davinci_pas_test_kit 0.11.1 → 0.12.1
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- checksums.yaml +4 -4
- data/config/presets/pas_client_example.json +30 -0
- data/config/presets/pas_ri.json +69 -0
- data/lib/davinci_pas_test_kit/client_suite.rb +28 -2
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_approval_submit_test.rb +29 -1
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_denial_submit_test.rb +27 -4
- data/lib/davinci_pas_test_kit/{generated/v2.0.1/client_tests/client_pended_pas_inquiry_request_bundle_validation_test.rb → custom_groups/v2.0.1/client_tests/pas_client_inquire_request_bundle_validation_test.rb} +22 -20
- data/lib/davinci_pas_test_kit/{generated/v2.0.1/client_tests/client_denial_pas_response_bundle_validation_test.rb → custom_groups/v2.0.1/client_tests/pas_client_inquire_response_bundle_validation_test.rb} +34 -21
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_pended_submit_test.rb +124 -5
- data/lib/davinci_pas_test_kit/{generated/v2.0.1/client_tests/client_pas_request_bundle_validation_test.rb → custom_groups/v2.0.1/client_tests/pas_client_request_bundle_validation_test.rb} +22 -20
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/{pas_client_approval_submit_response_attest.rb → pas_client_response_attest.rb} +26 -9
- data/lib/davinci_pas_test_kit/{generated/v2.0.1/client_tests/client_pended_pas_response_bundle_validation_test.rb → custom_groups/v2.0.1/client_tests/pas_client_response_bundle_validation_test.rb} +44 -20
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_subscription_create_test.rb +49 -0
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_subscription_pas_conformance_test.rb +48 -0
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_approval_group.rb +21 -9
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_authentication_group.rb +2 -2
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_denial_group.rb +21 -22
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/pas_client_pended_group.rb +97 -31
- data/lib/davinci_pas_test_kit/docs/PAS Requirements Interpretation.xlsx +0 -0
- data/lib/davinci_pas_test_kit/docs/client_suite_description_v201.md +213 -72
- data/lib/davinci_pas_test_kit/endpoints/claim_endpoint.rb +85 -134
- data/lib/davinci_pas_test_kit/endpoints/subscription_create_endpoint.rb +96 -0
- data/lib/davinci_pas_test_kit/endpoints/subscription_status_endpoint.rb +90 -0
- data/lib/davinci_pas_test_kit/fhir_resource_navigation.rb +3 -3
- data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_inquiry_request_bundle/metadata.yml +0 -2
- data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_inquiry_request_bundle/server_pas_inquiry_request_bundle_validation_test.rb +3 -1
- data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_inquiry_response_bundle/server_pas_inquiry_response_bundle_validation_test.rb +2 -1
- data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_request_bundle/metadata.yml +0 -2
- data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_request_bundle/server_pas_request_bundle_validation_test.rb +3 -1
- data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_response_bundle/metadata.yml +0 -4
- data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_response_bundle/server_pas_response_bundle_validation_test.rb +2 -1
- data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_server_denial_use_case_group.rb +1 -1
- data/lib/davinci_pas_test_kit/generated/v2.0.1/pas_server_pended_use_case_group.rb +6 -5
- data/lib/davinci_pas_test_kit/generated/v2.0.1/server_suite.rb +5 -2
- data/lib/davinci_pas_test_kit/generator/group_generator.rb +9 -8
- data/lib/davinci_pas_test_kit/generator/group_metadata_extractor.rb +7 -3
- data/lib/davinci_pas_test_kit/generator/templates/group.rb.erb +129 -0
- data/lib/davinci_pas_test_kit/generator/templates/must_support.rb.erb +73 -0
- data/lib/davinci_pas_test_kit/generator/templates/operation.rb.erb +62 -0
- data/lib/davinci_pas_test_kit/generator/templates/resource_list.rb.erb +13 -0
- data/lib/davinci_pas_test_kit/generator/templates/suite.rb.erb +92 -0
- data/lib/davinci_pas_test_kit/generator/templates/validation.rb.erb +98 -0
- data/lib/davinci_pas_test_kit/generator/validation_test_generator.rb +19 -56
- data/lib/davinci_pas_test_kit/generator/value_extractor.rb +4 -1
- data/lib/davinci_pas_test_kit/generator.rb +1 -1
- data/lib/davinci_pas_test_kit/igs/davinci_pas_2.0.1.tgz +0 -0
- data/lib/davinci_pas_test_kit/jobs/send_pas_subscription_notification.rb +136 -0
- data/lib/davinci_pas_test_kit/jobs/send_subscription_handshake.rb +139 -0
- data/lib/davinci_pas_test_kit/metadata.rb +87 -0
- data/lib/davinci_pas_test_kit/pas_bundle_validation.rb +8 -7
- data/lib/davinci_pas_test_kit/response_generator.rb +397 -0
- data/lib/davinci_pas_test_kit/tags.rb +9 -0
- data/lib/davinci_pas_test_kit/urls.rb +8 -0
- data/lib/davinci_pas_test_kit/user_input_response.rb +11 -8
- data/lib/davinci_pas_test_kit/validation_test.rb +0 -1
- data/lib/davinci_pas_test_kit/version.rb +2 -1
- data/lib/davinci_pas_test_kit.rb +1 -0
- metadata +44 -15
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_denial_submit_response_attest.rb +0 -38
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_pended_inquire_response_attest.rb +0 -39
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_pended_inquire_test.rb +0 -35
- data/lib/davinci_pas_test_kit/custom_groups/v2.0.1/client_tests/pas_client_pended_submit_response_attest.rb +0 -39
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{
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"title": "Prior Authorization Support Reference Implementation",
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"id": "pas-ri",
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"test_suite_id": "davinci_pas_server_suite_v201",
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"inputs": [
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{
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"name": "server_endpoint",
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"description": "Insert the FHIR server endpoint URL for PAS",
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"title": "FHIR Server Endpoint URL",
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"type": "text",
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"value": "https://prior-auth.davinci.hl7.org/fhir"
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},
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{
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"name": "smart_credentials",
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"type": "auth_info",
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"title": "OAuth Credentials",
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"optional": true,
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"value": "{\"access_token\":\"Y3YWq2l08kvFqy50fQJY\"}"
