diff --git a/config/PAS Test Kit Client Test Demo.postman_collection.json b/config/PAS Test Kit Client Test Demo.postman_collection.json index 1cb56a7..9f4d53d 100644 --- a/config/PAS Test Kit Client Test Demo.postman_collection.json +++ b/config/PAS Test Kit Client Test Demo.postman_collection.json @@ -54,7 +54,7 @@ ], "body": { "mode": "raw", - "raw": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"ReferralAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://notreal.com/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://notreal.com/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id:\\u00a0111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: See above (Patient/SubscriberExample)

created: 2005-05-02 11:01:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See above (PractitionerRole/ReferralPractitionerRoleExample)

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1G89.4 (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://notreal.com/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://notreal.com/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n }\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://notreal.com/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"ServiceRequest/ReferralRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: See above (Patient/SubscriberExample)

payor: See above (Organization/InsurerExample)

\"\n },\n \"status\": \"active\",\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id:\\u00a012345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://notreal.com/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ]\n }\n ],\n \"gender\": \"male\"\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/ServiceRequest/ReferralRequestExample\",\n \"resource\": {\n \"resourceType\": \"ServiceRequest\",\n \"id\": \"ReferralRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: active

intent: order

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: See above (Patient/SubscriberExample)

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"quantityQuantity\": {\n \"value\": 1,\n \"unit\": \"visit\",\n \"system\": \"http://unitsofmeasure.org\",\n \"code\": \"1\"\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See above (Practitioner/ReferralPractitionerExample)

location: See above (Location/ReferralLocationExample)

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n }\n ]\n }", + "raw": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"ReferralAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://notreal.com/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://notreal.com/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id:\\u00a0111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample

provider: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1G89.4 (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://notreal.com/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://notreal.com/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n }\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://notreal.com/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"ServiceRequest/ReferralRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: Patient/SubscriberExample

payor: Organization/InsurerExample

\"\n },\n \"status\": \"active\",\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id:\\u00a012345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://notreal.com/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ]\n }\n ],\n \"gender\": \"male\"\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/ServiceRequest/ReferralRequestExample\",\n \"resource\": {\n \"resourceType\": \"ServiceRequest\",\n \"id\": \"ReferralRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: active

intent: order

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: Patient/SubscriberExample

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"quantityQuantity\": {\n \"value\": 1,\n \"unit\": \"visit\",\n \"system\": \"http://unitsofmeasure.org\",\n \"code\": \"1\"\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: Practitioner/ReferralPractitionerExample

location: Location/ReferralLocationExample

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n }\n ]\n }", "options": { "raw": { "language": "json" @@ -89,7 +89,7 @@ ], "body": { "mode": "raw", - "raw": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"ReferralAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://notreal.com/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://notreal.com/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id:\\u00a0111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: See above (Patient/SubscriberExample)

created: 2005-05-02 11:01:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See above (PractitionerRole/ReferralPractitionerRoleExample)

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1G89.4 (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://notreal.com/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://notreal.com/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n }\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://notreal.com/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"ServiceRequest/ReferralRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: See above (Patient/SubscriberExample)

payor: See above (Organization/InsurerExample)

\"\n },\n \"status\": \"active\",\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id:\\u00a012345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://notreal.com/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ]\n }\n ],\n \"gender\": \"male\"\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/ServiceRequest/ReferralRequestExample\",\n \"resource\": {\n \"resourceType\": \"ServiceRequest\",\n \"id\": \"ReferralRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: active

intent: order

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: See above (Patient/SubscriberExample)

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"quantityQuantity\": {\n \"value\": 1,\n \"unit\": \"visit\",\n \"system\": \"http://unitsofmeasure.org\",\n \"code\": \"1\"\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See above (Practitioner/ReferralPractitionerExample)

location: See above (Location/ReferralLocationExample)

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n }\n ]\n }", + "raw": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"ReferralAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://notreal.com/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://notreal.com/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id:\\u00a0111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample

provider: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1G89.4 (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://notreal.com/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://notreal.com/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n }\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://notreal.com/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"ServiceRequest/ReferralRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: Patient/SubscriberExample

payor: Organization/InsurerExample

\"\n },\n \"status\": \"active\",\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id:\\u00a012345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://notreal.com/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ]\n }\n ],\n \"gender\": \"male\"\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/ServiceRequest/ReferralRequestExample\",\n \"resource\": {\n \"resourceType\": \"ServiceRequest\",\n \"id\": \"ReferralRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: active

intent: order

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: Patient/SubscriberExample

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"quantityQuantity\": {\n \"value\": 1,\n \"unit\": \"visit\",\n \"system\": \"http://unitsofmeasure.org\",\n \"code\": \"1\"\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: Practitioner/ReferralPractitionerExample

location: Location/ReferralLocationExample

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id:\\u00a0<a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html">NPI</a>#987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://notreal.com/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n }\n ]\n }", "options": { "raw": { "language": "json" diff --git a/config/presets/pas_ri.json b/config/presets/pas_ri.json index 6af34f6..a74e763 100644 --- a/config/presets/pas_ri.json +++ b/config/presets/pas_ri.json @@ -23,7 +23,7 @@ "optional": true, "title": "PAS Submit Request Payload for Approval Response", "type": "textarea", - "value": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"ReferralAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: See above (Patient/SubscriberExample)

created: 2005-05-02 11:01:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See above (PractitionerRole/ReferralPractitionerRoleExample)

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n \"valueReference\": {\n \"reference\": \"Encounter/SurgicalEncounterExample\"\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"ServiceRequest/ReferralRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"unitPrice\": {\n \"value\": 1000,\n \"currency\": \"USD\"\n },\n \"quantity\": {\n \"value\": 1\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"additionalInformation\",\n \"display\": \"Additional Information\"\n }\n ]\n },\n \"sequence\": 1,\n \"valueReference\": {\n \"reference\": \"DocumentReference/episode-summary\"\n }\n },\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: See above (Patient/SubscriberExample)

payor: See above (Organization/InsurerExample)

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n \"resource\": {\n \"resourceType\": \"ServiceRequest\",\n \"id\": \"ReferralRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: active

intent: order

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: See above (Patient/SubscriberExample)

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"occurrenceTiming\": {\n \"repeat\": {\n \"duration\": 15,\n \"durationMax\": 25,\n \"durationUnit\": \"min\",\n \"frequency\": 1,\n \"frequencyMax\": 4,\n \"period\": 1,\n \"periodUnit\": \"d\"\n }\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n \"extension\": [\n {\n \"url\": \"coverage\",\n \"valueReference\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n },\n {\n \"url\": \"covered\",\n \"valueCode\": \"covered\"\n },\n {\n \"url\": \"pa-needed\",\n \"valueCode\": \"auth-needed\"\n },\n {\n \"url\": \"date\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"coverage-assertion-id\",\n \"valueString\": \"1122445\"\n }\n ]\n }\n ],\n \"quantityQuantity\": {\n \"value\": 1,\n \"unit\": \"visit\",\n \"system\": \"http://unitsofmeasure.org\",\n \"code\": \"1\"\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See above (Practitioner/ReferralPractitionerExample)

location: See above (Location/ReferralLocationExample)

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n \"resource\": {\n \"resourceType\": \"DocumentReference\",\n \"id\": \"episode-summary\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative

id: episode-summary

meta:

identifier: id: urn:oid:2.16.840.1.113883.19.5.99999.1

status: current

type: CCD Document

category: Clinical Note

subject: Amy Shaw. Generated Summary: id: example; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20

date: 10/03/2016 2:29:46 AM

author: Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone

description: Pulmonology clinic acute visit

Contents

-AttachmentFormat
*Documents following C-CDA constraints using a structured body

Contexts

-Period
*23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM
\"\n },\n \"identifier\": [\n {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n }\n ],\n \"status\": \"current\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"34133-9\",\n \"display\": \"Summary of episode note\"\n }\n ],\n \"text\": \"CCD Document\"\n },\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n \"code\": \"clinical-note\",\n \"display\": \"Clinical Note\"\n }\n ],\n \"text\": \"Clinical Note\"\n }\n ],\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"date\": \"2016-03-09T15:29:46Z\",\n \"author\": [\n {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n ],\n \"description\": \"Pulmonology clinic acute visit\",\n \"content\": [\n {\n \"attachment\": {\n \"contentType\": \"text/plain\",\n \"url\": \"/Binary/1-note\",\n \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n },\n \"format\": {\n \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n \"display\": \"Documents following C-CDA constraints using a structured body\"\n }\n }\n ],\n \"context\": {\n \"period\": {\n \"start\": \"2004-12-23T08:00:00+11:00\",\n \"end\": \"2004-12-23T08:01:00+11:00\"\n }\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n \"resource\": {\n \"resourceType\": \"Encounter\",\n \"id\": \"SurgicalEncounterExample\",\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative with Details

id: f201

identifier: Encounter_Roel_20130404 (TEMP)

