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

## CF1 Sample JSON Bundle - Member is not the Patient

    {
      "resourceType": "Bundle",
      "id": "ClaimsForm1-1",
      "type": "transaction",
      "identifier": {
        "system": "http://nhdr.gov.ph/fhir/ValueSet-form-type",
        "value": "CF1"
    },
    "entry": [
        {
          "fullUrl": "urn:uuid:CF1-RelatedPerson",
          "resource": {
            "resourceType": "RelatedPerson",
            "meta": {
              "profile": [
                "https://nhdr.gov.ph/fhir/StructureDefinition/PH-RelatedPerson"
              ]
            },
            "identifier": [
              {
                "type": {
                  "coding": [
                    {
                      "code": "NIIP"
                    }
                  ],
                  "text": "PhilHealth Identification Number"
                },
                "value": "PH54321"
              }
            ],
            "patient": {
              "reference": "urn:uuid:CF1-Patient-2"
            },
            "name": [
              {
                "family": "Bautista",
                "given": [
                  "Lorna Mae",
                  "Santos"
                ],
                "suffix": [
                  "Mrs."
                ]
              }
            ],
            "birthDate": "1971-02-11",
            "address": [
              {
                "line": [
                  "Fordham Road"
                ],
                "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"
                    }
                  }
                ],
                "country": "PH",
                "postalCode": "1110"
              }
            ],
            "extension": [
              {
                "url": "https://nhdr.gov.ph/fhir/StructureDefinition/Sex",
                "valueCode": "F"
              }
            ],
            "telecom": [
              {
                "system": "phone",
                "value": "912-00-00"
              },
              {
                "system": "phone",
                "value": "0927-000-0000"
              },
              {
                "system": "email",
                "value": "lmbautista@email.com"
              }
            ]
          },
          "request": {
            "method": "POST",
            "url": "RelatedPerson"
          }
        },
           {
          "fullUrl": "urn:uuid:CF1-Patient",
          "resource": {
            "resourceType": "Patient",
            "meta": {
              "profile": [
                "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Patient"
              ]
            },
            "link": [
            {
                "other": {
                    "reference": "urn:uuid:CF1-RelatedPerson"
                },
                "type": "refer"
            }
          ]
          },
          "request": {
            "method": "POST",
            "url": "Patient"
          }
        },
        {
          "fullUrl": "urn:uuid:CF1-Organization",
          "resource": {
            "resourceType": "Organization",
            "meta": {
              "profile": [
                "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Organization"
              ]
            },
            "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:CF1-Provenance",
          "resource": {
            "resourceType": "Provenance",
            "meta": {
              "profile": [
                "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Provenance"
              ]
            },
            "target": [
              {
                "reference": "urn:uuid:CF1-Claim"
              }
            ],
            "recorded": "2026-02-03T09:00:00+08:00",
            "agent": [
              {
                "who": {
                  "reference": "urn:uuid:CF1-Organization"
                }
              }
            ],
            "signature": [
              {
                "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": "urn:uuid:CF1-RelatedPerson"
                },
                "data": "QkFTRTY0X1NJR05BVFVSRV9QQVRJRU5U",
                "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": "urn:uuid:CF1-Organization"
                },
                "data": "QkFTRTY0X1NJR05BVFVSRV9PUkdBTklaVElPTg=="
              }
            ]
          },
          "request": {
            "method": "POST",
            "url": "Provenance"
          }
        },
        {
          "fullUrl": "urn:uuid:CF1-Questionnaire",
          "resource": {
            "resourceType": "Questionnaire",
            "meta": {
              "profile": [
                "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Questionnaire"
              ]
            },
            "status": "active",
            "item": [
              {
                "linkId": "CF1-Q1",
                "text": "Patient is the member?",
                "type": "boolean"
              }
            ]
          },
          "request": {
            "method": "POST",
            "url": "Questionnaire"
          }
        },
        {
          "fullUrl": "urn:uuid:CF1-QuestionnaireResponse",
          "resource": {
            "resourceType": "QuestionnaireResponse",
            "meta": {
              "profile": [
                "https://nhdr.gov.ph/fhir/StructureDefinition/PH-QuestionnaireResponse"
              ]
            },
            "status": "completed",
            "item": [
              {
                "linkId": "CF1-Q1",
                "answer": [
                  {
                    "valueBoolean": true
                  }
                ]
              }
            ]
          },
          "request": {
            "method": "POST",
            "url": "QuestionnaireResponse"
          }
        },
        {
          "fullUrl": "urn:uuid:CF1-Coverage",
          "resource": {
            "resourceType": "Coverage",
            "meta": {
              "profile": [
                "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Coverage"
              ]
            },
            "status": "active",
            "policyHolder": {
              "reference": "urn:uuid:CF1-Organization"
            },
            "beneficiary": {
              "reference": "urn:uuid:CF1-Patient-2"
            },
            "payor": [
              {
                "reference": "urn:uuid:CF1-Organization"
              }
            ]
          },
          "request": {
            "method": "POST",
            "url": "Coverage"
          }
        },
        {
          "fullUrl": "urn:uuid:CF1-Claim",
          "resource": {
            "resourceType": "Claim",
            "meta": {
              "profile": [
                "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Claim"
              ]
            },
            "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",
            "created": "2026-02-03T08:00:00+08:00",
            "provider": {
              "reference": "urn:uuid:CF1-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": "urn:uuid:CF1-RelatedPerson"
              }
            },
            "patient": {
              "reference": "urn:uuid:CF1-Patient-2"
            },
            "insurance": [
              {
                "sequence": 1,
                "focal": true,
                "coverage": {
                  "reference": "urn:uuid:CF1-Coverage"
                }
              }
            ]
          },
          "request": {
            "method": "POST",
            "url": "Claim"
          }
        }
      ]
    }