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

## : ClaimsForm4 - XML Representation

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    <Bundle xmlns="http://hl7.org/fhir">
      <id value="ClaimsForm4"/>
      <identifier>
        <system value="http://nhdr.gov.ph/fhir/ValueSet-form-type"/>
        <value value="CF4"/>
      </identifier>
      <type value="transaction"/>
      <entry>
        <fullUrl value="urn:uuid:patient"/>
        <resource>
          <Patient>
            <id value="CF4-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_CF4-Patient"> </a><p class="res-header-id"><b>Generated Narrative: Patient CF4-Patient</b></p><a name="CF4-Patient"> </a><a name="hcCF4-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 Mark Apilyido  (no stated gender), DoB Unknown ( PhilHealth ID: PH-00001)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Extension to capture the sex of a patient, practitioner, or person."><a href="StructureDefinition-Sex.html">Sex at birth</a></td><td colspan="3">M</td></tr></table></div>
            </text>
            <extension url="https://nhdr.gov.ph/fhir/StructureDefinition/Sex">
              <valueCode value="M"/>
            </extension>
            <identifier>
              <type>
                <text value="PhilHealth ID"/>
              </type>
              <system value="http://nhdr.gov.ph/fhir/Identifier/philhealth-id"/>
              <value value="PH-00001"/>
            </identifier>
            <name>
              <family value="Apilyido"/>
              <given value="John"/>
              <given value="Mark"/>
              <suffix value="Mr."/>
            </name>
          </Patient>
        </resource>
        <request>
          <method value="POST"/>
          <url value="Patient"/>
        </request>
      </entry>
      <entry>
        <fullUrl value="urn:uuid:organization"/>
        <resource>
          <Organization>
            <id value="CF4-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_CF4-Organization"> </a><p class="res-header-id"><b>Generated Narrative: Organization CF4-Organization</b></p><a name="CF4-Organization"> </a><a name="hcCF4-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>: 572 BLK 2 LOT 21 Maharlika Village 2300 </p></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>
              <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="572 BLK 2 LOT 21"/>
              <line value="Maharlika Village"/>
              <postalCode value="2300"/>
            </address>
          </Organization>
        </resource>
        <request>
          <method value="POST"/>
          <url value="Organization"/>
        </request>
      </entry>
      <entry>
        <fullUrl value="urn:uuid:encounter"/>
        <resource>
          <Encounter>
            <id value="CF4-Encounter"/>
            <meta>
              <profile
                       value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Encounter"/>
            </meta>
            <text>
              <status value="extensions"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="Encounter_CF4-Encounter"> </a><p class="res-header-id"><b>Generated Narrative: Encounter CF4-Encounter</b></p><a name="CF4-Encounter"> </a><a name="hcCF4-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>Age in Years</b>: 35</p><p><b>status</b>: Finished</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>: 2026-03-11 08:00:00+0800 --&gt; 2026-03-11 09:30:00+0800</p><p><b>reasonReference</b>: <a href="Bundle-ClaimsForm4.html#Observation_CF4-Observation-Pertinent-Past-Medical-History">Observation</a></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></div>
            </text>
            <extension
                       url="https://nhdr.gov.ph/fhir/StructureDefinition/AgeYears">
              <valueInteger value="35"/>
            </extension>
            <status value="finished"/>
            <class>
              <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
              <code value="AMB"/>
              <display value="Ambulatory"/>
            </class>
            <period>
              <start value="2026-03-11T08:00:00+08:00"/>
              <end value="2026-03-11T09:30:00+08:00"/>
            </period>
            <reasonReference>
              <reference
                         value="Observation/CF4-Observation-Pertinent-Past-Medical-History"/>
              <display value="Observation"/>
            </reasonReference>
            <hospitalization>
              <dischargeDisposition>
                <coding>
                  <system
                          value="http://terminology.hl7.org/CodeSystem/discharge-disposition"/>
                  <code value="home"/>
                  <display value="Discharged to home"/>
                </coding>
              </dischargeDisposition>
            </hospitalization>
          </Encounter>
        </resource>
        <request>
          <method value="POST"/>
          <url value="Encounter"/>
        </request>
      </entry>
      <entry>
        <fullUrl value="urn:uuid:condition"/>
        <resource>
          <Condition>
            <id value="CF4-Condition"/>
            <meta>
              <profile