status: finished

class: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')

type: Consultation (Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})

priority: Normal (Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})

subject: Roel

Participants

-Individual
*Practitioner/ReferralPractitionerExample

reasonCode: The patient had fever peaks over the last couple of days. He is worried about these peaks. (Details )

serviceProvider: Organization/UMOExample

\"\n },\n \"identifier\": [\n {\n \"use\": \"temp\",\n \"system\": \"http://www.temp.com\",\n \"value\": \"Encounter_SubscriberExample_20130404\"\n }\n ],\n \"status\": \"planned\",\n \"class\": {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n \"code\": \"AMB\",\n \"display\": \"ambulatory\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"11429006\",\n \"display\": \"Consultation\"\n }\n ]\n }\n ],\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"17621005\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"participant\": [\n {\n \"individual\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n \"code\": \"REF\"\n }\n ]\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n }\n }\n ],\n \"reasonCode\": [\n {\n \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n },\n \"serviceProvider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"hospitalization\": {\n \"admitSource\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n \"code\": \"5\"\n }\n ]\n },\n \"dischargeDisposition\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n \"code\": \"oth\"\n }\n ]\n }\n },\n \"location\": [\n {\n \"location\": {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n }\n ]\n }\n }\n ]\n }" + "value": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"ReferralAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample

provider: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n \"valueReference\": {\n \"reference\": \"Encounter/SurgicalEncounterExample\"\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"ServiceRequest/ReferralRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"unitPrice\": {\n \"value\": 1000,\n \"currency\": \"USD\"\n },\n \"quantity\": {\n \"value\": 1\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"additionalInformation\",\n \"display\": \"Additional Information\"\n }\n ]\n },\n \"sequence\": 1,\n \"valueReference\": {\n \"reference\": \"DocumentReference/episode-summary\"\n }\n },\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: Patient/SubscriberExample

payor: Organization/InsurerExample

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n \"resource\": {\n \"resourceType\": \"ServiceRequest\",\n \"id\": \"ReferralRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: active

intent: order

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: Patient/SubscriberExample

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"occurrenceTiming\": {\n \"repeat\": {\n \"duration\": 15,\n \"durationMax\": 25,\n \"durationUnit\": \"min\",\n \"frequency\": 1,\n \"frequencyMax\": 4,\n \"period\": 1,\n \"periodUnit\": \"d\"\n }\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n \"extension\": [\n {\n \"url\": \"coverage\",\n \"valueReference\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n },\n {\n \"url\": \"covered\",\n \"valueCode\": \"covered\"\n },\n {\n \"url\": \"pa-needed\",\n \"valueCode\": \"auth-needed\"\n },\n {\n \"url\": \"date\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"coverage-assertion-id\",\n \"valueString\": \"1122445\"\n }\n ]\n }\n ],\n \"quantityQuantity\": {\n \"value\": 1,\n \"unit\": \"visit\",\n \"system\": \"http://unitsofmeasure.org\",\n \"code\": \"1\"\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: Practitioner/ReferralPractitionerExample

location: Location/ReferralLocationExample

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n \"resource\": {\n \"resourceType\": \"DocumentReference\",\n \"id\": \"episode-summary\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative

id: episode-summary

meta:

identifier: id: urn:oid:2.16.840.1.113883.19.5.99999.1

status: current

type: CCD Document

category: Clinical Note

subject: Amy Shaw. Generated Summary: id: example; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20

date: 10/03/2016 2:29:46 AM

author: Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone

description: Pulmonology clinic acute visit

Contents

-AttachmentFormat
*Documents following C-CDA constraints using a structured body

Contexts

-Period
*23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM
\"\n },\n \"identifier\": [\n {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n }\n ],\n \"status\": \"current\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"34133-9\",\n \"display\": \"Summary of episode note\"\n }\n ],\n \"text\": \"CCD Document\"\n },\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n \"code\": \"clinical-note\",\n \"display\": \"Clinical Note\"\n }\n ],\n \"text\": \"Clinical Note\"\n }\n ],\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"date\": \"2016-03-09T15:29:46Z\",\n \"author\": [\n {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n ],\n \"description\": \"Pulmonology clinic acute visit\",\n \"content\": [\n {\n \"attachment\": {\n \"contentType\": \"text/plain\",\n \"url\": \"/Binary/1-note\",\n \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n },\n \"format\": {\n \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n \"display\": \"Documents following C-CDA constraints using a structured body\"\n }\n }\n ],\n \"context\": {\n \"period\": {\n \"start\": \"2004-12-23T08:00:00+11:00\",\n \"end\": \"2004-12-23T08:01:00+11:00\"\n }\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n \"resource\": {\n \"resourceType\": \"Encounter\",\n \"id\": \"SurgicalEncounterExample\",\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative with Details

id: f201

identifier: Encounter_Roel_20130404 (TEMP)

status: finished

class: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')

type: Consultation (Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})

priority: Normal (Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})

subject: Roel

Participants

-Individual
*Practitioner/ReferralPractitionerExample

reasonCode: The patient had fever peaks over the last couple of days. He is worried about these peaks. (Details )

serviceProvider: Organization/UMOExample

\"\n },\n \"identifier\": [\n {\n \"use\": \"temp\",\n \"system\": \"http://www.temp.com\",\n \"value\": \"Encounter_SubscriberExample_20130404\"\n }\n ],\n \"status\": \"planned\",\n \"class\": {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n \"code\": \"AMB\",\n \"display\": \"ambulatory\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"11429006\",\n \"display\": \"Consultation\"\n }\n ]\n }\n ],\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"17621005\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"participant\": [\n {\n \"individual\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n \"code\": \"REF\"\n }\n ]\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n }\n }\n ],\n \"reasonCode\": [\n {\n \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n },\n \"serviceProvider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"hospitalization\": {\n \"admitSource\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n \"code\": \"5\"\n }\n ]\n },\n \"dischargeDisposition\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n \"code\": \"oth\"\n }\n ]\n }\n },\n \"location\": [\n {\n \"location\": {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n }\n ]\n }\n }\n ]\n }" }, { "name": "denial_pa_submit_request_payload", @@ -31,7 +31,7 @@ "optional": true, "title": "PAS Submit Request Payload for Denial Response", "type": "textarea", - "value": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"ReferralAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: See above (Patient/SubscriberExample)

created: 2005-05-02 11:01:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See above (PractitionerRole/ReferralPractitionerRoleExample)

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n \"valueReference\": {\n \"reference\": \"Encounter/SurgicalEncounterExample\"\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"ServiceRequest/ReferralRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"unitPrice\": {\n \"value\": 1000,\n \"currency\": \"USD\"\n },\n \"quantity\": {\n \"value\": 1\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"additionalInformation\",\n \"display\": \"Additional Information\"\n }\n ]\n },\n \"sequence\": 1,\n \"valueReference\": {\n \"reference\": \"DocumentReference/episode-summary\"\n }\n },\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: See above (Patient/SubscriberExample)

payor: See above (Organization/InsurerExample)

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n \"resource\": {\n \"resourceType\": \"ServiceRequest\",\n \"id\": \"ReferralRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: active

intent: order

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: See above (Patient/SubscriberExample)

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"occurrenceTiming\": {\n \"repeat\": {\n \"duration\": 15,\n \"durationMax\": 25,\n \"durationUnit\": \"min\",\n \"frequency\": 1,\n \"frequencyMax\": 4,\n \"period\": 1,\n \"periodUnit\": \"d\"\n }\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n \"extension\": [\n {\n \"url\": \"coverage\",\n \"valueReference\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n },\n {\n \"url\": \"covered\",\n \"valueCode\": \"covered\"\n },\n {\n \"url\": \"pa-needed\",\n \"valueCode\": \"auth-needed\"\n },\n {\n \"url\": \"date\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"coverage-assertion-id\",\n \"valueString\": \"1122445\"\n }\n ]\n }\n ],\n \"quantityQuantity\": {\n \"value\": 1,\n \"unit\": \"visit\",\n \"system\": \"http://unitsofmeasure.org\",\n \"code\": \"1\"\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See above (Practitioner/ReferralPractitionerExample)

location: See above (Location/ReferralLocationExample)

