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

• Narrative Content
• XML
• JSON
• TTL

: 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>