{ "resourceType" : "Bundle", "id" : "ex01", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementdemand"] }, "language" : "en", "type" : "message", "timestamp" : "2015-07-14T11:15:33+02:00", "entry" : [{ "fullUrl" : "urn:uuid:267b18ce-3d37-4581-9baa-6fada338038b", "resource" : { "resourceType" : "MessageHeader", "id" : "267b18ce-3d37-4581-9baa-6fada338038b", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-messageheader"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: MessageHeader 267b18ce-3d37-4581-9baa-6fada338038b

Profile: MyCareNet MessageHeader BE profile

event: CodeSystem message events: claim-ask (claim-ask)

Destinations

-NameEndpoint
*MyCareNeturn:be:fgov:kbo-bce:organization:cbe-number:0820563481

sender: Organization: identifier = https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi#BeNIHDINamingSystem#71000436000; type = hospital

Sources

-Endpoint
*urn:be:fgov:ehealth:1.0:hospital:nihii-number:71000436000

focus: Claim: status = active; type = Institutional; subType = rehabilitation-convention; use = preauthorization; created = 2024-05-08 11:15:30+0200; priority = Normal

" }, "eventCoding" : { "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events", "code" : "claim-ask" }, "destination" : [{ "name" : "MyCareNet", "endpoint" : "urn:be:fgov:kbo-bce:organization:cbe-number:0820563481" }], "sender" : { "reference" : "urn:uuid:e2c6f73a-74d8-40f2-af0b-a61ad20c53d4" }, "source" : { "endpoint" : "urn:be:fgov:ehealth:1.0:hospital:nihii-number:71000436000" }, "focus" : [{ "reference" : "urn:uuid:e85173bc-6f0d-480b-a2cd-2b70d9ffff7a" }] } }, { "fullUrl" : "urn:uuid:e2c6f73a-74d8-40f2-af0b-a61ad20c53d4", "resource" : { "resourceType" : "Organization", "id" : "e2c6f73a-74d8-40f2-af0b-a61ad20c53d4", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization e2c6f73a-74d8-40f2-af0b-a61ad20c53d4

Profile: BeOrganization

identifier: BeNIHDINamingSystem/71000436000

type: hospital

" }, "identifier" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi", "value" : "71000436000" }], "type" : [{ "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty", "code" : "orghospital" }] }] } }, { "fullUrl" : "urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834", "resource" : { "resourceType" : "PractitionerRole", "id" : "62c7bfad-0cb3-4a39-9abb-3a62e06de834", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: PractitionerRole 62c7bfad-0cb3-4a39-9abb-3a62e06de834

Profile: BePractitionerRole

practitioner: Practitioner John Smith

code: physiotherapist

" }, "practitioner" : { "reference" : "urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931" }, "code" : [{ "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty", "code" : "persphysiotherapist" }] }] } }, { "fullUrl" : "urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931", "resource" : { "resourceType" : "Practitioner", "id" : "03972cc4-d781-4285-8d79-0f05810e1931", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Practitioner 03972cc4-d781-4285-8d79-0f05810e1931

Profile: BePractitioner

identifier: BeNIHDINamingSystem/54263481527

name: John Smith

" }, "identifier" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi", "value" : "54263481527" }], "name" : [{ "family" : "Smith", "given" : ["John"] }] } }, { "fullUrl" : "urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686", "resource" : { "resourceType" : "Patient", "id" : "a52efcb6-1f81-4333-a115-d45bd3183686", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Patient a52efcb6-1f81-4333-a115-d45bd3183686

Profile: BePatient

Jean Dupont Male, DoB Unknown ( https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancymembership#BeInsurancymembershipNamingSystem#n° inscription mutualiste)

" }, "identifier" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancymembership", "value" : "n° inscription mutualiste", "assigner" : { "identifier" : { "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancenumber", "value" : "n° mutualité" } } }], "name" : [{ "family" : "Dupont", "given" : ["Jean"] }], "gender" : "male" } }, { "fullUrl" : "urn:uuid:035e3de4-011f-48a4-92c9-15b2bbcec321", "resource" : { "resourceType" : "PractitionerRole", "id" : "035e3de4-011f-48a4-92c9-15b2bbcec32", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: PractitionerRole 035e3de4-011f-48a4-92c9-15b2bbcec32

Profile: BePractitionerRole

practitioner: Practitioner John Smith

code: physician

" }, "practitioner" : { "reference" : "urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c6" }, "code" : [{ "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty", "code" : "persphysician" }] }] } }, { "fullUrl" : "urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c6", "resource" : { "resourceType" : "Practitioner", "id" : "8fc72085-d349-4bd7-ba84-91a935a4e3c6", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Practitioner 8fc72085-d349-4bd7-ba84-91a935a4e3c6

Profile: BePractitioner

identifier: BeNIHDINamingSystem/19234011004

name: Prénom du prescripteur Nom du prescripteur

" }, "identifier" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi", "value" : "19234011004" }], "name" : [{ "family" : "Nom du prescripteur", "given" : ["Prénom du prescripteur"] }] } }, { "fullUrl" : "urn:uuid:b3586cda-f1e5-4c58-a389-94249957d87a", "resource" : { "resourceType" : "ServiceRequest", "id" : "b3586cda-f1e5-4c58-a389-94249957d87a", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementservicerequest"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: ServiceRequest b3586cda-f1e5-4c58-a389-94249957d87a