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n \"resource\": {\n \"resourceType\": \"DocumentReference\",\n \"id\": \"episode-summary\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative

id: episode-summary

meta:

identifier: id: urn:oid:2.16.840.1.113883.19.5.99999.1

status: current

type: CCD Document

category: Clinical Note

subject: Amy Shaw. Generated Summary: id: example; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20

date: 10/03/2016 2:29:46 AM

author: Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone

description: Pulmonology clinic acute visit

Contents

-AttachmentFormat
*Documents following C-CDA constraints using a structured body

Contexts

-Period
*23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM
\"\n },\n \"identifier\": [\n {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n }\n ],\n \"status\": \"current\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"34133-9\",\n \"display\": \"Summary of episode note\"\n }\n ],\n \"text\": \"CCD Document\"\n },\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n \"code\": \"clinical-note\",\n \"display\": \"Clinical Note\"\n }\n ],\n \"text\": \"Clinical Note\"\n }\n ],\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"date\": \"2016-03-09T15:29:46Z\",\n \"author\": [\n {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n ],\n \"description\": \"Pulmonology clinic acute visit\",\n \"content\": [\n {\n \"attachment\": {\n \"contentType\": \"text/plain\",\n \"url\": \"/Binary/1-note\",\n \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n },\n \"format\": {\n \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n \"display\": \"Documents following C-CDA constraints using a structured body\"\n }\n }\n ],\n \"context\": {\n \"period\": {\n \"start\": \"2004-12-23T08:00:00+11:00\",\n \"end\": \"2004-12-23T08:01:00+11:00\"\n }\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n \"resource\": {\n \"resourceType\": \"Encounter\",\n \"id\": \"SurgicalEncounterExample\",\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative with Details

id: f201

identifier: Encounter_Roel_20130404 (TEMP)

status: finished

class: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')

type: Consultation (Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})

priority: Normal (Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})

subject: Roel

Participants

-Individual
*Practitioner/ReferralPractitionerExample

reasonCode: The patient had fever peaks over the last couple of days. He is worried about these peaks. (Details )

serviceProvider: Organization/UMOExample

\"\n },\n \"identifier\": [\n {\n \"use\": \"temp\",\n \"system\": \"http://www.temp.com\",\n \"value\": \"Encounter_SubscriberExample_20130404\"\n }\n ],\n \"status\": \"planned\",\n \"class\": {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n \"code\": \"AMB\",\n \"display\": \"ambulatory\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"11429006\",\n \"display\": \"Consultation\"\n }\n ]\n }\n ],\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"17621005\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"participant\": [\n {\n \"individual\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n \"code\": \"REF\"\n }\n ]\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n }\n }\n ],\n \"reasonCode\": [\n {\n \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n },\n \"serviceProvider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"hospitalization\": {\n \"admitSource\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n \"code\": \"5\"\n }\n ]\n },\n \"dischargeDisposition\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n \"code\": \"oth\"\n }\n ]\n }\n },\n \"location\": [\n {\n \"location\": {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n }\n ]\n }\n }\n ]\n }" + "value": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"ReferralAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample

provider: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n \"valueReference\": {\n \"reference\": \"Encounter/SurgicalEncounterExample\"\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"ServiceRequest/ReferralRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"unitPrice\": {\n \"value\": 1000,\n \"currency\": \"USD\"\n },\n \"quantity\": {\n \"value\": 1\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"additionalInformation\",\n \"display\": \"Additional Information\"\n }\n ]\n },\n \"sequence\": 1,\n \"valueReference\": {\n \"reference\": \"DocumentReference/episode-summary\"\n }\n },\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: Patient/SubscriberExample

payor: Organization/InsurerExample

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n \"resource\": {\n \"resourceType\": \"ServiceRequest\",\n \"id\": \"ReferralRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: active

intent: order

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: Patient/SubscriberExample

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"occurrenceTiming\": {\n \"repeat\": {\n \"duration\": 15,\n \"durationMax\": 25,\n \"durationUnit\": \"min\",\n \"frequency\": 1,\n \"frequencyMax\": 4,\n \"period\": 1,\n \"periodUnit\": \"d\"\n }\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n \"extension\": [\n {\n \"url\": \"coverage\",\n \"valueReference\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n },\n {\n \"url\": \"covered\",\n \"valueCode\": \"covered\"\n },\n {\n \"url\": \"pa-needed\",\n \"valueCode\": \"auth-needed\"\n },\n {\n \"url\": \"date\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"coverage-assertion-id\",\n \"valueString\": \"1122445\"\n }\n ]\n }\n ],\n \"quantityQuantity\": {\n \"value\": 1,\n \"unit\": \"visit\",\n \"system\": \"http://unitsofmeasure.org\",\n \"code\": \"1\"\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: Practitioner/ReferralPractitionerExample

location: Location/ReferralLocationExample

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n \"resource\": {\n \"resourceType\": \"DocumentReference\",\n \"id\": \"episode-summary\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative

id: episode-summary

meta:

identifier: id: urn:oid:2.16.840.1.113883.19.5.99999.1

status: current

type: CCD Document

category: Clinical Note

subject: Amy Shaw. Generated Summary: id: example; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20

date: 10/03/2016 2:29:46 AM

author: Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone

description: Pulmonology clinic acute visit

Contents

-AttachmentFormat
*Documents following C-CDA constraints using a structured body

Contexts

-Period
*23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM
\"\n },\n \"identifier\": [\n {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n }\n ],\n \"status\": \"current\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"34133-9\",\n \"display\": \"Summary of episode note\"\n }\n ],\n \"text\": \"CCD Document\"\n },\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n \"code\": \"clinical-note\",\n \"display\": \"Clinical Note\"\n }\n ],\n \"text\": \"Clinical Note\"\n }\n ],\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"date\": \"2016-03-09T15:29:46Z\",\n \"author\": [\n {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n ],\n \"description\": \"Pulmonology clinic acute visit\",\n \"content\": [\n {\n \"attachment\": {\n \"contentType\": \"text/plain\",\n \"url\": \"/Binary/1-note\",\n \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n },\n \"format\": {\n \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n \"display\": \"Documents following C-CDA constraints using a structured body\"\n }\n }\n ],\n \"context\": {\n \"period\": {\n \"start\": \"2004-12-23T08:00:00+11:00\",\n \"end\": \"2004-12-23T08:01:00+11:00\"\n }\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n \"resource\": {\n \"resourceType\": \"Encounter\",\n \"id\": \"SurgicalEncounterExample\",\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative with Details

id: f201

identifier: Encounter_Roel_20130404 (TEMP)

status: finished

class: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')

type: Consultation (Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})

priority: Normal (Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})

subject: Roel

Participants

-Individual
*Practitioner/ReferralPractitionerExample

reasonCode: The patient had fever peaks over the last couple of days. He is worried about these peaks. (Details )

serviceProvider: Organization/UMOExample

\"\n },\n \"identifier\": [\n {\n \"use\": \"temp\",\n \"system\": \"http://www.temp.com\",\n \"value\": \"Encounter_SubscriberExample_20130404\"\n }\n ],\n \"status\": \"planned\",\n \"class\": {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n \"code\": \"AMB\",\n \"display\": \"ambulatory\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"11429006\",\n \"display\": \"Consultation\"\n }\n ]\n }\n ],\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"17621005\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"participant\": [\n {\n \"individual\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n \"code\": \"REF\"\n }\n ]\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n }\n }\n ],\n \"reasonCode\": [\n {\n \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n },\n \"serviceProvider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"hospitalization\": {\n \"admitSource\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n \"code\": \"5\"\n }\n ]\n },\n \"dischargeDisposition\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n \"code\": \"oth\"\n }\n ]\n }\n },\n \"location\": [\n {\n \"location\": {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n }\n ]\n }\n }\n ]\n }" }, { "name": "pended_pa_submit_request_payload", @@ -39,7 +39,7 @@ "optional": true, "title": "PAS Submit Request Payload for Pended Response", "type": "textarea", - "value": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"DeviceAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: See above (Patient/SubscriberExample)

created: 2005-05-02 11:01:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See above (PractitionerRole/ReferralPractitionerRoleExample)

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n \"valueReference\": {\n \"reference\": \"Encounter/SurgicalEncounterExample\"\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"DeviceRequest/DeviceRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"unitPrice\": {\n \"value\": 1000,\n \"currency\": \"USD\"\n },\n \"quantity\": {\n \"value\": 1\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"additionalInformation\",\n \"display\": \"Additional Information\"\n }\n ]\n },\n \"sequence\": 1,\n \"valueReference\": {\n \"reference\": \"DocumentReference/episode-summary\"\n }\n },\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: See above (Patient/SubscriberExample)

payor: See above (Organization/InsurerExample)

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DeviceRequest/DeviceRequestExample\",\n \"resource\": {\n \"resourceType\": \"DeviceRequest\",\n \"id\": \"DeviceRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-devicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: DeviceRequest

Resource DeviceRequest "DeviceRequestExample"

Profile: PAS Device Request

status: active

intent: order

code: E1223 (HCPCSReleaseCodeSets#E1223)

subject: Patient/SubscriberExample " SMITH"

authoredOn: 2005-06-02

requester: Practitioner/ReferralPractitionerExample " WATSON"