                       value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-Condition"/>
            </meta>
            <text>
              <status value="generated"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="Condition_CF4-Condition"> </a><p class="res-header-id"><b>Generated Narrative: Condition CF4-Condition</b></p><a name="CF4-Condition"> </a><a name="hcCF4-Condition"> </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-Condition.html">PH Condition</a></p></div><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/sid/icd-10 I10}">Essential (primary) hypertension</span></p><p><b>subject</b>: <a href="Bundle-ClaimsForm4.html#Patient_CF4-Patient">Patient</a></p><p><b>note</b>: , </p><blockquote><div><p>Patient reports persistent headaches for the past 2 weeks.</p>
    </div></blockquote><blockquote><div><p>Past medical history includes type 2 diabetes mellitus, controlled on metformin.</p>
    </div></blockquote></div>
            </text>
            <code>
              <coding>
                <system value="http://hl7.org/fhir/sid/icd-10"/>
                <code value="I10"/>
                <display value="Essential (primary) hypertension"/>
              </coding>
            </code>
            <subject>
              <reference value="Patient/CF4-Patient"/>
              <display value="Patient"/>
            </subject>
            <note>
              <text
                    value="Patient reports persistent headaches for the past 2 weeks."/>
            </note>
            <note>
              <text
                    value="Past medical history includes type 2 diabetes mellitus, controlled on metformin."/>
            </note>
          </Condition>
        </resource>
        <request>
          <method value="POST"/>
          <url value="Condition"/>
        </request>
      </entry>
      <entry>
        <fullUrl value="urn:uuid:observation"/>
        <resource>
          <Observation>
            <id value="CF4-Observation-Pertinent-Past-Medical-History"/>
            <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_CF4-Observation-Pertinent-Past-Medical-History"> </a><p class="res-header-id"><b>Generated Narrative: Observation CF4-Observation-Pertinent-Past-Medical-History</b></p><a name="CF4-Observation-Pertinent-Past-Medical-History"> </a><a name="hcCF4-Observation-Pertinent-Past-Medical-History"> </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 57075-4}">Pregnancy history panel</span></p><p><b>dataAbsentReason</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/data-absent-reason not-applicable}">Not Applicable</span></p><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">OB/GYN History (G)</span></p><p><b>value</b>: 3</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">OB/GYN History (P)</span></p><p><b>value</b>: 2</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">OB/GYN History (P)(T)</span></p><p><b>value</b>: 1</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">OB/GYN History (P)(P)</span></p><p><b>value</b>: 1</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">OB/GYN History (P)(A)</span></p><p><b>value</b>: 0</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">OB/GYN History (P)(L)</span></p><p><b>value</b>: 2</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">OB/GYN History - LMP</span></p><p><b>value</b>: 2026-02-01</p></blockquote></div>
            </text>
            <status value="final"/>
            <code>
              <coding>
                <system value="http://loinc.org"/>
                <code value="57075-4"/>
                <display value="Pregnancy history panel"/>
              </coding>
            </code>
            <dataAbsentReason>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/data-absent-reason"/>
                <code value="not-applicable"/>
              </coding>
            </dataAbsentReason>
            <component>
              <code>
                <text value="OB/GYN History (G)"/>
              </code>
              <valueInteger value="3"/>
            </component>
            <component>
              <code>
                <text value="OB/GYN History (P)"/>
              </code>
              <valueInteger value="2"/>
            </component>
            <component>
              <code>
                <text value="OB/GYN History (P)(T)"/>
              </code>
              <valueInteger value="1"/>
            </component>
            <component>
              <code>
                <text value="OB/GYN History (P)(P)"/>
              </code>
              <valueInteger value="1"/>
            </component>
            <component>
              <code>
                <text value="OB/GYN History (P)(A)"/>
              </code>
              <valueInteger value="0"/>
            </component>
            <component>
              <code>
                <text value="OB/GYN History (P)(L)"/>
              </code>
              <valueInteger value="2"/>
            </component>
            <component>
              <code>
                <text value="OB/GYN History - LMP"/>
              </code>
              <valueDateTime value="2026-02-01"/>
            </component>
          </Observation>