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},
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{
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"name": "approval_pa_submit_request_payload",
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"description": "Insert Bundle to be sent for PAS Submit Request",
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"optional": true,
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"title": "PAS Submit Request Payload for Approval Response",
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"type": "textarea",
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"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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Claim</b><a name=\\\"ReferralAuthorizationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Claim "ReferralAuthorizationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-claim.html\\\">PAS Claim</a></p></div><p><b>LevelOfServiceCode</b>: Urgent <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1338#U)</span></p><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\\\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: Patient/SubscriberExample</p><p><b>created</b>: 2005-05-02 11:01:00+0500</p><p><b>insurer</b>: Organization/InsurerExample</p><p><b>provider</b>: Organization/UMOExample</p><p><b>priority</b>: Normal <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\\\">Process Priority Codes</a>#normal)</span></p><h3>CareTeams</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>PractitionerRole/ReferralPractitionerRoleExample</td></tr></table><h3>Diagnoses</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>Chronic pain syndrome <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-icd10CM.html\\\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G89.4)</span></td></tr></table><h3>Insurances</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>1</td><td>true</td><td>Coverage/InsuranceExample</td></tr></table><h3>Items</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>DiagnosisSequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Location[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>, , , , , , , , , </td><td>1</td><td>1</td><td>1</td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>11 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-CMSPlaceofServiceCodes.html\\\">CMS Place of Service Codes (POS)</a>#11)</span></td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"UMOExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "UMOExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-requestor.html\\\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>8189991234</p><p><b>active</b>: true</p><p><b>type</b>: X3 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#X3)</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"InsurerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "InsurerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-insurer.html\\\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>789312</p><p><b>active</b>: true</p><p><b>type</b>: PR <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#PR)</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Coverage</b><a name=\\\"InsuranceExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Coverage "InsuranceExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-coverage.html\\\">PAS Coverage</a></p></div><p><b>status</b>: active</p><p><b>beneficiary</b>: Patient/SubscriberExample</p><p><b>payor</b>: Organization/InsurerExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Patient</b><a name=\\\"SubscriberExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Patient "SubscriberExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-subscriber.html\\\">PAS Subscriber Patient</a></p></div><p><b>MilitaryStatus</b>: RU <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (584#RU)</span></p><p><b>identifier</b>: id: 12345678901</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: ServiceRequest</b><a name=\\\"ReferralRequestExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource ServiceRequest "ReferralRequestExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-servicerequest.html\\\">PAS Service Request</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>code</b>: Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></p><p><b>quantity</b>: 1 visit<span style=\\\"background: LightGoldenRodYellow\\\"> (Details: UCUM code 1 = '1')</span></p><p><b>subject</b>: Patient/SubscriberExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: PractitionerRole</b><a name=\\\"ReferralPractitionerRoleExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource PractitionerRole "ReferralPractitionerRoleExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitionerrole.html\\\">PAS PractitionerRole</a></p></div><p><b>practitioner</b>: Practitioner/ReferralPractitionerExample</p><p><b>location</b>: Location/ReferralLocationExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Practitioner</b><a name=\\\"ReferralPractitionerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Practitioner "ReferralPractitionerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitioner.html\\\">PAS Practitioner</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>987654321</p><p><b>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Location</b><a name=\\\"ReferralLocationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Location "ReferralLocationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-location.html\\\">PAS Location Profile</a></p></div><p><b>name</b>: REFERRAL CLINIC</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative</b></p><p><b>id</b>: episode-summary</p><p><b>meta</b>: </p><p><b>identifier</b>: id: urn:oid:2.16.840.1.113883.19.5.99999.1</p><p><b>status</b>: current</p><p><b>type</b>: <span title=\\\"Codes: {http://loinc.org 34133-9}\\\">CCD Document</span></p><p><b>category</b>: <span title=\\\"Codes: {http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category clinical-note}\\\">Clinical Note</span></p><p><b>subject</b>: <a href=\\\"Patient-example.html\\\">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</a></p><p><b>date</b>: 10/03/2016 2:29:46 AM</p><p><b>author</b>: <a href=\\\"Practitioner-practitioner-1.html\\\">Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone </a></p><p><b>description</b>: Pulmonology clinic acute visit</p><h3>Contents</h3><table class=\\\"grid\\\"><tr><td>-</td><td><b>Attachment</b></td><td><b>Format</b></td></tr><tr><td>*</td><td></td><td><span title=\\\"{urn:oid:1.3.6.1.4.1.19376.1.2.3 urn:hl7-org:sdwg:ccda-structuredBody:2.1}\\\">Documents following C-CDA constraints using a structured body</span></td></tr></table><h3>Contexts</h3><table class=\\\"grid\\\"><tr><td>-</td><td><b>Period</b></td></tr><tr><td>*</td><td>23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM</td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: f201</p><p><b>identifier</b>: Encounter_Roel_20130404 (TEMP)</p><p><b>status</b>: finished</p><p><b>class</b>: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')</p><p><b>type</b>: Consultation <span>(Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})</span></p><p><b>priority</b>: Normal <span>(Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})</span></p><p><b>subject</b>: <a>Roel</a></p><h3>Participants</h3><table><tr><td>-</td><td><b>Individual</b></td></tr><tr><td>*</td><td><a>Practitioner/ReferralPractitionerExample</a></td></tr></table><p><b>reasonCode</b>: The patient had fever peaks over the last couple of days. He is worried about these peaks. <span>(Details )</span></p><p><b>serviceProvider</b>: <a>Organization/UMOExample</a></p></div>\"\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 }"