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"codeCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E1223\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n \"extension\": [\n {\n \"url\": \"coverage\",\n \"valueReference\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n },\n {\n \"url\": \"covered\",\n \"valueCode\": \"covered\"\n },\n {\n \"url\": \"pa-needed\",\n \"valueCode\": \"auth-needed\"\n },\n {\n \"url\": \"date\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"coverage-assertion-id\",\n \"valueString\": \"1122445\"\n }\n ]\n }\n ],\n \"authoredOn\": \"2005-06-02\",\n \"occurrenceTiming\": {\n \"repeat\": {\n \"duration\": 15,\n \"durationMax\": 25,\n \"durationUnit\": \"min\",\n \"frequency\": 1,\n \"frequencyMax\": 4,\n \"period\": 1,\n \"periodUnit\": \"d\"\n }\n },\n \"requester\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See above (Practitioner/ReferralPractitionerExample)

location: See above (Location/ReferralLocationExample)

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n \"resource\": {\n \"resourceType\": \"DocumentReference\",\n \"id\": \"episode-summary\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative

id: episode-summary

meta:

identifier: id: urn:oid:2.16.840.1.113883.19.5.99999.1

status: current

type: CCD Document

category: Clinical Note

subject: Amy Shaw. Generated Summary: id: example; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20

date: 10/03/2016 2:29:46 AM

author: Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone

description: Pulmonology clinic acute visit

Contents

-AttachmentFormat
*Documents following C-CDA constraints using a structured body

Contexts

-Period
*23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM
\"\n },\n \"identifier\": [\n {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n }\n ],\n \"status\": \"current\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"34133-9\",\n \"display\": \"Summary of episode note\"\n }\n ],\n \"text\": \"CCD Document\"\n },\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n \"code\": \"clinical-note\",\n \"display\": \"Clinical Note\"\n }\n ],\n \"text\": \"Clinical Note\"\n }\n ],\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"date\": \"2016-03-09T15:29:46Z\",\n \"author\": [\n {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n ],\n \"description\": \"Pulmonology clinic acute visit\",\n \"content\": [\n {\n \"attachment\": {\n \"contentType\": \"text/plain\",\n \"url\": \"/Binary/1-note\",\n \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n },\n \"format\": {\n \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n \"display\": \"Documents following C-CDA constraints using a structured body\"\n }\n }\n ],\n \"context\": {\n \"period\": {\n \"start\": \"2004-12-23T08:00:00+11:00\",\n \"end\": \"2004-12-23T08:01:00+11:00\"\n }\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n \"resource\": {\n \"resourceType\": \"Encounter\",\n \"id\": \"SurgicalEncounterExample\",\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative with Details

id: f201

identifier: Encounter_Roel_20130404 (TEMP)

status: finished

class: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')

type: Consultation (Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})

priority: Normal (Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})

subject: Roel

Participants

-Individual
*Practitioner/ReferralPractitionerExample

reasonCode: The patient had fever peaks over the last couple of days. He is worried about these peaks. (Details )

serviceProvider: Organization/UMOExample

\"\n },\n \"identifier\": [\n {\n \"use\": \"temp\",\n \"system\": \"http://www.temp.com\",\n \"value\": \"Encounter_SubscriberExample_20130404\"\n }\n ],\n \"status\": \"planned\",\n \"class\": {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n \"code\": \"AMB\",\n \"display\": \"ambulatory\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"11429006\",\n \"display\": \"Consultation\"\n }\n ]\n }\n ],\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"17621005\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"participant\": [\n {\n \"individual\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n \"code\": \"REF\"\n }\n ]\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n }\n }\n ],\n \"reasonCode\": [\n {\n \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n },\n \"serviceProvider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"hospitalization\": {\n \"admitSource\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n \"code\": \"5\"\n }\n ]\n },\n \"dischargeDisposition\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n \"code\": \"oth\"\n }\n ]\n }\n },\n \"location\": [\n {\n \"location\": {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n }\n ]\n }\n }\n ]\n }" + "value": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"DeviceAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample

provider: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n \"valueReference\": {\n \"reference\": \"Encounter/SurgicalEncounterExample\"\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"DeviceRequest/DeviceRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"unitPrice\": {\n \"value\": 1000,\n \"currency\": \"USD\"\n },\n \"quantity\": {\n \"value\": 1\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"additionalInformation\",\n \"display\": \"Additional Information\"\n }\n ]\n },\n \"sequence\": 1,\n \"valueReference\": {\n \"reference\": \"DocumentReference/episode-summary\"\n }\n },\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: Patient/SubscriberExample

payor: Organization/InsurerExample

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DeviceRequest/DeviceRequestExample\",\n \"resource\": {\n \"resourceType\": \"DeviceRequest\",\n \"id\": \"DeviceRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-devicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: DeviceRequest

Resource DeviceRequest "DeviceRequestExample"

Profile: PAS Device Request

status: active

intent: order

code: E1223 (HCPCSReleaseCodeSets#E1223)

subject: Patient/SubscriberExample " SMITH"

authoredOn: 2005-06-02

requester: Practitioner/ReferralPractitionerExample " WATSON"

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"codeCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E1223\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n \"extension\": [\n {\n \"url\": \"coverage\",\n \"valueReference\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n },\n {\n \"url\": \"covered\",\n \"valueCode\": \"covered\"\n },\n {\n \"url\": \"pa-needed\",\n \"valueCode\": \"auth-needed\"\n },\n {\n \"url\": \"date\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"coverage-assertion-id\",\n \"valueString\": \"1122445\"\n }\n ]\n }\n ],\n \"authoredOn\": \"2005-06-02\",\n \"occurrenceTiming\": {\n \"repeat\": {\n \"duration\": 15,\n \"durationMax\": 25,\n \"durationUnit\": \"min\",\n \"frequency\": 1,\n \"frequencyMax\": 4,\n \"period\": 1,\n \"periodUnit\": \"d\"\n }\n },\n \"requester\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: Practitioner/ReferralPractitionerExample

location: Location/ReferralLocationExample

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n \"resource\": {\n \"resourceType\": \"DocumentReference\",\n \"id\": \"episode-summary\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative

id: episode-summary

meta:

identifier: id: urn:oid:2.16.840.1.113883.19.5.99999.1

status: current

type: CCD Document

category: Clinical Note

subject: Amy Shaw. Generated Summary: id: example; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20

date: 10/03/2016 2:29:46 AM

author: Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone

description: Pulmonology clinic acute visit

Contents

-AttachmentFormat
*Documents following C-CDA constraints using a structured body

Contexts

-Period
*23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM
\"\n },\n \"identifier\": [\n {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n }\n ],\n \"status\": \"current\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"34133-9\",\n \"display\": \"Summary of episode note\"\n }\n ],\n \"text\": \"CCD Document\"\n },\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n \"code\": \"clinical-note\",\n \"display\": \"Clinical Note\"\n }\n ],\n \"text\": \"Clinical Note\"\n }\n ],\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"date\": \"2016-03-09T15:29:46Z\",\n \"author\": [\n {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n ],\n \"description\": \"Pulmonology clinic acute visit\",\n \"content\": [\n {\n \"attachment\": {\n \"contentType\": \"text/plain\",\n \"url\": \"/Binary/1-note\",\n \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n },\n \"format\": {\n \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n \"display\": \"Documents following C-CDA constraints using a structured body\"\n }\n }\n ],\n \"context\": {\n \"period\": {\n \"start\": \"2004-12-23T08:00:00+11:00\",\n \"end\": \"2004-12-23T08:01:00+11:00\"\n }\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n \"resource\": {\n \"resourceType\": \"Encounter\",\n \"id\": \"SurgicalEncounterExample\",\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative with Details

id: f201

identifier: Encounter_Roel_20130404 (TEMP)

status: finished

class: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')

type: Consultation (Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})

priority: Normal (Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})

subject: Roel

Participants

-Individual
*Practitioner/ReferralPractitionerExample

reasonCode: The patient had fever peaks over the last couple of days. He is worried about these peaks. (Details )

serviceProvider: Organization/UMOExample

\"\n },\n \"identifier\": [\n {\n \"use\": \"temp\",\n \"system\": \"http://www.temp.com\",\n \"value\": \"Encounter_SubscriberExample_20130404\"\n }\n ],\n \"status\": \"planned\",\n \"class\": {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n \"code\": \"AMB\",\n \"display\": \"ambulatory\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"11429006\",\n \"display\": \"Consultation\"\n }\n ]\n }\n ],\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"17621005\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"participant\": [\n {\n \"individual\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n \"code\": \"REF\"\n }\n ]\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n }\n }\n ],\n \"reasonCode\": [\n {\n \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n },\n \"serviceProvider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"hospitalization\": {\n \"admitSource\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n \"code\": \"5\"\n }\n ]\n },\n \"dischargeDisposition\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n \"code\": \"oth\"\n }\n ]\n }\n },\n \"location\": [\n {\n \"location\": {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n }\n ]\n }\n }\n ]\n }" }, { "name": "pa_inquire_request_payload", @@ -47,7 +47,7 @@ "optional": true, "title": "PAS Inquiry Request Payload", "type": "textarea", - "value": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"PASBundleInquiryExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/PASClaimInquiryExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"PASClaimInquiryExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: See above (Patient/SubscriberExample)

created: 2005-05-02 11:01:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See above (PractitionerRole/ReferralPractitionerRoleExample)