        </resource>
        <request>
          <method value="POST"/>
          <url value="Observation"/>
        </request>
      </entry>
      <entry>
        <fullUrl value="urn:uuid:observation"/>
        <resource>
          <Observation>
            <id
                value="CF4-Observation-Pertinent-Signs-and-Symptoms-on-Admission"/>
            <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_CF4-Observation-Pertinent-Signs-and-Symptoms-on-Admission"> </a><p class="res-header-id"><b>Generated Narrative: Observation CF4-Observation-Pertinent-Signs-and-Symptoms-on-Admission</b></p><a name="CF4-Observation-Pertinent-Signs-and-Symptoms-on-Admission"> </a><a name="hcCF4-Observation-Pertinent-Signs-and-Symptoms-on-Admission"> </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 75325-1}">Pertinent signs and symptoms on admission</span></p><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">Altered mental sensorium</span></p><p><b>value</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">Abdominal cramp/pain</span></p><p><b>value</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">Anorexia</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">Bleeding gum</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">Body weakness</span></p><p><b>value</b>: true</p></blockquote></div>
            </text>
            <status value="final"/>
            <code>
              <coding>
                <system value="http://loinc.org"/>
                <code value="75325-1"/>
                <display value="Pertinent signs and symptoms on admission"/>
              </coding>
            </code>
            <component>
              <code>
                <text value="Altered mental sensorium"/>
              </code>
              <valueBoolean value="true"/>
            </component>
            <component>
              <code>
                <text value="Abdominal cramp/pain"/>
              </code>
              <valueBoolean value="true"/>
            </component>
            <component>
              <code>
                <text value="Anorexia"/>
              </code>
              <valueBoolean value="false"/>
            </component>
            <component>
              <code>
                <text value="Bleeding gum"/>
              </code>
              <valueBoolean value="false"/>
            </component>
            <component>
              <code>
                <text value="Body weakness"/>
              </code>
              <valueBoolean value="true"/>
            </component>
          </Observation>
        </resource>
        <request>
          <method value="POST"/>
          <url value="Observation"/>
        </request>
      </entry>
      <entry>
        <fullUrl value="urn:uuid:observation"/>
        <resource>
          <Observation>
            <id value="CF4-Observation-Physical-Examination-on-Admission"/>
            <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_CF4-Observation-Physical-Examination-on-Admission"> </a><p class="res-header-id"><b>Generated Narrative: Observation CF4-Observation-Physical-Examination-on-Admission</b></p><a name="CF4-Observation-Physical-Examination-on-Admission"> </a><a name="hcCF4-Observation-Physical-Examination-on-Admission"> </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 29545-1}">Physical findings on admission</span></p><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://loinc.org 8302-2}">Body height</span></p><p><b>value</b>: 160 cm</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://loinc.org 29463-7}">Body weight</span></p><p><b>value</b>: 65 kg</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://loinc.org 80313-0}">Mental status - level of consciousness</span></p><p><b>value</b>: Awake and alert</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://loinc.org 85354-9}">Blood pressure panel</span></p><p><b>value</b>: 120/80 mmHg</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://loinc.org 8867-4}">Heart rate</span></p><p><b>value</b>: 82 beats/min</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://loinc.org 9279-1}">Respiratory rate</span></p><p><b>value</b>: 20 breaths/min</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://loinc.org 8310-5}">Body temperature</span></p><p><b>value</b>: 37 °C</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">HEENT</span></p><p><b>value</b>: Essentially Normal</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">Chest/Lungs</span></p><p><b>value</b>: Symmetrical chest expansion</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">CVS</span></p><p><b>value</b>: Displaced apex beat</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">Abdomen</span></p><p><b>value</b>: Abdominal rigidity</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">GU (IE)</span></p><p><b>value</b>: Blood stained on examining finger</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">Skin/Extremities</span></p><p><b>value</b>: Rashes/petechiae</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:">Neuro Exam</span></p><p><b>value</b>: Essentially normal</p></blockquote></div>
            </text>
            <status value="final"/>
            <code>