|
|
27
|
+
},
|
|
28
|
+
{
|
|
29
|
+
"name": "denial_pa_submit_request_payload",
|
|
30
|
+
"description": "Insert Bundle to be sent for PAS Submit Request",
|
|
31
|
+
"optional": true,
|
|
32
|
+
"title": "PAS Submit Request Payload for Denial Response",
|
|
33
|
+
"type": "textarea",
|
|
34
|
+
"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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Claim</b><a name=\\\"ReferralAuthorizationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Claim "ReferralAuthorizationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-claim.html\\\">PAS Claim</a></p></div><p><b>LevelOfServiceCode</b>: Urgent <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1338#U)</span></p><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\\\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: Patient/SubscriberExample</p><p><b>created</b>: 2005-05-02 11:01:00+0500</p><p><b>insurer</b>: Organization/InsurerExample</p><p><b>provider</b>: Organization/UMOExample</p><p><b>priority</b>: Normal <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\\\">Process Priority Codes</a>#normal)</span></p><h3>CareTeams</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>PractitionerRole/ReferralPractitionerRoleExample</td></tr></table><h3>Diagnoses</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>Chronic pain syndrome <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-icd10CM.html\\\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G89.4)</span></td></tr></table><h3>Insurances</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>1</td><td>true</td><td>Coverage/InsuranceExample</td></tr></table><h3>Items</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>DiagnosisSequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Location[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>, , , , , , , , , </td><td>1</td><td>1</td><td>1</td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>11 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-CMSPlaceofServiceCodes.html\\\">CMS Place of Service Codes (POS)</a>#11)</span></td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"UMOExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "UMOExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-requestor.html\\\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>8189991234</p><p><b>active</b>: true</p><p><b>type</b>: X3 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#X3)</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"InsurerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "InsurerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-insurer.html\\\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>789312</p><p><b>active</b>: true</p><p><b>type</b>: PR <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#PR)</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Coverage</b><a name=\\\"InsuranceExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Coverage "InsuranceExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-coverage.html\\\">PAS Coverage</a></p></div><p><b>status</b>: active</p><p><b>beneficiary</b>: Patient/SubscriberExample</p><p><b>payor</b>: Organization/InsurerExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Patient</b><a name=\\\"SubscriberExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Patient "SubscriberExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-subscriber.html\\\">PAS Subscriber Patient</a></p></div><p><b>MilitaryStatus</b>: RU <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (584#RU)</span></p><p><b>identifier</b>: id: 12345678901</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: ServiceRequest</b><a name=\\\"ReferralRequestExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource ServiceRequest "ReferralRequestExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-servicerequest.html\\\">PAS Service Request</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>code</b>: Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></p><p><b>quantity</b>: 1 visit<span style=\\\"background: LightGoldenRodYellow\\\"> (Details: UCUM code 1 = '1')</span></p><p><b>subject</b>: Patient/SubscriberExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: PractitionerRole</b><a name=\\\"ReferralPractitionerRoleExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource PractitionerRole "ReferralPractitionerRoleExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitionerrole.html\\\">PAS PractitionerRole</a></p></div><p><b>practitioner</b>: Practitioner/ReferralPractitionerExample</p><p><b>location</b>: Location/ReferralLocationExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Practitioner</b><a name=\\\"ReferralPractitionerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Practitioner "ReferralPractitionerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitioner.html\\\">PAS Practitioner</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>987654321</p><p><b>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Location</b><a name=\\\"ReferralLocationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Location "ReferralLocationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-location.html\\\">PAS Location Profile</a></p></div><p><b>name</b>: REFERRAL CLINIC</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative</b></p><p><b>id</b>: episode-summary</p><p><b>meta</b>: </p><p><b>identifier</b>: id: urn:oid:2.16.840.1.113883.19.5.99999.1</p><p><b>status</b>: current</p><p><b>type</b>: <span title=\\\"Codes: {http://loinc.org 34133-9}\\\">CCD Document</span></p><p><b>category</b>: <span title=\\\"Codes: {http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category clinical-note}\\\">Clinical Note</span></p><p><b>subject</b>: <a href=\\\"Patient-example.html\\\">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</a></p><p><b>date</b>: 10/03/2016 2:29:46 