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

## : betsysmith-johnson01-SMP-Bundle-03-PCP - JSON Representation

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    {
      "resourceType" : "Bundle",
      "id" : "betsysmith-johnson01-SMP-Bundle-03-PCP",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/smp/StructureDefinition/smp-bundle"
        ]
      },
      "type" : "collection",
      "timestamp" : "2025-07-16T11:00:00Z",
      "entry" : [
        {
          "fullUrl" : "urn:patient-betsysmith-johnson01",
          "resource" : {
            "resourceType" : "Patient",
            "id" : "patient-betsysmith-johnson01",
            "meta" : {
              "lastUpdated" : "2021-03-29T14:25:34.001-05:00",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
              ]
            },
            "language" : "en-US",
            "text" : {
              "status" : "generated",
              "div" : "<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/STU6.1/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\u00a0(use:\u00a0usual,\u00a0)</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:\n\n - American Indian or Alaska Native\n - Asian\n - Black or African American\n - Native Hawaiian or Other Pacific Islander\n - 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 &amp; Ethnicity - CDC: 2106-3</a> (White)</li><li>text: White</li></ul></td></tr></table></div>"
            },
            "extension" : [
              {
                "extension" : [
                  {
                    "url" : "ombCategory",
                    "valueCoding" : {
                      "system" : "urn:oid:2.16.840.1.113883.6.238",
                      "code" : "2106-3",
                      "display" : "White"
                    }
                  },
                  {
                    "url" : "text",
                    "valueString" : "White"
                  }
                ],
                "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
              }
            ],
            "identifier" : [
              {
                "use" : "usual",
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                      "code" : "MR",
                      "display" : "Medical Record Number"
                    }
                  ],
                  "text" : "Medical Record Number"
                },
                "system" : "http://hospital.smarthealthit.org",
                "value" : "1032702"
              },
              {
                "system" : "http://hl7.org/fhir/sid/us-medicare",
                "value" : "1PA3D58WH16",
                "assigner" : {
                  "display" : "Medicare"
                }
              },
              {
                "system" : "http://hl7.org/fhir/sid/us-ssn",
                "value" : "SS"
              }
            ],
            "active" : true,
            "name" : [
              {
                "use" : "usual",
                "text" : "Smith-Johnson, Betsy",
                "family" : "Smith-Johnson",
                "given" : [
                  "Betsy"
                ]
              }
            ],
            "telecom" : [
              {
                "system" : "phone",
                "value" : "555-555-1111",
                "use" : "mobile"
              },
              {
                "system" : "email",
                "value" : "mmoen+betsysmithjohnson@mydirectives.com",
                "use" : "mobile"
              }
            ],
            "gender" : "female",
            "birthDate" : "1950-11-15",
            "address" : [
              {
                "text" : "17040 E Warren Avenue, Detroit, MI 48224",
                "line" : [
                  "17040 E Warren Avenue"
                ],
                "city" : "Detroit",
                "state" : "MI",
                "postalCode" : "48224",
                "country" : "US",
                "period" : {
                  "start" : "2016-12-06"
                }
              }
            ],
            "maritalStatus" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                  "code" : "UNK"
                }
              ]
            },
            "contact" : [
              {
                "relationship" : [
                  {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                        "code" : "SONC"
                      }
                    ]
                  }
                ],
                "name" : {
                  "text" : "Charles Johnson"
                },
                "telecom" : [
                  {
                    "system" : "phone",
                    "value" : "(555) 555-2222"
                  }
                ],
                "address" : {
                  "text" : "17040 E Warren Avenue, Detroit, MI 48224"
                }
              },
              {
                "relationship" : [
                  {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                        "code" : "DAUINLAW"
                      }
                    ]
                  }
                ],
                "name" : {
                  "text" : "Lisa Johnson"
                },
                "telecom" : [
                  {
                    "system" : "phone",
                    "value" : "(555) 555-3333"
                  }
                ],
                "address" : {
                  "text" : "17040 E Warren Avenue, Detroit, MI 48224"
                }
              }
            ],
            "communication" : [
              {
                "language" : {
                  "coding" : [
                    {
                      "system" : "urn:ietf:bcp:47",
                      "code" : "en",
                      "display" : "English"
                    }
                  ]
                },
                "preferred" : true
              }
            ]
          }
        },
        {
          "fullUrl" : "urn:bsj1-smp-medListNew-3",
          "resource" : {
            "resourceType" : "List",
            "id" : "bsj1-smp-medListNew-3",
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "status" : "current",
            "mode" : "working",
            "title" : "MedicationList for scene 3 - HHA",
            "code" : {
              "coding" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "104203-5",
                  "display" : "Reconciled medication list [Identifier] Episode Pharmacy"
                }
              ]
            },
            "subject" : {
              🔗 "reference" : "Patient/patient-betsysmith-johnson01",
              "display" : "Betsy Smith-Johnson"
            },
            "date" : "2025-07-04T13:00:00-08:00",
            "source" : {
              🔗 "reference" : "PractitionerRole/PractitionerRole-DNP-JudySalas"
            },
            "entry" : [
              {
                "item" : {
                  🔗 "reference" : "MedicationStatement/bsj1-smp-medstmt-lipitor-3-1",
                  "display" : "Lipitor 40 MG Oral Tablet"
                }
              },
              {
                "item" : {
                  🔗 "reference" : "MedicationStatement/bsj1-smp-medstmt-metformin-3-2",
                  "display" : "metFORMIN hydrochloride 500 MG Oral Tablet"
                }
              },
              {
                "item" : {
                  🔗 "reference" : "MedicationStatement/bsj1-smp-medstmt-metformin-3-3",
                  "display" : "metFORMIN hydrochloride 500 MG Oral Tablet"
                }
              },
              {
                "item" : {
                  🔗 "reference" : "MedicationStatement/bsj1-smp-medstmt-polyethylene-3-4",
                  "display" : "polyethylene glycol 3350 17000 MG Powder for Oral Solution"
                }
              },
              {
                "item" : {
                  🔗 "reference" : "MedicationStatement/bsj1-smp-medstmt-sertraline-3-5",
                  "display" : "sertraline 25 MG Oral Tablet"
                }
              },
              {
                "item" : {
                  🔗 "reference" : "MedicationStatement/bsj1-smp-medstmt-sitagliptin-3-6",
                  "display" : "sitagliptin 50 MG Oral Tablet"
                }
              }
            ]
          }
        }
      ]
    }