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"billablePeriod\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n },\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"HS\",\n \"display\": \"Health Services Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate\",\n \"valueDate\": \"2022-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"quantity\": {\n \"value\": 1\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"G0154\"\n }\n ]\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"HS\",\n \"display\": \"Health Services Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n }\n ],\n \"sequence\": 2,\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"B4184\"\n }\n ]\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n }\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: See above (Patient/SubscriberExample)

payor: See above (Organization/InsurerExample)

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See above (Practitioner/ReferralPractitionerExample)

location: See above (Location/ReferralLocationExample)

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n }\n ]\n}" + "value": "{\n \"resourceType\": \"Bundle\",\n \"id\": \"PASBundleInquiryExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/PASClaimInquiryExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"PASClaimInquiryExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample

provider: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"billablePeriod\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n },\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"HS\",\n \"display\": \"Health Services Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate\",\n \"valueDate\": \"2022-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"quantity\": {\n \"value\": 1\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"G0154\"\n }\n ]\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"HS\",\n \"display\": \"Health Services Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n }\n ],\n \"sequence\": 2,\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"B4184\"\n }\n ]\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n }\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: Patient/SubscriberExample

payor: Organization/InsurerExample

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: Practitioner/ReferralPractitionerExample

location: Location/ReferralLocationExample

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n }\n ]\n}" }, { "name": "must_support_pa_submit_request_payload", @@ -55,7 +55,7 @@ "optional": true, "title": "Additional PAS Submit Request Payloads", "type": "textarea", - "value": "[\n {\n \"resourceType\": \"Bundle\",\n \"id\": \"DeviceAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: See above (Patient/SubscriberExample)

created: 2005-05-02 11:01:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See above (PractitionerRole/ReferralPractitionerRoleExample)

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n \"valueReference\": {\n \"reference\": \"Encounter/SurgicalEncounterExample\"\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"DeviceRequest/DeviceRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"unitPrice\": {\n \"value\": 1000,\n \"currency\": \"USD\"\n },\n \"quantity\": {\n \"value\": 1\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"additionalInformation\",\n \"display\": \"Additional Information\"\n }\n ]\n },\n \"sequence\": 1,\n \"valueReference\": {\n \"reference\": \"DocumentReference/episode-summary\"\n }\n },\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: See above (Patient/SubscriberExample)

payor: See above (Organization/InsurerExample)

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DeviceRequest/DeviceRequestExample\",\n \"resource\": {\n \"resourceType\": \"DeviceRequest\",\n \"id\": \"DeviceRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-devicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: DeviceRequest

Resource DeviceRequest "DeviceRequestExample"

Profile: PAS Device Request

status: active

intent: order

code: E1223 (HCPCSReleaseCodeSets#E1223)

subject: Patient/SubscriberExample " SMITH"

authoredOn: 2005-06-02

requester: Practitioner/ReferralPractitionerExample " WATSON"

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"codeCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E1223\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n \"extension\": [\n {\n \"url\": \"coverage\",\n \"valueReference\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n },\n {\n \"url\": \"covered\",\n \"valueCode\": \"covered\"\n },\n {\n \"url\": \"pa-needed\",\n \"valueCode\": \"auth-needed\"\n },\n {\n \"url\": \"date\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"coverage-assertion-id\",\n \"valueString\": \"1122445\"\n }\n ]\n }\n ],\n \"authoredOn\": \"2005-06-02\",\n \"occurrenceTiming\": {\n \"repeat\": {\n \"duration\": 15,\n \"durationMax\": 25,\n \"durationUnit\": \"min\",\n \"frequency\": 1,\n \"frequencyMax\": 4,\n \"period\": 1,\n \"periodUnit\": \"d\"\n }\n },\n \"requester\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See above (Practitioner/ReferralPractitionerExample)

location: See above (Location/ReferralLocationExample)

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n \"resource\": {\n \"resourceType\": \"DocumentReference\",\n \"id\": \"episode-summary\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative

id: episode-summary

meta:

identifier: id: urn:oid:2.16.840.1.113883.19.5.99999.1

status: current

type: CCD Document

category: Clinical Note

subject: Amy Shaw. Generated Summary: id: example; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20

date: 10/03/2016 2:29:46 AM

author: Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone

description: Pulmonology clinic acute visit

Contents

-AttachmentFormat
*Documents following C-CDA constraints using a structured body

Contexts

-Period
*23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM
\"\n },\n \"identifier\": [\n {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n }\n ],\n \"status\": \"current\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"34133-9\",\n \"display\": \"Summary of episode note\"\n }\n ],\n \"text\": \"CCD Document\"\n },\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n \"code\": \"clinical-note\",\n \"display\": \"Clinical Note\"\n }\n ],\n \"text\": \"Clinical Note\"\n }\n ],\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"date\": \"2016-03-09T15:29:46Z\",\n \"author\": [\n {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n ],\n \"description\": \"Pulmonology clinic acute visit\",\n \"content\": [\n {\n \"attachment\": {\n \"contentType\": \"text/plain\",\n \"url\": \"/Binary/1-note\",\n \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n },\n \"format\": {\n \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n \"display\": \"Documents following C-CDA constraints using a structured body\"\n }\n }\n ],\n \"context\": {\n \"period\": {\n \"start\": \"2004-12-23T08:00:00+11:00\",\n \"end\": \"2004-12-23T08:01:00+11:00\"\n }\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n \"resource\": {\n \"resourceType\": \"Encounter\",\n \"id\": \"SurgicalEncounterExample\",\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative with Details

id: f201

identifier: Encounter_Roel_20130404 (TEMP)

status: finished

class: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')

type: Consultation (Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})

priority: Normal (Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})

subject: Roel

Participants

-Individual
*Practitioner/ReferralPractitionerExample

reasonCode: The patient had fever peaks over the last couple of days. He is worried about these peaks. (Details )

serviceProvider: Organization/UMOExample

\"\n },\n \"identifier\": [\n {\n \"use\": \"temp\",\n \"system\": \"http://www.temp.com\",\n \"value\": \"Encounter_SubscriberExample_20130404\"\n }\n ],\n \"status\": \"planned\",\n \"class\": {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n \"code\": \"AMB\",\n \"display\": \"ambulatory\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"11429006\",\n \"display\": \"Consultation\"\n }\n ]\n }\n ],\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"17621005\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"participant\": [\n {\n \"individual\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n \"code\": \"REF\"\n }\n ]\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n }\n }\n ],\n \"reasonCode\": [\n {\n \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n },\n \"serviceProvider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"hospitalization\": {\n \"admitSource\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n \"code\": \"5\"\n }\n ]\n },\n \"dischargeDisposition\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n \"code\": \"oth\"\n }\n ]\n }\n },\n \"location\": [\n {\n \"location\": {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n }\n ]\n }\n }\n ]\n },\n {\n \"resourceType\": \"Bundle\",\n \"id\": \"ReferralAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: See above (Patient/SubscriberExample)

created: 2005-05-02 11:01:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See above (PractitionerRole/ReferralPractitionerRoleExample)

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n \"valueReference\": {\n \"reference\": \"Encounter/SurgicalEncounterExample\"\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"ServiceRequest/ReferralRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"unitPrice\": {\n \"value\": 1000,\n \"currency\": \"USD\"\n },\n \"quantity\": {\n \"value\": 1\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"additionalInformation\",\n \"display\": \"Additional Information\"\n }\n ]\n },\n \"sequence\": 1,\n \"valueReference\": {\n \"reference\": \"DocumentReference/episode-summary\"\n }\n },\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: See above (Patient/SubscriberExample)

payor: See above (Organization/InsurerExample)

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n \"resource\": {\n \"resourceType\": \"ServiceRequest\",\n \"id\": \"ReferralRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: active

intent: order

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: See above (Patient/SubscriberExample)

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"occurrenceTiming\": {\n \"repeat\": {\n \"duration\": 15,\n \"durationMax\": 25,\n \"durationUnit\": \"min\",\n \"frequency\": 1,\n \"frequencyMax\": 4,\n \"period\": 1,\n \"periodUnit\": \"d\"\n }\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n \"extension\": [\n {\n \"url\": \"coverage\",\n \"valueReference\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n },\n {\n \"url\": \"covered\",\n \"valueCode\": \"covered\"\n },\n {\n \"url\": \"pa-needed\",\n \"valueCode\": \"auth-needed\"\n },\n {\n \"url\": \"date\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"coverage-assertion-id\",\n \"valueString\": \"1122445\"\n }\n ]\n }\n ],\n \"quantityQuantity\": {\n \"value\": 1,\n \"unit\": \"visit\",\n \"system\": \"http://unitsofmeasure.org\",\n \"code\": \"1\"\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See above (Practitioner/ReferralPractitionerExample)

location: See above (Location/ReferralLocationExample)