AM</p><p><b>author</b>: <a href=\\\"Practitioner-practitioner-1.html\\\">Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone </a></p><p><b>description</b>: Pulmonology clinic acute visit</p><h3>Contents</h3><table class=\\\"grid\\\"><tr><td>-</td><td><b>Attachment</b></td><td><b>Format</b></td></tr><tr><td>*</td><td></td><td><span title=\\\"{urn:oid:1.3.6.1.4.1.19376.1.2.3 urn:hl7-org:sdwg:ccda-structuredBody:2.1}\\\">Documents following C-CDA constraints using a structured body</span></td></tr></table><h3>Contexts</h3><table class=\\\"grid\\\"><tr><td>-</td><td><b>Period</b></td></tr><tr><td>*</td><td>23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM</td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: f201</p><p><b>identifier</b>: Encounter_Roel_20130404 (TEMP)</p><p><b>status</b>: finished</p><p><b>class</b>: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')</p><p><b>type</b>: Consultation <span>(Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})</span></p><p><b>priority</b>: Normal <span>(Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})</span></p><p><b>subject</b>: <a>Roel</a></p><h3>Participants</h3><table><tr><td>-</td><td><b>Individual</b></td></tr><tr><td>*</td><td><a>Practitioner/ReferralPractitionerExample</a></td></tr></table><p><b>reasonCode</b>: The patient had fever peaks over the last couple of days. He is worried about these peaks. <span>(Details )</span></p><p><b>serviceProvider</b>: <a>Organization/UMOExample</a></p></div>\"\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 }"
|
|
35
|
+
},
|
|
36
|
+
{
|
|
37
|
+
"name": "pended_pa_submit_request_payload",
|
|
38
|
+
"description": "Insert Bundle to be sent for PAS Submit Request",
|
|
39
|
+
"optional": true,
|
|
40
|
+
"title": "PAS Submit Request Payload for Pended Response",
|
|
41
|
+
"type": "textarea",
|
|
42
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+
"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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Claim</b><a name=\\\"ReferralAuthorizationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Claim "ReferralAuthorizationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-claim.html\\\">PAS Claim</a></p></div><p><b>LevelOfServiceCode</b>: Urgent <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1338#U)</span></p><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\\\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: Patient/SubscriberExample</p><p><b>created</b>: 2005-05-02 11:01:00+0500</p><p><b>insurer</b>: Organization/InsurerExample</p><p><b>provider</b>: Organization/UMOExample</p><p><b>priority</b>: Normal <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\\\">Process Priority Codes</a>#normal)</span></p><h3>CareTeams</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>PractitionerRole/ReferralPractitionerRoleExample</td></tr></table><h3>Diagnoses</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>Chronic pain syndrome <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-icd10CM.html\\\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G89.4)</span></td></tr></table><h3>Insurances</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>1</td><td>true</td><td>Coverage/InsuranceExample</td></tr></table><h3>Items</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>DiagnosisSequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Location[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>, , , , , , , , , </td><td>1</td><td>1</td><td>1</td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>11 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-CMSPlaceofServiceCodes.html\\\">CMS Place of Service Codes (POS)</a>#11)</span></td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"UMOExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "UMOExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-requestor.html\\\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>8189991234</p><p><b>active</b>: true</p><p><b>type</b>: X3 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#X3)</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"InsurerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "InsurerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-insurer.html\\\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>789312</p><p><b>active</b>: true</p><p><b>type</b>: PR <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#PR)</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Coverage</b><a name=\\\"InsuranceExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Coverage "InsuranceExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-coverage.html\\\">PAS Coverage</a></p></div><p><b>status</b>: active</p><p><b>beneficiary</b>: Patient/SubscriberExample</p><p><b>payor</b>: Organization/InsurerExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Patient</b><a name=\\\"SubscriberExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Patient "SubscriberExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-subscriber.html\\\">PAS Subscriber Patient</a></p></div><p><b>MilitaryStatus</b>: RU <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (584#RU)</span></p><p><b>identifier</b>: id: 12345678901</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: DeviceRequest</b><a name=\\\"DeviceRequestExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource DeviceRequest "DeviceRequestExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-devicerequest.html\\\">PAS Device Request</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>code</b>: E1223 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (HCPCSReleaseCodeSets#E1223)</span></p><p><b>subject</b>: <a href=\\\"Patient-SubscriberExample.html\\\">Patient/SubscriberExample</a> " SMITH"</p><p><b>authoredOn</b>: 2005-06-02</p><p><b>requester</b>: <a href=\\\"Practitioner-ReferralPractitionerExample.html\\\">Practitioner/ReferralPractitionerExample</a> " WATSON"</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: PractitionerRole</b><a name=\\\"ReferralPractitionerRoleExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource PractitionerRole "ReferralPractitionerRoleExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitionerrole.html\\\">PAS PractitionerRole</a></p></div><p><b>practitioner</b>: Practitioner/ReferralPractitionerExample</p><p><b>location</b>: Location/ReferralLocationExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Practitioner</b><a name=\\\"ReferralPractitionerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Practitioner "ReferralPractitionerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitioner.html\\\">PAS Practitioner</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>987654321</p><p><b>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Location</b><a name=\\\"ReferralLocationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Location "ReferralLocationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-location.html\\\">PAS Location Profile</a></p></div><p><b>name</b>: REFERRAL CLINIC</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative</b></p><p><b>id</b>: episode-summary</p><p><b>meta</b>: </p><p><b>identifier</b>: id: urn:oid:2.16.840.1.113883.19.5.99999.1</p><p><b>status</b>: current</p><p><b>type</b>: <span title=\\\"Codes: {http://loinc.org 34133-9}\\\">CCD Document</span></p><p><b>category</b>: <span title=\\\"Codes: {http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category clinical-note}\\\">Clinical Note</span></p><p><b>subject</b>: <a href=\\\"Patient-example.html\\\">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</a></p><p><b>date</b>: 10/03/2016 2:29:46 AM</p><p><b>author</b>: <a href=\\\"Practitioner-practitioner-1.html\\\">Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone </a></p><p><b>description</b>: Pulmonology clinic acute visit</p><h3>Contents</h3><table class=\\\"grid\\\"><tr><td>-</td><td><b>Attachment</b></td><td><b>Format</b></td></tr><tr><td>*</td><td></td><td><span title=\\\"{urn:oid:1.3.6.1.4.1.19376.1.2.3 urn:hl7-org:sdwg:ccda-structuredBody:2.1}\\\">Documents following C-CDA constraints using a structured body</span></td></tr></table><h3>Contexts</h3><table class=\\\"grid\\\"><tr><td>-</td><td><b>Period</b></td></tr><tr><td>*</td><td>23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM</td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: f201</p><p><b>identifier</b>: Encounter_Roel_20130404 (TEMP)</p><p><b>status</b>: finished</p><p><b>class</b>: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')</p><p><b>type</b>: Consultation <span>(Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})</span></p><p><b>priority</b>: Normal <span>(Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})</span></p><p><b>subject</b>: <a>Roel</a></p><h3>Participants</h3><table><tr><td>-</td><td><b>Individual</b></td></tr><tr><td>*</td><td><a>Practitioner/ReferralPractitionerExample</a></td></tr></table><p><b>reasonCode</b>: The patient had fever peaks over the last couple of days. He is worried about these peaks. <span>(Details )</span></p><p><b>serviceProvider</b>: <a>Organization/UMOExample</a></p></div>\"\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 }"
|
|
43
|
+
},
|
|
44
|
+
{
|
|
45
|
+
"name": "pa_inquire_request_payload",
|
|
46
|
+
"description": "Insert Bundle to be sent for PAS Inquiry Request",
|
|
47
|
+
"optional": true,
|
|
48
|
+
"title": "PAS Inquiry Request Payload",
|
|
49
|
+
"type": "textarea",
|
|
50
|
+
"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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Claim</b><a name=\\\"ReferralAuthorizationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Claim "ReferralAuthorizationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-claim.html\\\">PAS Claim</a></p></div><p><b>LevelOfServiceCode</b>: Urgent <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1338#U)</span></p><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\\\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: Patient/SubscriberExample</p><p><b>created</b>: 2005-05-02 11:01:00+0500</p><p><b>insurer</b>: Organization/InsurerExample</p><p><b>provider</b>: Organization/UMOExample</p><p><b>priority</b>: Normal <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\\\">Process Priority Codes</a>#normal)</span></p><h3>CareTeams</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>PractitionerRole/ReferralPractitionerRoleExample</td></tr></table><h3>Diagnoses</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>Chronic pain syndrome <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-icd10CM.html\\\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G89.4)</span></td></tr></table><h3>Insurances</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>1</td><td>true</td><td>Coverage/InsuranceExample</td></tr></table><h3>Items</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>DiagnosisSequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Location[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>, , , , , , , , , </td><td>1</td><td>1</td><td>1</td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>11 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-CMSPlaceofServiceCodes.html\\\">CMS Place of Service Codes (POS)</a>#11)</span></td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"UMOExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "UMOExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-requestor.html\\\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>8189991234</p><p><b>active</b>: true</p><p><b>type</b>: X3 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#X3)</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"InsurerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "InsurerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-insurer.html\\\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>789312</p><p><b>active</b>: true</p><p><b>type</b>: PR <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#PR)</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Coverage</b><a name=\\\"InsuranceExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Coverage "InsuranceExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-coverage.html\\\">PAS Coverage</a></p></div><p><b>status</b>: active</p><p><b>beneficiary</b>: Patient/SubscriberExample</p><p><b>payor</b>: Organization/InsurerExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Patient</b><a name=\\\"SubscriberExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Patient "SubscriberExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-subscriber.html\\\">PAS Subscriber Patient</a></p></div><p><b>MilitaryStatus</b>: RU <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (584#RU)</span></p><p><b>identifier</b>: id: 12345678901</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: PractitionerRole</b><a name=\\\"ReferralPractitionerRoleExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource PractitionerRole "ReferralPractitionerRoleExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitionerrole.html\\\">PAS PractitionerRole</a></p></div><p><b>practitioner</b>: Practitioner/ReferralPractitionerExample</p><p><b>location</b>: Location/ReferralLocationExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Practitioner</b><a name=\\\"ReferralPractitionerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Practitioner "ReferralPractitionerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitioner.html\\\">PAS Practitioner</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>987654321</p><p><b>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Location</b><a name=\\\"ReferralLocationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Location "ReferralLocationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-location.html\\\">PAS Location Profile</a></p></div><p><b>name</b>: REFERRAL CLINIC</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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}"