Profile: MyCareNet eAgreement ServiceRequest BE profile

status: Active

intent: Order

category: Physical therapy procedure

code: Physical therapy procedure

quantity: 15

subject: Jean Dupont Male, DoB Unknown ( https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin#BeSSINNamingSystem#79121137740)

authoredOn: 2015-07-10

requester: PractitionerRole physician

supportingInfo: Binary: application/pdf (32 bytes base64)

Generated Narrative: Binary #annexSR1

contentType: application/pdf

data: QW5uZXhlIGlubGluZSwgYmFzZTY0ZWQ=

" }, "contained" : [{ "resourceType" : "Binary", "id" : "annexSR1", "contentType" : "application/pdf", "data" : "QW5uZXhlIGlubGluZSwgYmFzZTY0ZWQ=" }], "status" : "active", "intent" : "order", "category" : [{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "91251008", "display" : "Physical therapy procedure" }] }], "code" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "91251008", "display" : "Physical therapy procedure" }] }, "quantityQuantity" : { "value" : 15 }, "subject" : { "reference" : "urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686" }, "authoredOn" : "2015-07-10", "requester" : { "reference" : "urn:uuid:035e3de4-011f-48a4-92c9-15b2bbcec321" }, "supportingInfo" : [{ "reference" : "#annexSR1" }] } }, { "fullUrl" : "urn:uuid:3b8e1245-b480-4af6-90c0-f67037ef276b", "resource" : { "resourceType" : "ServiceRequest", "id" : "3b8e1245-b480-4af6-90c0-f67037ef276b", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementservicerequest"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: ServiceRequest 3b8e1245-b480-4af6-90c0-f67037ef276b

Profile: MyCareNet eAgreement ServiceRequest BE profile

identifier: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/uhmep/n° de la prescription

status: Active

intent: Order

category: Physical therapy procedure

code: Physical therapy procedure

subject: Jean Dupont Male, DoB Unknown ( https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin#BeSSINNamingSystem#79121137740)

authoredOn: 2015-07-08

requester: PractitionerRole physician

" }, "identifier" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/uhmep", "value" : "n° de la prescription" }], "status" : "active", "intent" : "order", "category" : [{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "91251008", "display" : "Physical therapy procedure" }] }], "code" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "91251008", "display" : "Physical therapy procedure" }] }, "subject" : { "reference" : "urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686" }, "authoredOn" : "2015-07-08", "requester" : { "reference" : "urn:uuid:035e3de4-011f-48a4-92c9-15b2bbcec321" } } }, { "fullUrl" : "urn:uuid:e85173bc-6f0d-480b-a2cd-2b70d9ffff7a", "resource" : { "resourceType" : "Claim", "id" : "e85173bc-6f0d-480b-a2cd-2b70d9ffff7a", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaim-kine"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Claim e85173bc-6f0d-480b-a2cd-2b70d9ffff7a

Profile: MyCareNet eAgreement Claim Kine BE profile

status: Active

type: Professional

subType: physiotherapy-fb

use: Preauthorization

patient: Jean Dupont Male, DoB Unknown ( https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin#BeSSINNamingSystem#79121137740)

billablePeriod: 2020-01-15 --> (ongoing)

created: 2015-07-14 11:15:30+0200

enterer: PractitionerRole physiotherapist

provider: PractitionerRole physiotherapist

priority: Immediate

referral: ServiceRequest Physical therapy procedure

supportingInfo

sequence: 1

category: Attachment

code: functional-report

value: application/pdf: QW5uZXhlIGlubGluZSwgYmFzZTY0ZWQ=

supportingInfo

sequence: 2

category: Information

value: additional Information

supportingInfo

sequence: 3

category: Information

value: ServiceRequest Physical therapy procedure

Insurances

-SequenceFocalCoverage
*1trueuse of mandatory insurance coverage, no further details provided here.

Items

-SequenceProductOrServiceServiced[x]
*1fb-512020-01-14
" }, "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "professional" }] }, "subType" : { "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types", "code" : "physiotherapy-fb" }] }, "use" : "preauthorization", "patient" : { "reference" : "urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686" }, "billablePeriod" : { "start" : "2020-01-15" }, "created" : "2015-07-14T11:15:30+02:00", "enterer" : { "reference" : "urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834" }, "provider" : { "reference" : "urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "stat" }] }, "referral" : { "reference" : "urn:uuid:b3586cda-f1e5-4c58-a389-94249957d87a" }, "supportingInfo" : [{ "sequence" : 1, "category" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code" : "attachment" }] }, "code" : { "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/annex-types", "code" : "functional-report" }] }, "valueAttachment" : { "contentType" : "application/pdf", "data" : "QW5uZXhlIGlubGluZSwgYmFzZTY0ZWQ=", "title" : "nom/description de l'annexe" } }, { "sequence" : 2, "category" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code" : "info" }] }, "valueString" : "additional Information" }, { "sequence" : 3, "category" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code" : "info" }] }, "valueReference" : { "reference" : "urn:uuid:3b8e1245-b480-4af6-90c0-f67037ef276b" } }], "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "display" : "use of mandatory insurance coverage, no further details provided here." } }], "item" : [{ "sequence" : 1, "productOrService" : { "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/nihdi-physiotherapy-pathologysituationcode", "code" : "fb-51" }] }, "servicedDate" : "2020-01-14" }] } }] }