text:
    v: Premature contraction
value: Boolean
  v: true

code:
  text:
    v: Weight
value: Quantity
  value:
    v: 65
  unit:
    v: kg

code:
  text:
    v: Cardiac Rate
value: Quantity
  value:
    v: 80
  unit:
    v: beats/minute

code:
  text:
    v: Respiratory Rate
value: Quantity
  value:
    v: 18
  unit:
    v: breaths/minute

code:
  text:
    v: Blood Pressure
value: String
  v: 120/80 mmHg

code:
  text:
    v: Temperature
value: Quantity
  value:
    v: 36.8
  unit:
    v: °C

code:
  text:
    v: Maternal Outcome - Obstetric Index
value: String
  v: G2P1 (1-0-0-1)

code:
  text:
    v: Pregnancy Uterine - AOG by LMP
value: String
  v: 20 weeks

code:
  text:
    v: Pregnancy Uterine - Manner of Delivery
value: String
  v: Normal Spontaneous Vaginal Delivery

code:
  text:
    v: Pregnancy Uterine - Presentation
value: String
  v: Cephalic

code:
  text:
    v: Birth Outcome - Fetal Outcome
value: String
  v: Live birth

code:
  text:
    v: Birth Outcome - Sex
value: String
  v: Male

code:
  text:
    v: Birth Outcome - Birth Weight (grm)
value: Quantity
  value:
    v: 3200
  unit:
    v: g

code:
  text:
    v: Birth Outcome - APGAR Score
value: Integer
  v: 9

DateTime
v: 2026-03-10

sequence:
  v: 1
focal:
  v: true
coverage:
  l: K1-Coverage
  reference:
    v: Coverage/K1-Coverage
  display:
    v: Coverage

sequence:
  v: 1
product or service:
  text:
    v: Maternity Care Package Service
serviced: Date
  v: 2024-07-18