|
|
51
|
+
},
|
|
52
|
+
{
|
|
53
|
+
"name": "must_support_pa_submit_request_payload",
|
|
54
|
+
"description": "Insert an additional request bundle or a list of bundles (e.g. [bundle_1, bundle_2])",
|
|
55
|
+
"optional": true,
|
|
56
|
+
"title": "Additional PAS Submit Request Payloads",
|
|
57
|
+
"type": "textarea",
|
|
58
|
+
"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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Claim</b><a name=\\\"ReferralAuthorizationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Claim "ReferralAuthorizationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-claim.html\\\">PAS Claim</a></p></div><p><b>LevelOfServiceCode</b>: Urgent <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1338#U)</span></p><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\\\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: Patient/SubscriberExample</p><p><b>created</b>: 2005-05-02 11:01:00+0500</p><p><b>insurer</b>: Organization/InsurerExample</p><p><b>provider</b>: Organization/UMOExample</p><p><b>priority</b>: Normal <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\\\">Process Priority Codes</a>#normal)</span></p><h3>CareTeams</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>PractitionerRole/ReferralPractitionerRoleExample</td></tr></table><h3>Diagnoses</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>Chronic pain syndrome <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-icd10CM.html\\\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G89.4)</span></td></tr></table><h3>Insurances</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>1</td><td>true</td><td>Coverage/InsuranceExample</td></tr></table><h3>Items</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>DiagnosisSequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Location[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>, , , , , , , , , </td><td>1</td><td>1</td><td>1</td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>11 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-CMSPlaceofServiceCodes.html\\\">CMS Place of Service Codes (POS)</a>#11)</span></td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"UMOExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "UMOExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-requestor.html\\\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>8189991234</p><p><b>active</b>: true</p><p><b>type</b>: X3 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#X3)</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"InsurerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "InsurerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-insurer.html\\\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>789312</p><p><b>active</b>: true</p><p><b>type</b>: PR <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#PR)</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Coverage</b><a name=\\\"InsuranceExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Coverage "InsuranceExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-coverage.html\\\">PAS Coverage</a></p></div><p><b>status</b>: active</p><p><b>beneficiary</b>: Patient/SubscriberExample</p><p><b>payor</b>: Organization/InsurerExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Patient</b><a name=\\\"SubscriberExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Patient "SubscriberExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-subscriber.html\\\">PAS Subscriber Patient</a></p></div><p><b>MilitaryStatus</b>: RU <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (584#RU)</span></p><p><b>identifier</b>: id: 12345678901</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: DeviceRequest</b><a name=\\\"DeviceRequestExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource DeviceRequest "DeviceRequestExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-devicerequest.html\\\">PAS Device Request</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>code</b>: E1223 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (HCPCSReleaseCodeSets#E1223)</span></p><p><b>subject</b>: <a href=\\\"Patient-SubscriberExample.html\\\">Patient/SubscriberExample</a> " SMITH"</p><p><b>authoredOn</b>: 2005-06-02</p><p><b>requester</b>: <a href=\\\"Practitioner-ReferralPractitionerExample.html\\\">Practitioner/ReferralPractitionerExample</a> " WATSON"</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: PractitionerRole</b><a name=\\\"ReferralPractitionerRoleExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource PractitionerRole "ReferralPractitionerRoleExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitionerrole.html\\\">PAS PractitionerRole</a></p></div><p><b>practitioner</b>: Practitioner/ReferralPractitionerExample</p><p><b>location</b>: Location/ReferralLocationExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Practitioner</b><a name=\\\"ReferralPractitionerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Practitioner "ReferralPractitionerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitioner.html\\\">PAS Practitioner</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>987654321</p><p><b>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Location</b><a name=\\\"ReferralLocationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Location "ReferralLocationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-location.html\\\">PAS Location Profile</a></p></div><p><b>name</b>: REFERRAL CLINIC</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative</b></p><p><b>id</b>: episode-summary</p><p><b>meta</b>: </p><p><b>identifier</b>: id: urn:oid:2.16.840.1.113883.19.5.99999.1</p><p><b>status</b>: current</p><p><b>type</b>: <span title=\\\"Codes: {http://loinc.org 34133-9}\\\">CCD Document</span></p><p><b>category</b>: <span title=\\\"Codes: {http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category clinical-note}\\\">Clinical Note</span></p><p><b>subject</b>: <a href=\\\"Patient-example.html\\\">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</a></p><p><b>date</b>: 10/03/2016 2:29:46 AM</p><p><b>author</b>: <a href=\\\"Practitioner-practitioner-1.html\\\">Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone </a></p><p><b>description</b>: Pulmonology clinic acute visit</p><h3>Contents</h3><table class=\\\"grid\\\"><tr><td>-</td><td><b>Attachment</b></td><td><b>Format</b></td></tr><tr><td>*</td><td></td><td><span title=\\\"{urn:oid:1.3.6.1.4.1.19376.1.2.3 urn:hl7-org:sdwg:ccda-structuredBody:2.1}\\\">Documents following C-CDA constraints using a structured body</span></td></tr></table><h3>Contexts</h3><table