PACIO Sample Data Depot
0.1.0 - draft
PACIO Sample Data Depot, published by MITRE. 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/paciowg/sample-data-fsh/ and changes regularly. See the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="betsysmith-johnson01-SMP-Bundle-03-PCP"/>
<meta>
<profile
value="http://hl7.org/fhir/us/smp/StructureDefinition/smp-bundle"/>
</meta>
<type value="collection"/>
<timestamp value="2025-07-16T11:00:00Z"/>
<entry>
<fullUrl value="urn:patient-betsysmith-johnson01"/>
<resource>
<Patient>
<id value="patient-betsysmith-johnson01"/>
<meta>
<lastUpdated value="2021-03-29T14:25:34.001-05:00"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"/>
</meta>
<language value="en-US"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US"><a name="Patient_patient-betsysmith-johnson01"> </a><p class="res-header-id"><b>Generated Narrative: Patient patient-betsysmith-johnson01</b></p><a name="patient-betsysmith-johnson01"> </a><a name="hcpatient-betsysmith-johnson01"> </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">Last updated: 2021-03-29 14:25:34-0500; Language: en-US</p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html">US Core Patient Profile</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Record is active">Active:</td><td>true</td><td style="background-color: #f3f5da" title="Known Marital status of Patient">Marital Status:</td><td colspan="3"><span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}">unknown</span></td></tr><tr><td style="background-color: #f3f5da" title="Other Ids (see the one above)">Other Ids:</td><td colspan="3"><ul><li>Medical Record Number/1032702 (use: usual, )</li><li><a href="http://terminology.hl7.org/6.1.0/NamingSystem-ssn.html" title="United States Social Security Number (SSN). Assigned by the U.S. Social Security Administration. Note: IRS assigned ITINs are often used as drop-ins for social security numbers. The SSN is represented in resources with dashes removed. See http://www.ssa.gov/.">United States Social Security Number</a>/SS</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3"><ul><li>ph: 555-555-1111(Mobile)</li><li><a href="mailto:mmoen+betsysmithjohnson@mydirectives.com">mmoen+betsysmithjohnson@mydirectives.com</a></li><li>17040 E Warren Avenue, Detroit, MI 48224</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Language spoken">Language:</td><td colspan="3"><span title="Codes:{urn:ietf:bcp:47 en}">English</span> (preferred)</td></tr><tr><td style="background-color: #f3f5da" title="Nominated Contact: son">son:</td><td colspan="3"><ul><li>Charles Johnson</li><li>17040 E Warren Avenue, Detroit, MI 48224</li><li>ph: (555) 555-2222</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Nominated Contact: daughter in-law">daughter in-law:</td><td colspan="3"><ul><li>Lisa Johnson</li><li>17040 E Warren Avenue, Detroit, MI 48224</li><li>ph: (555) 555-3333</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the [CDC Race and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html#3) which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories:
- American Indian or Alaska Native
- Asian
- Black or African American
- Native Hawaiian or Other Pacific Islander
- White.">US Core Race Extension:</td><td colspan="3"><ul><li>ombCategory: <a href="http://hl7.org/fhir/us/core/STU4/CodeSystem-cdcrec.html#cdcrec-2106-3">Race & Ethnicity - CDC 2106-3</a>: White</li><li>text: White</li></ul></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-race">
<extension url="ombCategory">
<valueCoding>
<system value="urn:oid:2.16.840.1.113883.6.238"/>
<code value="2106-3"/>
<display value="White"/>
</valueCoding>
</extension>
<extension url="text">
<valueString value="White"/>
</extension>
</extension>
<identifier>
<use value="usual"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MR"/>
<display value="Medical Record Number"/>
</coding>
<text value="Medical Record Number"/>
</type>
<system value="http://hospital.smarthealthit.org"/>
<value value="1032702"/>
</identifier>
<identifier>
<system value="http://hl7.org/fhir/sid/us-medicare"/>
<value value="1PA3D58WH16"/>
<assigner>
<display value="Medicare"/>
</assigner>
</identifier>
<identifier>
<system value="http://hl7.org/fhir/sid/us-ssn"/>
<value value="SS"/>
</identifier>
<active value="true"/>
<name>
<use value="usual"/>
<text value="Smith-Johnson, Betsy"/>
<family value="Smith-Johnson"/>
<given value="Betsy"/>
</name>