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n \"resource\": {\n \"resourceType\": \"DocumentReference\",\n \"id\": \"episode-summary\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative

id: episode-summary

meta:

identifier: id: urn:oid:2.16.840.1.113883.19.5.99999.1

status: current

type: CCD Document

category: Clinical Note

subject: Amy Shaw. Generated Summary: id: example; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20

date: 10/03/2016 2:29:46 AM

author: Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone

description: Pulmonology clinic acute visit

Contents

-AttachmentFormat
*Documents following C-CDA constraints using a structured body

Contexts

-Period
*23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM
\"\n },\n \"identifier\": [\n {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n }\n ],\n \"status\": \"current\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"34133-9\",\n \"display\": \"Summary of episode note\"\n }\n ],\n \"text\": \"CCD Document\"\n },\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n \"code\": \"clinical-note\",\n \"display\": \"Clinical Note\"\n }\n ],\n \"text\": \"Clinical Note\"\n }\n ],\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"date\": \"2016-03-09T15:29:46Z\",\n \"author\": [\n {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n ],\n \"description\": \"Pulmonology clinic acute visit\",\n \"content\": [\n {\n \"attachment\": {\n \"contentType\": \"text/plain\",\n \"url\": \"/Binary/1-note\",\n \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n },\n \"format\": {\n \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n \"display\": \"Documents following C-CDA constraints using a structured body\"\n }\n }\n ],\n \"context\": {\n \"period\": {\n \"start\": \"2004-12-23T08:00:00+11:00\",\n \"end\": \"2004-12-23T08:01:00+11:00\"\n }\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n \"resource\": {\n \"resourceType\": \"Encounter\",\n \"id\": \"SurgicalEncounterExample\",\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative with Details

id: f201

identifier: Encounter_Roel_20130404 (TEMP)

status: finished

class: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')

type: Consultation (Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})

priority: Normal (Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})

subject: Roel

Participants

-Individual
*Practitioner/ReferralPractitionerExample

reasonCode: The patient had fever peaks over the last couple of days. He is worried about these peaks. (Details )

serviceProvider: Organization/UMOExample

\"\n },\n \"identifier\": [\n {\n \"use\": \"temp\",\n \"system\": \"http://www.temp.com\",\n \"value\": \"Encounter_SubscriberExample_20130404\"\n }\n ],\n \"status\": \"planned\",\n \"class\": {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n \"code\": \"AMB\",\n \"display\": \"ambulatory\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"11429006\",\n \"display\": \"Consultation\"\n }\n ]\n }\n ],\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"17621005\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"participant\": [\n {\n \"individual\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n \"code\": \"REF\"\n }\n ]\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n }\n }\n ],\n \"reasonCode\": [\n {\n \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n },\n \"serviceProvider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"hospitalization\": {\n \"admitSource\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n \"code\": \"5\"\n }\n ]\n },\n \"dischargeDisposition\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n \"code\": \"oth\"\n }\n ]\n }\n },\n \"location\": [\n {\n \"location\": {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n }\n ]\n }\n }\n ]\n }\n]" + "value": "[\n {\n \"resourceType\": \"Bundle\",\n \"id\": \"DeviceAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample

provider: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n \"valueReference\": {\n \"reference\": \"Encounter/SurgicalEncounterExample\"\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"DeviceRequest/DeviceRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"unitPrice\": {\n \"value\": 1000,\n \"currency\": \"USD\"\n },\n \"quantity\": {\n \"value\": 1\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"additionalInformation\",\n \"display\": \"Additional Information\"\n }\n ]\n },\n \"sequence\": 1,\n \"valueReference\": {\n \"reference\": \"DocumentReference/episode-summary\"\n }\n },\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: Patient/SubscriberExample

payor: Organization/InsurerExample

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DeviceRequest/DeviceRequestExample\",\n \"resource\": {\n \"resourceType\": \"DeviceRequest\",\n \"id\": \"DeviceRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-devicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: DeviceRequest

Resource DeviceRequest "DeviceRequestExample"

Profile: PAS Device Request

status: active

intent: order

code: E1223 (HCPCSReleaseCodeSets#E1223)

subject: Patient/SubscriberExample " SMITH"

authoredOn: 2005-06-02

requester: Practitioner/ReferralPractitionerExample " WATSON"

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"codeCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E1223\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n \"extension\": [\n {\n \"url\": \"coverage\",\n \"valueReference\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n },\n {\n \"url\": \"covered\",\n \"valueCode\": \"covered\"\n },\n {\n \"url\": \"pa-needed\",\n \"valueCode\": \"auth-needed\"\n },\n {\n \"url\": \"date\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"coverage-assertion-id\",\n \"valueString\": \"1122445\"\n }\n ]\n }\n ],\n \"authoredOn\": \"2005-06-02\",\n \"occurrenceTiming\": {\n \"repeat\": {\n \"duration\": 15,\n \"durationMax\": 25,\n \"durationUnit\": \"min\",\n \"frequency\": 1,\n \"frequencyMax\": 4,\n \"period\": 1,\n \"periodUnit\": \"d\"\n }\n },\n \"requester\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: Practitioner/ReferralPractitionerExample

location: Location/ReferralLocationExample

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n \"resource\": {\n \"resourceType\": \"DocumentReference\",\n \"id\": \"episode-summary\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative

id: episode-summary

meta:

identifier: id: urn:oid:2.16.840.1.113883.19.5.99999.1

status: current

type: CCD Document

category: Clinical Note

subject: Amy Shaw. Generated Summary: id: example; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20

date: 10/03/2016 2:29:46 AM

author: Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone

description: Pulmonology clinic acute visit

Contents

-AttachmentFormat
*Documents following C-CDA constraints using a structured body

Contexts

-Period
*23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM
\"\n },\n \"identifier\": [\n {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n }\n ],\n \"status\": \"current\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"34133-9\",\n \"display\": \"Summary of episode note\"\n }\n ],\n \"text\": \"CCD Document\"\n },\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n \"code\": \"clinical-note\",\n \"display\": \"Clinical Note\"\n }\n ],\n \"text\": \"Clinical Note\"\n }\n ],\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"date\": \"2016-03-09T15:29:46Z\",\n \"author\": [\n {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n ],\n \"description\": \"Pulmonology clinic acute visit\",\n \"content\": [\n {\n \"attachment\": {\n \"contentType\": \"text/plain\",\n \"url\": \"/Binary/1-note\",\n \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n },\n \"format\": {\n \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n \"display\": \"Documents following C-CDA constraints using a structured body\"\n }\n }\n ],\n \"context\": {\n \"period\": {\n \"start\": \"2004-12-23T08:00:00+11:00\",\n \"end\": \"2004-12-23T08:01:00+11:00\"\n }\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n \"resource\": {\n \"resourceType\": \"Encounter\",\n \"id\": \"SurgicalEncounterExample\",\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative with Details

id: f201

identifier: Encounter_Roel_20130404 (TEMP)

status: finished

class: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')

type: Consultation (Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})

priority: Normal (Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})

subject: Roel

Participants

-Individual
*Practitioner/ReferralPractitionerExample

reasonCode: The patient had fever peaks over the last couple of days. He is worried about these peaks. (Details )

serviceProvider: Organization/UMOExample

\"\n },\n \"identifier\": [\n {\n \"use\": \"temp\",\n \"system\": \"http://www.temp.com\",\n \"value\": \"Encounter_SubscriberExample_20130404\"\n }\n ],\n \"status\": \"planned\",\n \"class\": {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n \"code\": \"AMB\",\n \"display\": \"ambulatory\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"11429006\",\n \"display\": \"Consultation\"\n }\n ]\n }\n ],\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"17621005\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"participant\": [\n {\n \"individual\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n \"code\": \"REF\"\n }\n ]\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n }\n }\n ],\n \"reasonCode\": [\n {\n \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n },\n \"serviceProvider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"hospitalization\": {\n \"admitSource\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n \"code\": \"5\"\n }\n ]\n },\n \"dischargeDisposition\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n \"code\": \"oth\"\n }\n ]\n }\n },\n \"location\": [\n {\n \"location\": {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n }\n ]\n }\n }\n ]\n },\n {\n \"resourceType\": \"Bundle\",\n \"id\": \"ReferralAuthorizationBundleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"ReferralAuthorizationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample

provider: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n \"valueReference\": {\n \"reference\": \"Encounter/SurgicalEncounterExample\"\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"SC\",\n \"display\": \"Specialty Care Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n \"valueReference\": {\n \"reference\": \"ServiceRequest/ReferralRequestExample\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n \"valueBoolean\": false\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1345\",\n \"code\": \"2\",\n \"display\": \"Newly Admitted\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1337\",\n \"code\": \"2\",\n \"display\": \"Intermediate Care Facility (ICF)\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n \"valueDecimal\": 100\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"unitPrice\": {\n \"value\": 1000,\n \"currency\": \"USD\"\n },\n \"quantity\": {\n \"value\": 1\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"additionalInformation\",\n \"display\": \"Additional Information\"\n }\n ]\n },\n \"sequence\": 1,\n \"valueReference\": {\n \"reference\": \"DocumentReference/episode-summary\"\n }\n },\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: Patient/SubscriberExample

payor: Organization/InsurerExample

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n \"resource\": {\n \"resourceType\": \"ServiceRequest\",\n \"id\": \"ReferralRequestExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: ServiceRequest