class=\\\"grid\\\"><tr><td>-</td><td><b>Period</b></td></tr><tr><td>*</td><td>23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM</td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: f201</p><p><b>identifier</b>: Encounter_Roel_20130404 (TEMP)</p><p><b>status</b>: finished</p><p><b>class</b>: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')</p><p><b>type</b>: Consultation <span>(Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})</span></p><p><b>priority</b>: Normal <span>(Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})</span></p><p><b>subject</b>: <a>Roel</a></p><h3>Participants</h3><table><tr><td>-</td><td><b>Individual</b></td></tr><tr><td>*</td><td><a>Practitioner/ReferralPractitionerExample</a></td></tr></table><p><b>reasonCode</b>: The patient had fever peaks over the last couple of days. He is worried about these peaks. <span>(Details )</span></p><p><b>serviceProvider</b>: <a>Organization/UMOExample</a></p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Claim</b><a name=\\\"ReferralAuthorizationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Claim "ReferralAuthorizationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-claim.html\\\">PAS Claim</a></p></div><p><b>LevelOfServiceCode</b>: Urgent <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1338#U)</span></p><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\\\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: Patient/SubscriberExample</p><p><b>created</b>: 2005-05-02 11:01:00+0500</p><p><b>insurer</b>: Organization/InsurerExample</p><p><b>provider</b>: Organization/UMOExample</p><p><b>priority</b>: Normal <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\\\">Process Priority Codes</a>#normal)</span></p><h3>CareTeams</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>PractitionerRole/ReferralPractitionerRoleExample</td></tr></table><h3>Diagnoses</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>Chronic pain syndrome <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-icd10CM.html\\\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G89.4)</span></td></tr></table><h3>Insurances</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>1</td><td>true</td><td>Coverage/InsuranceExample</td></tr></table><h3>Items</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>DiagnosisSequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Location[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>, , , , , , , , , </td><td>1</td><td>1</td><td>1</td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>11 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-CMSPlaceofServiceCodes.html\\\">CMS Place of Service Codes (POS)</a>#11)</span></td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"UMOExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "UMOExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-requestor.html\\\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>8189991234</p><p><b>active</b>: true</p><p><b>type</b>: X3 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#X3)</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"InsurerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "InsurerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-insurer.html\\\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>789312</p><p><b>active</b>: true</p><p><b>type</b>: PR <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#PR)</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Coverage</b><a name=\\\"InsuranceExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Coverage "InsuranceExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-coverage.html\\\">PAS Coverage</a></p></div><p><b>status</b>: active</p><p><b>beneficiary</b>: Patient/SubscriberExample</p><p><b>payor</b>: Organization/InsurerExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Patient</b><a name=\\\"SubscriberExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Patient "SubscriberExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-subscriber.html\\\">PAS Subscriber Patient</a></p></div><p><b>MilitaryStatus</b>: RU <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (584#RU)</span></p><p><b>identifier</b>: id: 12345678901</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: ServiceRequest</b><a name=\\\"ReferralRequestExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource ServiceRequest "ReferralRequestExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-servicerequest.html\\\">PAS Service Request</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>code</b>: Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></p><p><b>quantity</b>: 1 visit<span style=\\\"background: LightGoldenRodYellow\\\"> (Details: UCUM code 1 = '1')</span></p><p><b>subject</b>: Patient/SubscriberExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: PractitionerRole</b><a name=\\\"ReferralPractitionerRoleExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource PractitionerRole "ReferralPractitionerRoleExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitionerrole.html\\\">PAS PractitionerRole</a></p></div><p><b>practitioner</b>: Practitioner/ReferralPractitionerExample</p><p><b>location</b>: Location/ReferralLocationExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Practitioner</b><a name=\\\"ReferralPractitionerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Practitioner "ReferralPractitionerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitioner.html\\\">PAS Practitioner</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>987654321</p><p><b>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Location</b><a name=\\\"ReferralLocationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Location "ReferralLocationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-location.html\\\">PAS Location Profile</a></p></div><p><b>name</b>: REFERRAL CLINIC</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative</b></p><p><b>id</b>: episode-summary</p><p><b>meta</b>: </p><p><b>identifier</b>: id: urn:oid:2.16.840.1.113883.19.5.99999.1</p><p><b>status</b>: current</p><p><b>type</b>: <span title=\\\"Codes: {http://loinc.org 34133-9}\\\">CCD Document</span></p><p><b>category</b>: <span title=\\\"Codes: {http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category clinical-note}\\\">Clinical Note</span></p><p><b>subject</b>: <a href=\\\"Patient-example.html\\\">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</a></p><p><b>date</b>: 10/03/2016 2:29:46 AM</p><p><b>author</b>: <a href=\\\"Practitioner-practitioner-1.html\\\">Ronald Bone, MD. Generated Summary: id: practitioner-1; id: 9941339108, id: 25456; Ronald Bone </a></p><p><b>description</b>: Pulmonology clinic acute visit</p><h3>Contents</h3><table class=\\\"grid\\\"><tr><td>-</td><td><b>Attachment</b></td><td><b>Format</b></td></tr><tr><td>*</td><td></td><td><span