{ "resourceType": "Bundle", "type": "transaction", "entry": [ { "fullUrl": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "resource": { "resourceType": "Patient", "id": "462cc215-c055-3e77-8e4c-9d3bf7f886f5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient" ] }, "text": { "status": "generated", "div": "
Generated by Synthea.Version identifier: 3c23908\n . Person seed: 5043995490631340354 Population seed: 1693908535569
" }, "extension": [ { "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race", "extension": [ { "url": "ombCategory", "valueCoding": { "system": "urn:oid:2.16.840.1.113883.6.238", "code": "2106-3", "display": "White" } }, { "url": "text", "valueString": "White" } ] }, { "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity", "extension": [ { "url": "ombCategory", "valueCoding": { "system": "urn:oid:2.16.840.1.113883.6.238", "code": "2186-5", "display": "Not Hispanic or Latino" } }, { "url": "text", "valueString": "Not Hispanic or Latino" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName", "valueString": "Kallie862 Kiehn525" }, { "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex", "valueCode": "M" }, { "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace", "valueAddress": { "city": "Lexington", "state": "Massachusetts", "country": "US" } }, { "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years", "valueDecimal": 1.4913831853113209 }, { "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years", "valueDecimal": 25.50861681468868 } ], "identifier": [ { "system": "https://github.com/synthetichealth/synthea", "value": "462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "MR", "display": "Medical Record Number" } ], "text": "Medical Record Number" }, "system": "http://hospital.smarthealthit.org", "value": "462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "SS", "display": "Social Security Number" } ], "text": "Social Security Number" }, "system": "http://hl7.org/fhir/sid/us-ssn", "value": "999-68-7377" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "DL", "display": "Driver's license number" } ], "text": "Driver's license number" }, "system": "urn:oid:2.16.840.1.113883.4.3.25", "value": "S99955975" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PPN", "display": "Passport Number" } ], "text": "Passport Number" }, "system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber", "value": "X15069801X" } ], "name": [ { "use": "official", "family": "Abshire638", "given": [ "Florentino8" ], "prefix": [ "Mr." ] } ], "telecom": [ { "system": "phone", "value": "555-644-3645", "use": "home" } ], "gender": "male", "birthDate": "1995-12-02", "address": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/geolocation", "extension": [ { "url": "latitude", "valueDecimal": 42.769128817229756 }, { "url": "longitude", "valueDecimal": -71.0683305252125 } ] } ], "line": [ "942 Hansen Dam Apt 2" ], "city": "Haverhill", "state": "MA", "postalCode": "01832", "country": "US" } ], "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "S", "display": "Never Married" } ], "text": "Never Married" }, "multipleBirthBoolean": false, "communication": [ { "language": { "coding": [ { "system": "urn:ietf:bcp:47", "code": "en-US", "display": "English (United States)" } ], "text": "English (United States)" } } ] }, "request": { "method": "POST", "url": "Patient" } }, { "fullUrl": "urn:uuid:34feb0bb-3b2f-ff44-ec65-d949793b7a43", "resource": { "resourceType": "Encounter", "id": "34feb0bb-3b2f-ff44-ec65-d949793b7a43", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "34feb0bb-3b2f-ff44-ec65-d949793b7a43" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1995-12-02T01:33:04+01:00", "end": "1995-12-02T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "1995-12-02T01:33:04+01:00", "end": "1995-12-02T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:8e9e23b5-41e9-cfdf-17f3-ca95d33d88a5", "resource": { "resourceType": "Condition", "id": "8e9e23b5-41e9-cfdf-17f3-ca95d33d88a5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:34feb0bb-3b2f-ff44-ec65-d949793b7a43" }, "onsetDateTime": "1995-12-02T01:33:04+01:00", "abatementDateTime": "1996-01-06T01:33:04+01:00", "recordedDate": "1995-12-02T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:f1539cd8-1dfa-910f-5fd3-a50cf30a5cbf", "resource": { "resourceType": "DiagnosticReport", "id": "f1539cd8-1dfa-910f-5fd3-a50cf30a5cbf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:34feb0bb-3b2f-ff44-ec65-d949793b7a43" }, "effectiveDateTime": "1995-12-02T01:33:04+01:00", "issued": "1995-12-02T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "CjE5OTUtMTItMDIKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgbmV3Ym9ybiBub25oaXNwYW5pYyB3aGl0ZSBtYWxlLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgoKClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTk8gSU5TVVJBTkNFLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwpObyBBY3RpdmUgTWVkaWNhdGlvbnMuCgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KUGF0aWVudCBpcyBwcmVzZW50aW5nIHdpdGggbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLiAKCiMjIFBsYW4KCg==" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:9b4555b9-1620-24a5-19a2-d12d1661cb4e", "resource": { "resourceType": "DocumentReference", "id": "9b4555b9-1620-24a5-19a2-d12d1661cb4e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:f1539cd8-1dfa-910f-5fd3-a50cf30a5cbf" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1995-12-02T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:34feb0bb-3b2f-ff44-ec65-d949793b7a43" } ], "period": { "start": "1995-12-02T01:33:04+01:00", "end": "1995-12-02T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:9d88deba-6a50-91b4-7ebd-da5cd6374bb0", "resource": { "resourceType": "Claim", "id": "9d88deba-6a50-91b4-7ebd-da5cd6374bb0", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1995-12-02T01:33:04+01:00", "end": "1995-12-02T01:48:04+01:00" }, "created": "1995-12-02T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:8e9e23b5-41e9-cfdf-17f3-ca95d33d88a5" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:34feb0bb-3b2f-ff44-ec65-d949793b7a43" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 