              <coding>
                <system value="http://loinc.org"/>
                <code value="29545-1"/>
                <display value="Physical findings on admission"/>
              </coding>
            </code>
            <component>
              <code>
                <coding>
                  <system value="http://loinc.org"/>
                  <code value="8302-2"/>
                  <display value="Body height"/>
                </coding>
              </code>
              <valueQuantity>
                <value value="160"/>
                <unit value="cm"/>
              </valueQuantity>
            </component>
            <component>
              <code>
                <coding>
                  <system value="http://loinc.org"/>
                  <code value="29463-7"/>
                  <display value="Body weight"/>
                </coding>
              </code>
              <valueQuantity>
                <value value="65"/>
                <unit value="kg"/>
              </valueQuantity>
            </component>
            <component>
              <code>
                <coding>
                  <system value="http://loinc.org"/>
                  <code value="80313-0"/>
                  <display value="Mental status - level of consciousness"/>
                </coding>
              </code>
              <valueString value="Awake and alert"/>
            </component>
            <component>
              <code>
                <coding>
                  <system value="http://loinc.org"/>
                  <code value="85354-9"/>
                  <display value="Blood pressure panel"/>
                </coding>
              </code>
              <valueString value="120/80 mmHg"/>
            </component>
            <component>
              <code>
                <coding>
                  <system value="http://loinc.org"/>
                  <code value="8867-4"/>
                  <display value="Heart rate"/>
                </coding>
              </code>
              <valueQuantity>
                <value value="82"/>
                <unit value="beats/min"/>
              </valueQuantity>
            </component>
            <component>
              <code>
                <coding>
                  <system value="http://loinc.org"/>
                  <code value="9279-1"/>
                  <display value="Respiratory rate"/>
                </coding>
              </code>
              <valueQuantity>
                <value value="20"/>
                <unit value="breaths/min"/>
              </valueQuantity>
            </component>
            <component>
              <code>
                <coding>
                  <system value="http://loinc.org"/>
                  <code value="8310-5"/>
                  <display value="Body temperature"/>
                </coding>
              </code>
              <valueQuantity>
                <value value="37"/>
                <unit value="°C"/>
              </valueQuantity>
            </component>
            <component>
              <code>
                <text value="HEENT"/>
              </code>
              <valueString value="Essentially Normal"/>
            </component>
            <component>
              <code>
                <text value="Chest/Lungs"/>
              </code>
              <valueString value="Symmetrical chest expansion"/>
            </component>
            <component>
              <code>
                <text value="CVS"/>
              </code>
              <valueString value="Displaced apex beat"/>
            </component>
            <component>
              <code>
                <text value="Abdomen"/>
              </code>
              <valueString value="Abdominal rigidity"/>
            </component>
            <component>
              <code>
                <text value="GU (IE)"/>
              </code>
              <valueString value="Blood stained on examining finger"/>
            </component>
            <component>
              <code>
                <text value="Skin/Extremities"/>
              </code>
              <valueString value="Rashes/petechiae"/>
            </component>
            <component>
              <code>
                <text value="Neuro Exam"/>
              </code>
              <valueString value="Essentially normal"/>
            </component>
          </Observation>
        </resource>
        <request>
          <method value="POST"/>
          <url value="Observation"/>
        </request>
      </entry>
      <entry>
        <fullUrl value="urn:uuid:servicerequest"/>
        <resource>
          <ServiceRequest>
            <id value="CF4-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_CF4-ServiceRequest"> </a><p class="res-header-id"><b>Generated Narrative: ServiceRequest CF4-ServiceRequest</b></p><a name="CF4-ServiceRequest"> </a><a name="hcCF4-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-ClaimsForm4.html#Patient_CF4-Patient">Patient</a></p><p><b>requester</b>: <a href="Bundle-ClaimsForm4.html#Organization_CF4-Organization">Organization</a></p><p><b>reasonReference</b>: <a href="Bundle-ClaimsForm4.html#Observation_CF4-Observation-Physical-Examination-on-Admission">Observation</a></p></div>
