Bundle ClaimsForm4 of type transaction

Entry 1 - fullUrl = urn:uuid:patient

Resource Patient:

Profile: PH Patient

John Mark Apilyido (no stated gender), DoB Unknown ( PhilHealth ID: PH-00001)

---

Sex at birth

M

Request:

POST Patient

Entry 2 - fullUrl = urn:uuid:organization

Resource Organization:

Profile: PH Organization

identifier: PhilHealth Accreditation Number (PAN)/AN199513893

name: 6th General Hospital

Contacts

-	Address
*	572 BLK 2 LOT 21 Maharlika Village 2300

Request:

POST Organization

Entry 3 - fullUrl = urn:uuid:encounter

Resource Encounter:

Profile: PH Encounter

Age in Years: 35

status: completed

class: Ambulatory

Request:

POST Encounter

Entry 4 - fullUrl = urn:uuid:condition

Resource Condition:

Profile: PH Condition

code: Essential (primary) hypertension

subject: Patient

note: ,

Patient reports persistent headaches for the past 2 weeks.

Past medical history includes type 2 diabetes mellitus, controlled on metformin.

Request:

POST Condition

Entry 5 - fullUrl = urn:uuid:observation

Resource Observation:

Profile: PH Observation

status: Final

code: Pregnancy history panel

dataAbsentReason: Not Applicable

component

code: OB/GYN History (G)

value: 3

component

code: OB/GYN History (P)

value: 2

component

code: OB/GYN History (P)(T)

value: 1

component

code: OB/GYN History (P)(P)

value: 1

component

code: OB/GYN History (P)(A)

value: 0

component

code: OB/GYN History (P)(L)

value: 2

component

code: OB/GYN History - LMP

value: 2026-02-01

Request:

POST Observation

Entry 6 - fullUrl = urn:uuid:observation

Resource Observation:

Profile: PH Observation

status: Final

code: Pertinent signs and symptoms on admission

component

code: Altered mental sensorium

value: true

component

code: Abdominal cramp/pain

value: true

component

code: Anorexia

value: false

component

code: Bleeding gum

value: false

component

code: Body weakness

value: true

Request:

POST Observation

Entry 7 - fullUrl = urn:uuid:observation

Resource Observation:

Profile: PH Observation

status: Final

code: Physical findings on admission

component

code: Body height

value: 160 cm

component

code: Body weight

value: 65 kg

component

code: Mental status - level of consciousness

value: Awake and alert

component

code: Blood pressure panel

value: 120/80 mmHg

component

code: Heart rate

value: 82 beats/min

component

code: Respiratory rate

value: 20 breaths/min

component

code: Body temperature

value: 37 °C

component

code: HEENT

value: Essentially Normal

component

code: Chest/Lungs

value: Symmetrical chest expansion

component

code: CVS

value: Displaced apex beat

component

code: Abdomen

value: Abdominal rigidity

component

code: GU (IE)

value: Blood stained on examining finger

component

code: Skin/Extremities

value: Rashes/petechiae

component

code: Neuro Exam

value: Essentially normal

Request:

POST Observation

Entry 8 - fullUrl = urn:uuid:servicerequest

Resource ServiceRequest:

Profile: PH ServiceRequest

status: Completed

intent: Order

subject: Patient

requester: Organization

Request:

POST ServiceRequest

Entry 9 - fullUrl = urn:uuid:clinicalimpression

Resource ClinicalImpression:

Profile: PH ClinicalImpression

status: Completed

description: Clinical impression on admission based on history, pertinent signs and symptoms, and physical examination.

subject: Patient

effective: 2026-03-12 09:30:00+0800

Request:

POST ClinicalImpression

Entry 10 - fullUrl = urn:uuid:provenance

Resource Provenance:

Profile: PH Provenance

Provenance for Claim

Summary

Recorded

2026-02-03 09:00:00+0800

Agents

who

Practitioner

Request:

POST Provenance

Entry 11 - fullUrl = urn:uuid:claim

Resource Claim:

Profile: PH Claim

Encounter (Extension): Encounter

identifier: https://nhdr.gov.ph/claim/CLAIM-0001

status: Active

type: Institutional

use: Claim

patient: Patient

created: 2026-03-17

provider: Organization

priority: Normal

​prescription: MedicationRequest

referral: ServiceRequest

supportingInfo

sequence: 1

category: Pertinent Past Medical History

value: Observation

supportingInfo

sequence: 2

category: Signs and Symptoms

value: Observation

supportingInfo

sequence: 3

category: Physical Examination

value: Observation

Diagnoses

-	Sequence	Diagnosis[x]
*	1	Hypertension

Procedures

-	Sequence	Procedure[x]
*	1	Procedure

Insurances

-	Sequence	Focal	Coverage
*	1	true	Coverage

item

sequence: 1

productOrService: General Ward

quantity: 1

Nets

-	Value	Currency
*	1000	PHP

Request:

POST Claim