347.38, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:cb0e8a66-b5a4-4956-cb30-1c2778f2f310", "resource": { "resourceType": "ExplanationOfBenefit", "id": "cb0e8a66-b5a4-4956-cb30-1c2778f2f310", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "NO_INSURANCE" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "NO_INSURANCE" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "9d88deba-6a50-91b4-7ebd-da5cd6374bb0" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1995-12-02T01:48:04+01:00", "end": "1996-12-02T01:48:04+01:00" }, "created": "1995-12-02T01:48:04+01:00", "insurer": { "display": "NO_INSURANCE" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:9d88deba-6a50-91b4-7ebd-da5cd6374bb0" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:8e9e23b5-41e9-cfdf-17f3-ca95d33d88a5" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "1995-12-02T01:33:04+01:00", "end": "1995-12-02T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:34feb0bb-3b2f-ff44-ec65-d949793b7a43" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "1995-12-02T01:33:04+01:00", "end": "1995-12-02T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 347.38, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d78816ce-4b4f-6cfa-3452-0456e8703083", "resource": { "resourceType": "Encounter", "id": "d78816ce-4b4f-6cfa-3452-0456e8703083", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "d78816ce-4b4f-6cfa-3452-0456e8703083" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1996-03-09T01:33:04+01:00", "end": "1996-03-09T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "1996-03-09T01:33:04+01:00", "end": "1996-03-09T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:a6ab4683-648b-ab59-02f0-5880c37a9606", "resource": { "resourceType": "Condition", "id": "a6ab4683-648b-ab59-02f0-5880c37a9606", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d78816ce-4b4f-6cfa-3452-0456e8703083" }, "onsetDateTime": "1996-03-09T01:33:04+01:00", "abatementDateTime": "1996-03-09T01:33:04+01:00", "recordedDate": "1996-03-09T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:48e0a620-93eb-97ae-4922-4cc912491322", "resource": { "resourceType": "DiagnosticReport", "id": "48e0a620-93eb-97ae-4922-4cc912491322", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d78816ce-4b4f-6cfa-3452-0456e8703083" }, "effectiveDateTime": "1996-03-09T01:33:04+01:00", "issued": "1996-03-09T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:43675411-628e-b2d5-2f42-f4136fc3f6c8", "resource": { "resourceType": "DocumentReference", "id": "43675411-628e-b2d5-2f42-f4136fc3f6c8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:48e0a620-93eb-97ae-4922-4cc912491322" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1996-03-09T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:d78816ce-4b4f-6cfa-3452-0456e8703083" } ], "period": { "start": "1996-03-09T01:33:04+01:00", "end": "1996-03-09T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:b87a763e-3d44-cf86-6491-758aa23437c8", "resource": { "resourceType": "Claim", "id": "b87a763e-3d44-cf86-6491-758aa23437c8", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1996-03-09T01:33:04+01:00", "end": "1996-03-09T01:48:04+01:00" }, "created": "1996-03-09T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:a6ab4683-648b-ab59-02f0-5880c37a9606" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:d78816ce-4b4f-6cfa-3452-0456e8703083" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 1129.89, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:4ccc91c9-446a-97ac-4d0f-b93c2977eb20", "resource": { "resourceType": "ExplanationOfBenefit", "id": "4ccc91c9-446a-97ac-4d0f-b93c2977eb20", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "NO_INSURANCE" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "NO_INSURANCE" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b87a763e-3d44-cf86-6491-758aa23437c8" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1996-03-09T01:48:04+01:00", "end": "1997-03-09T01:48:04+01:00" }, "created": "1996-03-09T01:48:04+01:00", "insurer": { "display": "NO_INSURANCE" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:b87a763e-3d44-cf86-6491-758aa23437c8" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:a6ab4683-648b-ab59-02f0-5880c37a9606" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "1996-03-09T01:33:04+01:00", "end": "1996-03-09T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d78816ce-4b4f-6cfa-3452-0456e8703083" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "1996-03-09T01:33:04+01:00", "end": "1996-03-09T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1129.89, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:46d97da4-458b-b9d3-35ee-26cf3d5770b3", "resource": { "resourceType": "Encounter", "id": "46d97da4-458b-b9d3-35ee-26cf3d5770b3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "46d97da4-458b-b9d3-35ee-26cf3d5770b3" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1996-05-11T02:33:04+02:00", "end": "1996-05-11T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "1996-05-11T02:33:04+02:00", "end": "1996-05-11T02:48:04+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