Resource ServiceRequest "ReferralRequestExample"

Profile: PAS Service Request

status: active

intent: order

code: Consultation (1365#3)

quantity: 1 visit (Details: UCUM code 1 = '1')

subject: Patient/SubscriberExample

\"\n },\n \"status\": \"active\",\n \"intent\": \"order\",\n \"code\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n },\n \"occurrenceTiming\": {\n \"repeat\": {\n \"duration\": 15,\n \"durationMax\": 25,\n \"durationUnit\": \"min\",\n \"frequency\": 1,\n \"frequencyMax\": 4,\n \"period\": 1,\n \"periodUnit\": \"d\"\n }\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n \"extension\": [\n {\n \"url\": \"coverage\",\n \"valueReference\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n },\n {\n \"url\": \"covered\",\n \"valueCode\": \"covered\"\n },\n {\n \"url\": \"pa-needed\",\n \"valueCode\": \"auth-needed\"\n },\n {\n \"url\": \"date\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"coverage-assertion-id\",\n \"valueString\": \"1122445\"\n }\n ]\n }\n ],\n \"quantityQuantity\": {\n \"value\": 1,\n \"unit\": \"visit\",\n \"system\": \"http://unitsofmeasure.org\",\n \"code\": \"1\"\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: Practitioner/ReferralPractitionerExample

location: Location/ReferralLocationExample

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n \"resource\": {\n \"resourceType\": \"DocumentReference\",\n \"id\": \"episode-summary\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative

id: episode-summary

meta:

identifier: id: urn:oid:2.16.840.1.113883.19.5.99999.1

status: current

type: CCD Document

category: Clinical Note

subject: Amy Shaw. Generated Summary: id: example; Medical Record Number: 1032702 (USUAL); active; Amy V. Shaw , Amy V. Baxter ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: 1987-02-20

date: 10/03/2016 2:29:46 AM

author: Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone

description: Pulmonology clinic acute visit

Contents

-AttachmentFormat
*Documents following C-CDA constraints using a structured body

Contexts

-Period
*23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM
\"\n },\n \"identifier\": [\n {\n \"system\": \"urn:ietf:rfc:3986\",\n \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n }\n ],\n \"status\": \"current\",\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://loinc.org\",\n \"code\": \"34133-9\",\n \"display\": \"Summary of episode note\"\n }\n ],\n \"text\": \"CCD Document\"\n },\n \"category\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n \"code\": \"clinical-note\",\n \"display\": \"Clinical Note\"\n }\n ],\n \"text\": \"Clinical Note\"\n }\n ],\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"date\": \"2016-03-09T15:29:46Z\",\n \"author\": [\n {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n }\n ],\n \"description\": \"Pulmonology clinic acute visit\",\n \"content\": [\n {\n \"attachment\": {\n \"contentType\": \"text/plain\",\n \"url\": \"/Binary/1-note\",\n \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n },\n \"format\": {\n \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n \"display\": \"Documents following C-CDA constraints using a structured body\"\n }\n }\n ],\n \"context\": {\n \"period\": {\n \"start\": \"2004-12-23T08:00:00+11:00\",\n \"end\": \"2004-12-23T08:01:00+11:00\"\n }\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n \"resource\": {\n \"resourceType\": \"Encounter\",\n \"id\": \"SurgicalEncounterExample\",\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative with Details

id: f201

identifier: Encounter_Roel_20130404 (TEMP)

status: finished

class: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')

type: Consultation (Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})

priority: Normal (Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})

subject: Roel

Participants

-Individual
*Practitioner/ReferralPractitionerExample

reasonCode: The patient had fever peaks over the last couple of days. He is worried about these peaks. (Details )

serviceProvider: Organization/UMOExample

\"\n },\n \"identifier\": [\n {\n \"use\": \"temp\",\n \"system\": \"http://www.temp.com\",\n \"value\": \"Encounter_SubscriberExample_20130404\"\n }\n ],\n \"status\": \"planned\",\n \"class\": {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n \"code\": \"AMB\",\n \"display\": \"ambulatory\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"11429006\",\n \"display\": \"Consultation\"\n }\n ]\n }\n ],\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://snomed.info/sct\",\n \"code\": \"17621005\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"subject\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"participant\": [\n {\n \"individual\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n \"code\": \"REF\"\n }\n ]\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n }\n }\n ],\n \"reasonCode\": [\n {\n \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n }\n ],\n \"period\": {\n \"start\": \"2020-07-02\",\n \"end\": \"2020-07-09\"\n },\n \"serviceProvider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"hospitalization\": {\n \"admitSource\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n \"code\": \"5\"\n }\n ]\n },\n \"dischargeDisposition\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n \"code\": \"oth\"\n }\n ]\n }\n },\n \"location\": [\n {\n \"location\": {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n }\n ]\n }\n }\n ]\n }\n]" }, { "name": "must_support_pa_inquire_request_payload", @@ -63,7 +63,7 @@ "optional": true, "title": "Additional PAS Inquiry Request Payloads", "type": "textarea", - "value": "[\n{\n \"resourceType\": \"Bundle\",\n \"id\": \"PASBundleInquiryExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/PASClaimInquiryExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"PASClaimInquiryExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: See above (Patient/SubscriberExample)

created: 2005-05-02 11:01:00+0500

insurer: See above (Organization/InsurerExample)

provider: See above (Organization/UMOExample)

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1See above (PractitionerRole/ReferralPractitionerRoleExample)

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueSee above (Coverage/InsuranceExample)

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"billablePeriod\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n },\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"HS\",\n \"display\": \"Health Services Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate\",\n \"valueDate\": \"2022-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"quantity\": {\n \"value\": 1\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"G0154\"\n }\n ]\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"HS\",\n \"display\": \"Health Services Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n }\n ],\n \"sequence\": 2,\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"B4184\"\n }\n ]\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: See above (Patient/SubscriberExample)

payor: See above (Organization/InsurerExample)

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: See above (Practitioner/ReferralPractitionerExample)

location: See above (Location/ReferralLocationExample)

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n }\n ]\n}\n]" + "value": "[\n{\n \"resourceType\": \"Bundle\",\n \"id\": \"PASBundleInquiryExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n ]\n },\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n \"value\": \"A12345\"\n },\n \"type\": \"collection\",\n \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n \"entry\": [\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/PASClaimInquiryExample\",\n \"resource\": {\n \"resourceType\": \"Claim\",\n \"id\": \"PASClaimInquiryExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Claim

Resource Claim "ReferralAuthorizationExample"

Profile: PAS Claim

LevelOfServiceCode: Urgent (1338#U)

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample

created: 2005-05-02 11:01:00+0500

insurer: Organization/InsurerExample

provider: Organization/UMOExample

priority: Normal (Process Priority Codes#normal)

CareTeams

-ExtensionSequenceProvider
*1PractitionerRole/ReferralPractitionerRoleExample

Diagnoses

-ExtensionSequenceDiagnosis[x]
*1Chronic pain syndrome (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G89.4)

