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-02-SNFDischarge - XML Representation

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    <Bundle xmlns="http://hl7.org/fhir">
      <id value="betsysmith-johnson01-SMP-Bundle-02-SNFDischarge"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/smp/StructureDefinition/smp-bundle"/>
      </meta>
      <type value="collection"/>
      <timestamp value="2025-07-02T09:00:00Z"/>
      <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/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 (use: usual, )</li><li>Social Security Number/123-45-9999</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 &amp; 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>
              <type>
                <coding>
                  <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
                  <code value="SS"/>
                  <display value="Social Security Number"/>
                </coding>
                <text value="Social Security Number"/>
              </type>
              <system value="http://hl7.org/fhir/sid/us-ssn"/>
              <value value="123-45-9999"/>
            </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-2"/>
        <resource>
          <List>
            <id value="bsj1-smp-medListNew-2"/>
            <text>
              <status value="generated"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="List_bsj1-smp-medListNew-2"> </a><p class="res-header-id"><b>Generated Narrative: List bsj1-smp-medListNew-2</b></p><a name="bsj1-smp-medListNew-2"> </a><a name="hcbsj1-smp-medListNew-2"> </a><h2>MedicationList for scene 2 - SNF</h2><table class="clstu"><tr><td>Date: 2025-07-01 16:15:00-0800 </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-jardiance-2-1.html">Jardiance 10 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-lipitor-2-2.html">Lipitor 40 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-metformin-2-3.html">metFORMIN hydrochloride 500 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-polyethylene-2-4.html">polyethylene glycol 3350 17000 MG Powder for Oral Solution</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-sertraline-2-5.html">sertraline 25 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-acetaminophen-2-6.html">acetaminophen 325 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-carvedilol-2-7.html">carvedilol 6.25 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-clopidogrel-2-8.html">clopidogrel 75 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-ferrous-2-9.html">ferrous gluconate 240 MG Oral Tablet</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-ferrous-2-10.html">ferrous sulfate 44 MG/ML Oral Solution</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-insulin-2-11.html">insulin isophane, human 70 UNT/ML / insulin, regular, human 30 UNT/ML Injectable Suspension</a></td></tr><tr><td><a href="MedicationStatement-bsj1-smp-medstmt-jardiance-2-12.html">Jardiance 10 MG Oral Tablet</a></td></tr></table></div>
            </text>
            <status value="current"/>
            <mode value="working"/>
            <title value="MedicationList for scene 2 - SNF"/>
            <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="2025-07-01T16:15:00-08:00"/>
            <source>🔗
              <reference value="PractitionerRole/PractitionerRole-MD-HemaOnko"/>
            </source>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-jardiance-2-1"/>
                <display value="Jardiance 10 MG Oral Tablet"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-lipitor-2-2"/>
                <display value="Lipitor 40 MG Oral Tablet"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-metformin-2-3"/>
                <display value="metFORMIN hydrochloride 500 MG Oral Tablet"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-polyethylene-2-4"/>
                <display
                         value="polyethylene glycol 3350 17000 MG Powder for Oral Solution"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-sertraline-2-5"/>
                <display value="sertraline 25 MG Oral Tablet"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-acetaminophen-2-6"/>
                <display value="acetaminophen 325 MG Oral Tablet"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-carvedilol-2-7"/>
                <display value="carvedilol 6.25 MG Oral Tablet"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-clopidogrel-2-8"/>
                <display value="clopidogrel 75 MG Oral Tablet"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-ferrous-2-9"/>
                <display value="ferrous gluconate 240 MG Oral Tablet"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-ferrous-2-10"/>
                <display value="ferrous sulfate 44 MG/ML Oral Solution"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-insulin-2-11"/>
                <display
                         value="insulin isophane, human 70 UNT/ML / insulin, regular, human 30 UNT/ML Injectable Suspension"/>
              </item>
            </entry>
            <entry>
              <item>🔗
                <reference
                           value="MedicationStatement/bsj1-smp-medstmt-jardiance-2-12"/>
                <display value="Jardiance 10 MG Oral Tablet"/>
              </item>
            </entry>
          </List>
        </resource>
      </entry>
    </Bundle>