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 - JSON Representation

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    {
      "resourceType" : "Bundle",
      "id" : "ClaimsForm4",
      "identifier" : {
        "system" : "http://nhdr.gov.ph/fhir/ValueSet-form-type",
        "value" : "CF4"
      },
      "type" : "transaction",
      "entry" : [
        {
          "fullUrl" : "urn:uuid:patient",
          "resource" : {
            "resourceType" : "Patient",
            "id" : "CF4-Patient",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Patient"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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:\u00a0PH-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>"
            },
            "extension" : [
              {
                "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/Sex",
                "valueCode" : "M"
              }
            ],
            "identifier" : [
              {
                "type" : {
                  "text" : "PhilHealth ID"
                },
                "system" : "http://nhdr.gov.ph/fhir/Identifier/philhealth-id",
                "value" : "PH-00001"
              }
            ],
            "name" : [
              {
                "family" : "Apilyido",
                "given" : [
                  "John",
                  "Mark"
                ],
                "suffix" : [
                  "Mr."
                ]
              }
            ]
          },
          "request" : {
            "method" : "POST",
            "url" : "Patient"
          }
        },
        {
          "fullUrl" : "urn:uuid:organization",
          "resource" : {
            "resourceType" : "Organization",
            "id" : "CF4-Organization",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Organization"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "identifier" : [
              {
                "type" : {
                  "coding" : [
                    {
                      "code" : "AN"
                    }
                  ],
                  "text" : "PhilHealth Accreditation Number (PAN)"
                },
                "value" : "AN199513893"
              }
            ],
            "name" : "6th General Hospital",
            "address" : [
              {
                "extension" : [
                  {
                    "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/Barangay",
                    "valueCoding" : {
                      "code" : "036916001",
                      "display" : "San Roque"
                    }
                  },
                  {
                    "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/CityMunicipality",
                    "valueCoding" : {
                      "code" : "036916000",
                      "display" : "Tarlac City"
                    }
                  },
                  {
                    "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/Province",
                    "valueCoding" : {
                      "code" : "036900000",
                      "display" : "Tarlac"
                    }
                  }
                ],
                "line" : [
                  "572 BLK 2 LOT 21",
                  "Maharlika Village"
                ],
                "postalCode" : "2300"
              }
            ]
          },
          "request" : {
            "method" : "POST",
            "url" : "Organization"
          }
        },
        {
          "fullUrl" : "urn:uuid:encounter",
          "resource" : {
            "resourceType" : "Encounter",
            "id" : "CF4-Encounter",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Encounter"
              ]
            },
            "text" : {
              "status" : "extensions",
              "div" : "<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>"
            },
            "extension" : [
              {
                "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/AgeYears",
                "valueInteger" : 35
              }
            ],
            "status" : "finished",
            "class" : {
              "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code" : "AMB",
              "display" : "Ambulatory"
            },
            "period" : {
              "start" : "2026-03-11T08:00:00+08:00",
              "end" : "2026-03-11T09:30:00+08:00"
            },
            "reasonReference" : [
              {
                "reference" : "Observation/CF4-Observation-Pertinent-Past-Medical-History",
                "display" : "Observation"
              }
            ],
            "hospitalization" : {
              "dischargeDisposition" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/discharge-disposition",
                    "code" : "home",
                    "display" : "Discharged to home"
                  }
                ]
              }
            }
          },
          "request" : {
            "method" : "POST",
            "url" : "Encounter"
          }
        },
        {
          "fullUrl" : "urn:uuid:condition",
          "resource" : {
            "resourceType" : "Condition",
            "id" : "CF4-Condition",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Condition"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>\n</div></blockquote><blockquote><div><p>Past medical history includes type 2 diabetes mellitus, controlled on metformin.</p>\n</div></blockquote></div>"
            },
            "code" : {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/sid/icd-10",
                  "code" : "I10",
                  "display" : "Essential (primary) hypertension"
                }
              ]
            },
            "subject" : {
              "reference" : "Patient/CF4-Patient",
              "display" : "Patient"
            },
            "note" : [
              {
                "text" : "Patient reports persistent headaches for the past 2 weeks."
              },
              {
                "text" : "Past medical history includes type 2 diabetes mellitus, controlled on metformin."