title=\\\"{urn:oid:1.3.6.1.4.1.19376.1.2.3 urn:hl7-org:sdwg:ccda-structuredBody:2.1}\\\">Documents following C-CDA constraints using a structured body</span></td></tr></table><h3>Contexts</h3><table class=\\\"grid\\\"><tr><td>-</td><td><b>Period</b></td></tr><tr><td>*</td><td>23/12/2004 8:00:00 AM --> 23/12/2004 8:01:00 AM</td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: f201</p><p><b>identifier</b>: Encounter_Roel_20130404 (TEMP)</p><p><b>status</b>: finished</p><p><b>class</b>: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')</p><p><b>type</b>: Consultation <span>(Details : {SNOMED CT code '11429006' = 'Consultation', given as 'Consultation'})</span></p><p><b>priority</b>: Normal <span>(Details : {SNOMED CT code '17621005' = 'Normal', given as 'Normal'})</span></p><p><b>subject</b>: <a>Roel</a></p><h3>Participants</h3><table><tr><td>-</td><td><b>Individual</b></td></tr><tr><td>*</td><td><a>Practitioner/ReferralPractitionerExample</a></td></tr></table><p><b>reasonCode</b>: The patient had fever peaks over the last couple of days. He is worried about these peaks. <span>(Details )</span></p><p><b>serviceProvider</b>: <a>Organization/UMOExample</a></p></div>\"\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]"
|
|
59
|
+
},
|
|
60
|
+
{
|
|
61
|
+
"name": "must_support_pa_inquire_request_payload",
|
|
62
|
+
"description": "Insert an additional request bundle or a list of bundles (e.g. [bundle_1, bundle_2])",
|
|
63
|
+
"optional": true,
|
|
64
|
+
"title": "Additional PAS Inquiry Request Payloads",
|
|
65
|
+
"type": "textarea",
|
|
66
|
+
"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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Claim</b><a name=\\\"ReferralAuthorizationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Claim "ReferralAuthorizationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-claim.html\\\">PAS Claim</a></p></div><p><b>LevelOfServiceCode</b>: Urgent <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1338#U)</span></p><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\\\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: Patient/SubscriberExample</p><p><b>created</b>: 2005-05-02 11:01:00+0500</p><p><b>insurer</b>: Organization/InsurerExample</p><p><b>provider</b>: Organization/UMOExample</p><p><b>priority</b>: Normal <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\\\">Process Priority Codes</a>#normal)</span></p><h3>CareTeams</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>PractitionerRole/ReferralPractitionerRoleExample</td></tr></table><h3>Diagnoses</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td/><td>1</td><td>Chronic pain syndrome <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-icd10CM.html\\\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G89.4)</span></td></tr></table><h3>Insurances</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>1</td><td>true</td><td>Coverage/InsuranceExample</td></tr></table><h3>Items</h3><table class=\\\"grid\\\"><tr><td style=\\\"display: none\\\">-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>CareTeamSequence</b></td><td><b>DiagnosisSequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Location[x]</b></td></tr><tr><td style=\\\"display: none\\\">*</td><td>, , , , , , , , , </td><td>1</td><td>1</td><td>1</td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>Consultation <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (1365#3)</span></td><td>11 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (<a href=\\\"http://terminology.hl7.org/5.0.0/CodeSystem-CMSPlaceofServiceCodes.html\\\">CMS Place of Service Codes (POS)</a>#11)</span></td></tr></table></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"UMOExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "UMOExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-requestor.html\\\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>8189991234</p><p><b>active</b>: true</p><p><b>type</b>: X3 <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#X3)</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Organization</b><a name=\\\"InsurerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Organization "InsurerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-insurer.html\\\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>789312</p><p><b>active</b>: true</p><p><b>type</b>: PR <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (98#PR)</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Coverage</b><a name=\\\"InsuranceExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Coverage "InsuranceExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-coverage.html\\\">PAS Coverage</a></p></div><p><b>status</b>: active</p><p><b>beneficiary</b>: Patient/SubscriberExample</p><p><b>payor</b>: Organization/InsurerExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Patient</b><a name=\\\"SubscriberExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Patient "SubscriberExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-subscriber.html\\\">PAS Subscriber Patient</a></p></div><p><b>MilitaryStatus</b>: RU <span style=\\\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\\\"> (584#RU)</span></p><p><b>identifier</b>: id: 12345678901</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: PractitionerRole</b><a name=\\\"ReferralPractitionerRoleExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource PractitionerRole "ReferralPractitionerRoleExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitionerrole.html\\\">PAS PractitionerRole</a></p></div><p><b>practitioner</b>: Practitioner/ReferralPractitionerExample</p><p><b>location</b>: Location/ReferralLocationExample</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Practitioner</b><a name=\\\"ReferralPractitionerExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Practitioner "ReferralPractitionerExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-practitioner.html\\\">PAS Practitioner</a></p></div><p><b>identifier</b>: id: <a href=\\\"http://terminology.hl7.org/5.0.0/NamingSystem-npi.html\\\">#</a>987654321</p><p><b>name</b>: SUSAN WATSON </p><p><b>telecom</b>: ph: 4029993456</p></div>\"\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\": \"<div xmlns=\\\"http://www.w3.org/1999/xhtml\\\"><p><b>Generated Narrative: Location</b><a name=\\\"ReferralLocationExample\\\"> </a></p><div style=\\\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\\\"><p style=\\\"margin-bottom: 0px\\\">Resource Location "ReferralLocationExample" </p><p style=\\\"margin-bottom: 0px\\\">Profile: <a href=\\\"StructureDefinition-profile-location.html\\\">PAS Location Profile</a></p></div><p><b>name</b>: REFERRAL CLINIC</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>\"\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]"
|
|
67
|
+
}
|
|
68
|
+
]
|
|
69
|
+
}
|