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

## : ClaimsForm2 - XML Representation

Raw xml | Download

    <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 --&gt; 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 &amp; 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, " 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, " 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, " 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, " 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>