            </text>
            <status value="completed"/>
            <intent value="order"/>
            <subject>
              <reference value="Patient/CF4-Patient"/>
              <display value="Patient"/>
            </subject>
            <requester>
              <reference value="Organization/CF4-Organization"/>
              <display value="Organization"/>
            </requester>
            <reasonReference>
              <reference
                         value="Observation/CF4-Observation-Physical-Examination-on-Admission"/>
              <display value="Observation"/>
            </reasonReference>
          </ServiceRequest>
        </resource>
        <request>
          <method value="POST"/>
          <url value="ServiceRequest"/>
        </request>
      </entry>
      <entry>
        <fullUrl value="urn:uuid:clinicalimpression"/>
        <resource>
          <ClinicalImpression>
            <id value="CF4-ClinicalImpression"/>
            <meta>
              <profile
                       value="https://nhdr.gov.ph/fhir/StructureDefinition/PH-ClinicalImpression"/>
            </meta>
            <text>
              <status value="generated"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="ClinicalImpression_CF4-ClinicalImpression"> </a><p class="res-header-id"><b>Generated Narrative: ClinicalImpression CF4-ClinicalImpression</b></p><a name="CF4-ClinicalImpression"> </a><a name="hcCF4-ClinicalImpression"> </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-ClinicalImpression.html">PH ClinicalImpression</a></p></div><p><b>status</b>: Completed</p><p><b>description</b>: Clinical impression on admission based on history, pertinent signs and symptoms, and physical examination.</p><p><b>subject</b>: <a href="Bundle-ClaimsForm4.html#Patient_CF4-Patient">Patient</a></p><p><b>effective</b>: 2026-03-12 09:30:00+0800</p></div>
            </text>
            <status value="completed"/>
            <description
                         value="Clinical impression on admission based on history, pertinent signs and symptoms, and physical examination."/>
            <subject>
              <reference value="Patient/CF4-Patient"/>
              <display value="Patient"/>
            </subject>
            <effectiveDateTime value="2026-03-12T09:30:00+08:00"/>
          </ClinicalImpression>
        </resource>
        <request>
          <method value="POST"/>
          <url value="ClinicalImpression"/>
        </request>
      </entry>
      <entry>
        <fullUrl value="urn:uuid:provenance"/>
        <resource>
          <Provenance>
            <id value="CF4-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_CF4-Provenance"> </a><p class="res-header-id"><b>Generated Narrative: Provenance CF4-Provenance</b></p><a name="CF4-Provenance"> </a><a name="hcCF4-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-ClaimsForm4.html#Claim_CF4-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-Konsulta-Prescription-Slip.html#Practitioner_K4-Practitioner">Practitioner</a></td></tr></table></div>
            </text>
            <target>
              <reference value="Claim/CF4-Claim"/>
              <display value="Claim"/>
            </target>
            <recorded value="2026-02-03T09:00:00+08:00"/>
            <agent>
              <who>
                <reference value="Practitioner/K4-Practitioner"/>
                <display value="Practitioner"/>
              </who>
            </agent>
            <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="Practitioner/K4-Practitioner"/>
                <display value="Practitioner"/>
              </who>
              <data value="QkFTRTY0X1NJR05BVFVSRV9QQVRJRU5U"/>
            </signature>
          </Provenance>
        </resource>
        <request>
          <method value="POST"/>
          <url value="Provenance"/>
        </request>
      </entry>
      <entry>
        <fullUrl value="urn:uuid:claim"/>
        <resource>
          <Claim>
            <id value="CF4-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_CF4-Claim"> </a><p class="res-header-id"><b>Generated Narrative: Claim CF4-Claim</b></p><a name="CF4-Claim"> </a><a name="hcCF4-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-ClaimsForm4.html#Encounter_CF4-Encounter">Encounter</a></p><p><b>identifier</b>: <code>https://nhdr.gov.ph/claim</code>/CLAIM-0001</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-ClaimsForm4.html#Patient_CF4-Patient">Patient</a></p><p><b>created</b>: 2026-03-17</p><p><b>provider</b>: <a href="Bundle-ClaimsForm4.html#Organization_CF4-Organization">Organization</a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><p><b>prescription</b>: <a href="MedicationRequest/CF4-MedicationRequest">MedicationRequest</a></p><p><b>referral</b>: <a href="Bundle-ClaimsForm4.html#ServiceRequest_CF4-ServiceRequest">ServiceRequest</a></p><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title="Codes:">Pertinent Past Medical History</span></p><p><b>value</b>: <a href="Bundle-ClaimsForm4.html#Observation_CF4-Observation-Pertinent-Past-Medical-History">Observation</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title="Codes:">Signs