# betsysmith-johnson01-SMP-Bundle-02-SNFDischarge - PACIO Sample Data Depot v0.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **betsysmith-johnson01-SMP-Bundle-02-SNFDischarge**

## Example Bundle: betsysmith-johnson01-SMP-Bundle-02-SNFDischarge



## Resource Content

```json
{
  "resourceType" : "Bundle",
  "id" : "betsysmith-johnson01-SMP-Bundle-02-SNFDischarge",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/smp/StructureDefinition/smp-bundle"]
  },
  "type" : "collection",
  "timestamp" : "2025-07-02T09:00:00Z",
  "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 (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:\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"
        }
      },
      {
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "SS",
            "display" : "Social Security Number"
          }],
          "text" : "Social Security Number"
        },
        "system" : "http://hl7.org/fhir/sid/us-ssn",
        "value" : "123-45-9999"
      }],
      "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-2",
    "resource" : {
      "resourceType" : "List",
      "id" : "bsj1-smp-medListNew-2",
      "text" : {
        "status" : "generated",
        "div" : "<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>"
      },
      "status" : "current",
      "mode" : "working",
      "title" : "MedicationList for scene 2 - SNF",
      "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" : "2025-07-01T16:15:00-08:00",
      "source" : {
        "reference" : "PractitionerRole/PractitionerRole-MD-HemaOnko"
      },
      "entry" : [{
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-jardiance-2-1",
          "display" : "Jardiance 10 MG Oral Tablet"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-lipitor-2-2",
          "display" : "Lipitor 40 MG Oral Tablet"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-metformin-2-3",
          "display" : "metFORMIN hydrochloride 500 MG Oral Tablet"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-polyethylene-2-4",
          "display" : "polyethylene glycol 3350 17000 MG Powder for Oral Solution"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-sertraline-2-5",
          "display" : "sertraline 25 MG Oral Tablet"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-acetaminophen-2-6",
          "display" : "acetaminophen 325 MG Oral Tablet"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-carvedilol-2-7",
          "display" : "carvedilol 6.25 MG Oral Tablet"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-clopidogrel-2-8",
          "display" : "clopidogrel 75 MG Oral Tablet"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-ferrous-2-9",
          "display" : "ferrous gluconate 240 MG Oral Tablet"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-ferrous-2-10",
          "display" : "ferrous sulfate 44 MG/ML Oral Solution"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-insulin-2-11",
          "display" : "insulin isophane, human 70 UNT/ML / insulin, regular, human 30 UNT/ML Injectable Suspension"
        }
      },
      {
        "item" : {
          "reference" : "MedicationStatement/bsj1-smp-medstmt-jardiance-2-12",
          "display" : "Jardiance 10 MG Oral Tablet"
        }
      }]
    }
  }]
}

```