<telecom>
<system value="phone"/>
<value value="555-555-1111"/>
<use value="mobile"/>
</telecom>
<telecom>
<system value="email"/>
<value value="mmoen+betsysmithjohnson@mydirectives.com"/>
<use value="mobile"/>
</telecom>
<gender value="female"/>
<birthDate value="1950-11-15"/>
<address>
<text value="17040 E Warren Avenue, Detroit, MI 48224"/>
<line value="17040 E Warren Avenue"/>
<city value="Detroit"/>
<state value="MI"/>
<postalCode value="48224"/>
<country value="US"/>
<period>
<start value="2016-12-06"/>
</period>
</address>
<maritalStatus>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
<code value="UNK"/>
</coding>
</maritalStatus>
<contact>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="SONC"/>
</coding>
</relationship>
<name>
<text value="Charles Johnson"/>
</name>
<telecom>
<system value="phone"/>
<value value="(555) 555-2222"/>
</telecom>
<address>
<text value="17040 E Warren Avenue, Detroit, MI 48224"/>
</address>
</contact>
<contact>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="DAUINLAW"/>
</coding>
</relationship>
<name>
<text value="Lisa Johnson"/>
</name>
<telecom>
<system value="phone"/>
<value value="(555) 555-3333"/>
</telecom>
<address>
<text value="17040 E Warren Avenue, Detroit, MI 48224"/>
</address>
</contact>
<communication>
<language>
<coding>
<system value="urn:ietf:bcp:47"/>
<code value="en"/>
<display value="English"/>
</coding>
</language>
<preferred value="true"/>
</communication>
</Patient>
</resource>
</entry>
<entry>
<fullUrl value="urn:bsj1-smp-medListNew-3"/>
<resource>
<List>
<id value="bsj1-smp-medListNew-3"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="List_bsj1-smp-medListNew-3"> </a><p class="res-header-id"><b>Generated Narrative: List bsj1-smp-medListNew-3</b></p><a name="bsj1-smp-medListNew-3"> </a><a name="hcbsj1-smp-medListNew-3"> </a><h2>MedicationList for scene 3 - HHA</h2><table class="clstu"><tr><td>Date: 2025-07-04 13:00:00-0800 </td><td>Mode: Working List </td><td>Status: Current </td><td>Code: Reconciled medication list [Identifier] Episode Pharmacy </td></tr><tr><td>Subject: <a href="Patient-patient-betsysmith-johnson01.html">Betsy Smith-Johnson</a>Source: </td></tr></table><table class="grid"><tr style="backgound-color: #eeeeee"><td><b>Items</b></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-lipitor-3-1.html">Lipitor 40 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-metformin-3-2.html">metFORMIN hydrochloride 500 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-metformin-3-3.html">metFORMIN hydrochloride 500 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-polyethylene-3-4.html">polyethylene glycol 3350 17000 MG Powder for Oral Solution</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-sertraline-3-5.html">sertraline 25 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-sitagliptin-3-6.html">sitagliptin 50 MG Oral Tablet</a></td></tr></table></div>
</text>
<status value="current"/>
<mode value="working"/>
<title value="MedicationList for scene 3 - HHA"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="104203-5"/>
<display
value="Reconciled medication list [Identifier] Episode Pharmacy"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-betsysmith-johnson01"/>
<display value="Betsy Smith-Johnson"/>
</subject>
<date value="2025-07-04T13:00:00-08:00"/>
<source>🔗
<reference value="PractitionerRole/PractitionerRole-DNP-JudySalas"/>
</source>
<entry>
<item>🔗
<reference
value="MedicationStatement/bsj1-smp-medstmt-lipitor-3-1"/>
<display value="Lipitor 40 MG Oral Tablet"/>
</item>
</entry>
<entry>
<item>🔗
<reference
value="MedicationStatement/bsj1-smp-medstmt-metformin-3-2"/>
<display value="metFORMIN hydrochloride 500 MG Oral Tablet"/>
</item>
</entry>
<entry>
<item>🔗
<reference
value="MedicationStatement/bsj1-smp-medstmt-metformin-3-3"/>
<display value="metFORMIN hydrochloride 500 MG Oral Tablet"/>
</item>
</entry>
<entry>
<item>🔗
<reference
value="MedicationStatement/bsj1-smp-medstmt-polyethylene-3-4"/>
<display
value="polyethylene glycol 3350 17000 MG Powder for Oral Solution"/>
</item>
</entry>
<entry>
<item>🔗
<reference
value="MedicationStatement/bsj1-smp-medstmt-sertraline-3-5"/>
<display value="sertraline 25 MG Oral Tablet"/>
</item>
</entry>
<entry>
<item>🔗
<reference
value="MedicationStatement/bsj1-smp-medstmt-sitagliptin-3-6"/>
<display value="sitagliptin 50 MG Oral Tablet"/>
</item>
</entry>
</List>
</resource>
</entry>
</Bundle>