Insurances

-SequenceFocalCoverage
*1trueCoverage/InsuranceExample

Items

-ExtensionSequenceCareTeamSequenceDiagnosisSequenceCategoryProductOrServiceLocation[x]
*, , , , , , , , , 111Consultation (1365#3)Consultation (1365#3)11 (CMS Place of Service Codes (POS)#11)
\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1338\",\n \"code\": \"U\",\n \"display\": \"Urgent\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n }\n ],\n \"identifier\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.usps.com/\",\n \"code\": \"MA\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n \"valueString\": \"223412\"\n }\n ],\n \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n \"value\": \"111099\",\n \"assigner\": {\n \"identifier\": {\n \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n \"value\": \"9012345678\"\n }\n }\n }\n ],\n \"status\": \"active\",\n \"billablePeriod\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n },\n \"type\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n \"code\": \"professional\"\n }\n ]\n },\n \"use\": \"preauthorization\",\n \"patient\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"created\": \"2005-05-02T11:01:00+05:00\",\n \"insurer\": {\n \"reference\": \"Organization/InsurerExample\"\n },\n \"provider\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"code\": \"normal\"\n }\n ]\n },\n \"careTeam\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n \"valueBoolean\": true\n }\n ],\n \"sequence\": 1,\n \"provider\": {\n \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n },\n \"qualification\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n \"code\": \"604210\"\n }\n ]\n },\n \"role\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"code\": \"primary\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n \"valueDate\": \"2021-05-10\"\n }\n ],\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"code\": \"G89.4\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"patientreasonforvisit\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"sequence\": 1,\n \"focal\": true,\n \"coverage\": {\n \"reference\": \"Coverage/InsuranceExample\"\n }\n }\n ],\n \"item\": [\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n \"valueIdentifier\": {\n \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n \"value\": \"1122334\"\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n \"valueString\": \"1122445\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n \"valueString\": \"9988311\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"HS\",\n \"display\": \"Health Services Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate\",\n \"valueDate\": \"2022-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate\",\n \"valueDate\": \"2021-09-10\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/306\",\n \"code\": \"A1\",\n \"display\": \"Certified in total\"\n }\n ]\n }\n }\n ],\n \"sequence\": 1,\n \"careTeamSequence\": [\n 1\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"informationSequence\": [\n 1\n ],\n \"revenue\": {\n \"coding\": [\n {\n \"system\": \"https://www.nubc.org/revenue-code\",\n \"code\": \"0105\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"E0110\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2016-08-09\",\n \"quantity\": {\n \"value\": 1\n },\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n \"code\": \"11\"\n }\n ]\n },\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"G0154\"\n }\n ]\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1525\",\n \"code\": \"HS\",\n \"display\": \"Health Services Review\"\n }\n ]\n }\n },\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1322\",\n \"code\": \"I\",\n \"display\": \"Initial\"\n }\n ]\n }\n }\n ],\n \"sequence\": 2,\n \"productOrService\": {\n \"coding\": [\n {\n \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"code\": \"B4184\"\n }\n ]\n },\n \"category\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/1365\",\n \"code\": \"3\",\n \"display\": \"Consultation\"\n }\n ]\n }\n }\n ],\n \"supportingInfo\": [\n {\n \"category\": {\n \"coding\": [\n {\n \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n \"code\": \"freeFormMessage\",\n \"display\": \"Free Form Message\"\n }\n ]\n },\n \"sequence\": 2,\n \"valueString\": \"1\"\n }\n ],\n \"accident\": {\n \"date\": \"2016-03-09\"\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"UMOExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "UMOExample"

Profile: PAS Requestor Organization

identifier: id: #8189991234

active: true

type: X3 (98#X3)

name: DR. JOE SMITH CORPORATION

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"8189991234\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"8189948234\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"X3\"\n }\n ]\n }\n ],\n \"name\": \"DR. JOE SMITH CORPORATION\",\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"contact\": [\n {\n \"telecom\": [\n {\n \"system\": \"other\",\n \"value\": \"http://hl7.org/fhir\"\n }\n ],\n \"name\": {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n \"resource\": {\n \"resourceType\": \"Organization\",\n \"id\": \"InsurerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Organization

Resource Organization "InsurerExample"

Profile: PAS Insurer Organization

identifier: id: #789312

active: true

type: PR (98#PR)

name: MARYLAND CAPITAL INSURANCE COMPANY

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"789312\"\n },\n {\n \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n \"value\": \"7239994834\"\n }\n ],\n \"active\": true,\n \"type\": [\n {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/98\",\n \"code\": \"PR\"\n }\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"3029993456\"\n }\n ],\n \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n \"resource\": {\n \"resourceType\": \"Coverage\",\n \"id\": \"InsuranceExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Coverage

Resource Coverage "InsuranceExample"

Profile: PAS Coverage

status: active

beneficiary: Patient/SubscriberExample

payor: Organization/InsurerExample

\"\n },\n \"status\": \"active\",\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"1234567cov\"\n }\n ],\n \"beneficiary\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"payor\": [\n {\n \"reference\": \"Organization/InsurerExample\"\n }\n ],\n \"subscriber\": {\n \"reference\": \"Patient/SubscriberExample\"\n },\n \"subscriberId\": \"12345678901\",\n \"relationship\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n \"code\": \"self\"\n }\n ]\n }\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n \"resource\": {\n \"resourceType\": \"Patient\",\n \"id\": \"SubscriberExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n ]\n },\n \"text\": {\n \"status\": \"extensions\",\n \"div\": \"

Generated Narrative: Patient

Resource Patient "SubscriberExample"

Profile: PAS Subscriber Patient

MilitaryStatus: RU (584#RU)

identifier: id: 12345678901

name: JOE SMITH

gender: male

\"\n },\n \"extension\": [\n {\n \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n \"valueCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"https://codesystem.x12.org/005010/584\",\n \"code\": \"RU\"\n }\n ]\n }\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2106-3\",\n \"display\": \"White\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Caucasian\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n },\n {\n \"extension\": [\n {\n \"url\": \"ombCategory\",\n \"valueCoding\": {\n \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n \"code\": \"2135-2\",\n \"display\": \"Hispanic or Latino\"\n }\n },\n {\n \"url\": \"text\",\n \"valueString\": \"Filipino\"\n }\n ],\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n },\n {\n \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n \"valueCode\": \"M\"\n }\n ],\n \"identifier\": [\n {\n \"system\": \"http://davinci-pas.org/MIN\",\n \"value\": \"12345678901\"\n }\n ],\n \"name\": [\n {\n \"family\": \"SMITH\",\n \"given\": [\n \"JOE\"\n ],\n \"prefix\": [\n \"Mr\"\n ],\n \"suffix\": [\n \"PharmD\"\n ]\n }\n ],\n \"gender\": \"male\",\n \"birthDate\": \"1987-02-20\",\n \"multipleBirthInteger\": 1,\n \"communication\": [\n {\n \"language\": {\n \"coding\": [\n {\n \"system\": \"urn:ietf:bcp:47\",\n \"code\": \"nl-NL\",\n \"display\": \"Dutch (Netherlands)\"\n }\n ]\n },\n \"preferred\": true\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"555-555-5555\",\n \"use\": \"home\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"49 Meadow St\"\n ],\n \"city\": \"Mounds\",\n \"state\": \"OK\",\n \"district\": \"Meadow\",\n \"postalCode\": \"74047\",\n \"country\": \"US\",\n \"period\": {\n \"start\": \"2016-12-06\",\n \"end\": \"2020-07-22\"\n }\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n \"resource\": {\n \"resourceType\": \"PractitionerRole\",\n \"id\": \"ReferralPractitionerRoleExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: PractitionerRole

Resource PractitionerRole "ReferralPractitionerRoleExample"

Profile: PAS PractitionerRole

practitioner: Practitioner/ReferralPractitionerExample

location: Location/ReferralLocationExample

\"\n },\n \"practitioner\": {\n \"reference\": \"Practitioner/ReferralPractitionerExample\"\n },\n \"organization\": {\n \"reference\": \"Organization/UMOExample\"\n },\n \"location\": [\n {\n \"reference\": \"Location/ReferralLocationExample\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n \"resource\": {\n \"resourceType\": \"Practitioner\",\n \"id\": \"ReferralPractitionerExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Practitioner

Resource Practitioner "ReferralPractitionerExample"

Profile: PAS Practitioner

identifier: id: #987654321

name: SUSAN WATSON

telecom: ph: 4029993456

\"\n },\n \"identifier\": [\n {\n \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n \"value\": \"987654321\"\n }\n ],\n \"name\": [\n {\n \"family\": \"WATSON\",\n \"given\": [\n \"SUSAN\"\n ]\n }\n ],\n \"telecom\": [\n {\n \"system\": \"phone\",\n \"value\": \"4029993456\"\n }\n ],\n \"address\": [\n {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n ]\n }\n },\n {\n \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n \"resource\": {\n \"resourceType\": \"Location\",\n \"id\": \"ReferralLocationExample\",\n \"meta\": {\n \"profile\": [\n \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n ]\n },\n \"text\": {\n \"status\": \"generated\",\n \"div\": \"

Generated Narrative: Location

Resource Location "ReferralLocationExample"

Profile: PAS Location Profile

name: REFERRAL CLINIC

address: 111 1ST STREET SAN DIEGO CA 92101 US

\"\n },\n \"name\": \"REFERRAL CLINIC\",\n \"address\": {\n \"line\": [\n \"111 1ST STREET\"\n ],\n \"city\": \"SAN DIEGO\",\n \"state\": \"CA\",\n \"postalCode\": \"92101\",\n \"country\": \"US\"\n }\n }\n }\n ]\n}\n]" } ] } diff --git a/lib/davinci_pas_test_kit/validator_suppressions.rb b/lib/davinci_pas_test_kit/validator_suppressions.rb index 290b92b..7e3e849 100644 --- a/lib/davinci_pas_test_kit/validator_suppressions.rb +++ b/lib/davinci_pas_test_kit/validator_suppressions.rb @@ -134,7 +134,7 @@ module DaVinciPASTestKit /Details for (.+) matching against profile/, ': All OK', # This was ignored natively in the Inferno validator but needs to be ignored by the test kit with the HL7 validator - "URL value '.*' does not resolve", + /URL value '.*' does not resolve/, # addition validator clean-up based on Bundle sub-validations where Inferno error supression doesn't # work. The test kit validates these instances individually as well, so they are still checked, # but in a way that Inferno can supress errors