              }
            ]
          },
          "request" : {
            "method" : "POST",
            "url" : "Condition"
          }
        },
        {
          "fullUrl" : "urn:uuid:observation",
          "resource" : {
            "resourceType" : "Observation",
            "id" : "CF4-Observation-Pertinent-Past-Medical-History",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "status" : "final",
            "code" : {
              "coding" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "57075-4",
                  "display" : "Pregnancy history panel"
                }
              ]
            },
            "dataAbsentReason" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/data-absent-reason",
                  "code" : "not-applicable"
                }
              ]
            },
            "component" : [
              {
                "code" : {
                  "text" : "OB/GYN History (G)"
                },
                "valueInteger" : 3
              },
              {
                "code" : {
                  "text" : "OB/GYN History (P)"
                },
                "valueInteger" : 2
              },
              {
                "code" : {
                  "text" : "OB/GYN History (P)(T)"
                },
                "valueInteger" : 1
              },
              {
                "code" : {
                  "text" : "OB/GYN History (P)(P)"
                },
                "valueInteger" : 1
              },
              {
                "code" : {
                  "text" : "OB/GYN History (P)(A)"
                },
                "valueInteger" : 0
              },
              {
                "code" : {
                  "text" : "OB/GYN History (P)(L)"
                },
                "valueInteger" : 2
              },
              {
                "code" : {
                  "text" : "OB/GYN History - LMP"
                },
                "valueDateTime" : "2026-02-01"
              }
            ]
          },
          "request" : {
            "method" : "POST",
            "url" : "Observation"
          }
        },
        {
          "fullUrl" : "urn:uuid:observation",
          "resource" : {
            "resourceType" : "Observation",
            "id" : "CF4-Observation-Pertinent-Signs-and-Symptoms-on-Admission",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "status" : "final",
            "code" : {
              "coding" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "75325-1",
                  "display" : "Pertinent signs and symptoms on admission"
                }
              ]
            },
            "component" : [
              {
                "code" : {
                  "text" : "Altered mental sensorium"
                },
                "valueBoolean" : true
              },
              {
                "code" : {
                  "text" : "Abdominal cramp/pain"
                },
                "valueBoolean" : true
              },
              {
                "code" : {
                  "text" : "Anorexia"
                },
                "valueBoolean" : false
              },
              {
                "code" : {
                  "text" : "Bleeding gum"
                },
                "valueBoolean" : false
              },
              {
                "code" : {
                  "text" : "Body weakness"
                },
                "valueBoolean" : true
              }
            ]
          },
          "request" : {
            "method" : "POST",
            "url" : "Observation"
          }
        },
        {
          "fullUrl" : "urn:uuid:observation",
          "resource" : {
            "resourceType" : "Observation",
            "id" : "CF4-Observation-Physical-Examination-on-Admission",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Observation"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "status" : "final",
            "code" : {
              "coding" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "29545-1",
                  "display" : "Physical findings on admission"
                }
              ]
            },
            "component" : [
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://loinc.org",
                      "code" : "8302-2",
                      "display" : "Body height"
                    }
                  ]
                },
                "valueQuantity" : {
                  "value" : 160,
                  "unit" : "cm"
                }
              },
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://loinc.org",
                      "code" : "29463-7",
                      "display" : "Body weight"
                    }
                  ]
                },
                "valueQuantity" : {
                  "value" : 65,
                  "unit" : "kg"
                }
              },
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://loinc.org",
                      "code" : "80313-0",
                      "display" : "Mental status - level of consciousness"
                    }
                  ]
                },
                "valueString" : "Awake and alert"
              },
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://loinc.org",
                      "code" : "85354-9",
                      "display" : "Blood pressure panel"
                    }
                  ]
                },
                "valueString" : "120/80 mmHg"
              },
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://loinc.org",
                      "code" : "8867-4",
                      "display" : "Heart rate"
                    }
                  ]
                },
                "valueQuantity" : {
                  "value" : 82,
                  "unit" : "beats/min"
                }
              },
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://loinc.org",
                      "code" : "9279-1",
                      "display" : "Respiratory rate"
                    }
                  ]
                },
                "valueQuantity" : {
                  "value" : 20,
                  "unit" : "breaths/min"
                }
              },
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://loinc.org",
                      "code" : "8310-5",
                      "display" : "Body temperature"
                    }
                  ]
                },
                "valueQuantity" : {
                  "value" : 37,
                  "unit" : "°C"
                }
              },
              {
                "code" : {
                  "text" : "HEENT"
                },
                "valueString" : "Essentially Normal"
              },
              {
                "code" : {
                  "text" : "Chest/Lungs"
                },
                "valueString" : "Symmetrical chest expansion"
              },
              {
                "code" : {
                  "text" : "CVS"
                },
                "valueString" : "Displaced apex beat"
              },
              {
                "code" : {
                  "text" : "Abdomen"
                },
                "valueString" : "Abdominal rigidity"
              },
              {
                "code" : {
                  "text" : "GU (IE)"
                },
                "valueString" : "Blood stained on examining finger"
              },
              {
                "code" : {
                  "text" : "Skin/Extremities"
                },