and Symptoms</span></p><p><b>value</b>: <a href="Bundle-ClaimsForm4.html#Observation_CF4-Observation-Pertinent-Signs-and-Symptoms-on-Admission">Observation</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: <span title="Codes:">Physical Examination</span></p><p><b>value</b>: <a href="Bundle-ClaimsForm4.html#Observation_CF4-Observation-Physical-Examination-on-Admission">Observation</a></p></blockquote><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:">Hypertension</span></td></tr></table><h3>Procedures</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Procedure[x]</b></td></tr><tr><td style="display: none">*</td><td>1</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-Konsulta-Registration.html#Coverage_K1-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:">General Ward</span></p><p><b>quantity</b>: 1</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>1000</td><td>Philippine piso</td></tr></table></blockquote></div>
            </text>
            <extension
                       url="https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension">
              <valueReference>
                <reference value="Encounter/CF4-Encounter"/>
                <display value="Encounter"/>
              </valueReference>
            </extension>
            <identifier>
              <system value="https://nhdr.gov.ph/claim"/>
              <value value="CLAIM-0001"/>
            </identifier>
            <status value="active"/>
            <type>
              <coding>
                <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
                <code value="institutional"/>
              </coding>
            </type>
            <use value="claim"/>
            <patient>
              <reference value="Patient/CF4-Patient"/>
              <display value="Patient"/>
            </patient>
            <created value="2026-03-17"/>
            <provider>
              <reference value="Organization/CF4-Organization"/>
              <display value="Organization"/>
            </provider>
            <priority>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/processpriority"/>
                <code value="normal"/>
              </coding>
            </priority>
            <prescription>
              <reference value="MedicationRequest/CF4-MedicationRequest"/>
              <display value="MedicationRequest"/>
            </prescription>
            <referral>
              <reference value="ServiceRequest/CF4-ServiceRequest"/>
              <display value="ServiceRequest"/>
            </referral>
            <supportingInfo>
              <sequence value="1"/>
              <category>
                <text value="Pertinent Past Medical History"/>
              </category>
              <valueReference>
                <reference
                           value="Observation/CF4-Observation-Pertinent-Past-Medical-History"/>
                <display value="Observation"/>
              </valueReference>
            </supportingInfo>
            <supportingInfo>
              <sequence value="2"/>
              <category>
                <text value="Signs and Symptoms"/>
              </category>
              <valueReference>
                <reference
                           value="Observation/CF4-Observation-Pertinent-Signs-and-Symptoms-on-Admission"/>
                <display value="Observation"/>
              </valueReference>
            </supportingInfo>
            <supportingInfo>
              <sequence value="3"/>
              <category>
                <text value="Physical Examination"/>
              </category>
              <valueReference>
                <reference
                           value="Observation/CF4-Observation-Physical-Examination-on-Admission"/>
                <display value="Observation"/>
              </valueReference>
            </supportingInfo>
            <diagnosis>
              <sequence value="1"/>
              <diagnosisCodeableConcept>
                <text value="Hypertension"/>
              </diagnosisCodeableConcept>
            </diagnosis>
            <procedure>
              <sequence value="1"/>
              <procedureReference>
                <reference value="Procedure/CF2-Procedure"/>
                <display value="Procedure"/>
              </procedureReference>
            </procedure>
            <insurance>
              <sequence value="1"/>
              <focal value="true"/>
              <coverage>
                <reference value="Coverage/K1-Coverage"/>
                <display value="Coverage"/>
              </coverage>
            </insurance>
            <item>
              <sequence value="1"/>
              <productOrService>
                <text value="General Ward"/>
              </productOrService>
              <quantity>
                <value value="1"/>
              </quantity>
              <net>
                <value value="1000"/>
                <currency value="PHP"/>
              </net>
            </item>
          </Claim>
        </resource>
        <request>
          <method value="POST"/>
          <url value="Claim"/>
        </request>
      </entry>
    </Bundle>