                "valueString" : "Rashes/petechiae"
              },
              {
                "code" : {
                  "text" : "Neuro Exam"
                },
                "valueString" : "Essentially normal"
              }
            ]
          },
          "request" : {
            "method" : "POST",
            "url" : "Observation"
          }
        },
        {
          "fullUrl" : "urn:uuid:servicerequest",
          "resource" : {
            "resourceType" : "ServiceRequest",
            "id" : "CF4-ServiceRequest",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-ServiceRequest"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "status" : "completed",
            "intent" : "order",
            "subject" : {
              "reference" : "Patient/CF4-Patient",
              "display" : "Patient"
            },
            "requester" : {
              "reference" : "Organization/CF4-Organization",
              "display" : "Organization"
            },
            "reasonReference" : [
              {
                "reference" : "Observation/CF4-Observation-Physical-Examination-on-Admission",
                "display" : "Observation"
              }
            ]
          },
          "request" : {
            "method" : "POST",
            "url" : "ServiceRequest"
          }
        },
        {
          "fullUrl" : "urn:uuid:clinicalimpression",
          "resource" : {
            "resourceType" : "ClinicalImpression",
            "id" : "CF4-ClinicalImpression",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-ClinicalImpression"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "status" : "completed",
            "description" : "Clinical impression on admission based on history, pertinent signs and symptoms, and physical examination.",
            "subject" : {
              "reference" : "Patient/CF4-Patient",
              "display" : "Patient"
            },
            "effectiveDateTime" : "2026-03-12T09:30:00+08:00"
          },
          "request" : {
            "method" : "POST",
            "url" : "ClinicalImpression"
          }
        },
        {
          "fullUrl" : "urn:uuid:provenance",
          "resource" : {
            "resourceType" : "Provenance",
            "id" : "CF4-Provenance",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Provenance"
              ]
            },
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "target" : [
              {
                "reference" : "Claim/CF4-Claim",
                "display" : "Claim"
              }
            ],
            "recorded" : "2026-02-03T09:00:00+08:00",
            "agent" : [
              {
                "who" : {
                  "reference" : "Practitioner/K4-Practitioner",
                  "display" : "Practitioner"
                }
              }
            ],
            "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" : "Practitioner/K4-Practitioner",
                  "display" : "Practitioner"
                },
                "data" : "QkFTRTY0X1NJR05BVFVSRV9QQVRJRU5U"
              }
            ]
          },
          "request" : {
            "method" : "POST",
            "url" : "Provenance"
          }
        },
        {
          "fullUrl" : "urn:uuid:claim",
          "resource" : {
            "resourceType" : "Claim",
            "id" : "CF4-Claim",
            "meta" : {
              "profile" : [
                🔗 "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Claim"
              ]
            },
            "text" : {
              "status" : "extensions",
              "div" : "<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>"
            },
            "extension" : [
              {
                "url" : "https://nhdr.gov.ph/fhir/StructureDefinition/EncounterExtension",
                "valueReference" : {
                  "reference" : "Encounter/CF4-Encounter",
                  "display" : "Encounter"
                }
              }
            ],
            "identifier" : [
              {
                "system" : "https://nhdr.gov.ph/claim",
                "value" : "CLAIM-0001"
              }
            ],
            "status" : "active",
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
                  "code" : "institutional"
                }
              ]
            },
            "use" : "claim",
            "patient" : {
              "reference" : "Patient/CF4-Patient",
              "display" : "Patient"
            },
            "created" : "2026-03-17",
            "provider" : {
              "reference" : "Organization/CF4-Organization",
              "display" : "Organization"
            },
            "priority" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
                  "code" : "normal"
                }
              ]
            },
            "prescription" : {
              "reference" : "MedicationRequest/CF4-MedicationRequest",
              "display" : "MedicationRequest"
            },
            "referral" : {
              "reference" : "ServiceRequest/CF4-ServiceRequest",
              "display" : "ServiceRequest"
            },
            "supportingInfo" : [
              {
                "sequence" : 1,
                "category" : {
                  "text" : "Pertinent Past Medical History"
                },
                "valueReference" : {
                  "reference" : "Observation/CF4-Observation-Pertinent-Past-Medical-History",
                  "display" : "Observation"
                }
              },
              {
                "sequence" : 2,
                "category" : {
                  "text" : "Signs and Symptoms"
                },
                "valueReference" : {
                  "reference" : "Observation/CF4-Observation-Pertinent-Signs-and-Symptoms-on-Admission",
                  "display" : "Observation"
                }
              },
              {
                "sequence" : 3,
                "category" : {
                  "text" : "Physical Examination"
                },
                "valueReference" : {
                  "reference" : "Observation/CF4-Observation-Physical-Examination-on-Admission",
                  "display" : "Observation"
                }
              }
            ],
            "diagnosis" : [
              {
                "sequence" : 1,
                "diagnosisCodeableConcept" : {
                  "text" : "Hypertension"
                }
              }
            ],
            "procedure" : [
              {
                "sequence" : 1,
                "procedureReference" : {
                  "reference" : "Procedure/CF2-Procedure",
                  "display" : "Procedure"
                }
              }
            ],
            "insurance" : [
              {
                "sequence" : 1,
                "focal" : true,
                "coverage" : {
                  "reference" : "Coverage/K1-Coverage",
                  "display" : "Coverage"
                }
              }
            ],
            "item" : [
              {
                "sequence" : 1,
                "productOrService" : {
                  "text" : "General Ward"
                },
                "quantity" : {
                  "value" : 1
                },
                "net" : {
                  "value" : 1000,
                  "currency" : "PHP"
                }
              }
            ]
          },
          "request" : {
            "method" : "POST",
            "url" : "Claim"
          }
        }
      ]
    }