:c5ab9f5d-89ec-5e05-ff48-de6e1b7751c5", "resource": { "resourceType": "Condition", "id": "c5ab9f5d-89ec-5e05-ff48-de6e1b7751c5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:46d97da4-458b-b9d3-35ee-26cf3d5770b3" }, "onsetDateTime": "1996-05-11T02:33:04+02:00", "abatementDateTime": "1996-05-11T02:33:04+02:00", "recordedDate": "1996-05-11T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:74b06d6a-6591-5029-9583-c1a9944f0a29", "resource": { "resourceType": "DiagnosticReport", "id": "74b06d6a-6591-5029-9583-c1a9944f0a29", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:46d97da4-458b-b9d3-35ee-26cf3d5770b3" }, "effectiveDateTime": "1996-05-11T02:33:04+02:00", "issued": "1996-05-11T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:e11a7883-3242-6e1f-d6ea-7989cce46795", "resource": { "resourceType": "DocumentReference", "id": "e11a7883-3242-6e1f-d6ea-7989cce46795", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:74b06d6a-6591-5029-9583-c1a9944f0a29" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1996-05-11T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:46d97da4-458b-b9d3-35ee-26cf3d5770b3" } ], "period": { "start": "1996-05-11T02:33:04+02:00", "end": "1996-05-11T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:4d8a9386-a59a-de83-4340-8f1de5d774ca", "resource": { "resourceType": "Claim", "id": "4d8a9386-a59a-de83-4340-8f1de5d774ca", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1996-05-11T02:33:04+02:00", "end": "1996-05-11T02:48:04+02:00" }, "created": "1996-05-11T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:c5ab9f5d-89ec-5e05-ff48-de6e1b7751c5" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:46d97da4-458b-b9d3-35ee-26cf3d5770b3" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 1144.85, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:8d9fe386-2a11-b887-01a0-26b025d80ddb", "resource": { "resourceType": "ExplanationOfBenefit", "id": "8d9fe386-2a11-b887-01a0-26b025d80ddb", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "NO_INSURANCE" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "NO_INSURANCE" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "4d8a9386-a59a-de83-4340-8f1de5d774ca" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1996-05-11T02:48:04+02:00", "end": "1997-05-11T02:48:04+02:00" }, "created": "1996-05-11T02:48:04+02:00", "insurer": { "display": "NO_INSURANCE" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:4d8a9386-a59a-de83-4340-8f1de5d774ca" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:c5ab9f5d-89ec-5e05-ff48-de6e1b7751c5" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "1996-05-11T02:33:04+02:00", "end": "1996-05-11T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:46d97da4-458b-b9d3-35ee-26cf3d5770b3" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "1996-05-11T02:33:04+02:00", "end": "1996-05-11T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1144.85, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a2e48f33-b303-8bb5-2884-ef6651180550", "resource": { "resourceType": "Encounter", "id": "a2e48f33-b303-8bb5-2884-ef6651180550", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "a2e48f33-b303-8bb5-2884-ef6651180550" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem" } ], "text": "Encounter for problem" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1996-07-12T02:33:04+02:00", "end": "1996-07-12T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "1996-07-12T02:33:04+02:00", "end": "1996-07-12T02:48:04+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "24079001", "display": "Atopic dermatitis" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:41476d17-6fe3-6868-8524-30875982d0af", "resource": { "resourceType": "Condition", "id": "41476d17-6fe3-6868-8524-30875982d0af", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "24079001", "display": "Atopic dermatitis" } ], "text": "Atopic dermatitis" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:a2e48f33-b303-8bb5-2884-ef6651180550" }, "onsetDateTime": "1996-07-12T02:33:04+02:00", "recordedDate": "1996-07-12T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:c8b89d01-920f-7d71-820d-fa01a2da9c08", "resource": { "resourceType": "CareTeam", "id": "c8b89d01-920f-7d71-820d-fa01a2da9c08", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "active", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:a2e48f33-b303-8bb5-2884-ef6651180550" }, "period": { "start": "1996-07-12T02:33:04+02:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } } ], "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "24079001", "display": "Atopic dermatitis" } ], "text": "Atopic dermatitis" } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:1c874bdb-0b03-ca49-97aa-9253ec59c373", "resource": { "resourceType": "CarePlan", "id": "1c874bdb-0b03-ca49-97aa-9253ec59c373", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Skin condition care.
Care plan is meant to treat Atopic dermatitis.
Activities:
" }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "711282006", "display": "Skin condition care" } ], "text": "Skin condition care" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:a2e48f33-b303-8bb5-2884-ef6651180550" }, "period": { "start": "1996-07-12T02:33:04+02:00" }, "careTeam": [ { "reference": "urn:uuid:c8b89d01-920f-7d71-820d-fa01a2da9c08" } ], "addresses": [ { "reference": "urn:uuid:41476d17-6fe3-6868-8524-30875982d0af" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "225130001", "display": "Application of moisturizer to skin" } ], "text": "Application of moisturizer to skin" }, "reasonReference": [ { "reference": "urn:uuid:41476d17-6fe3-6868-8524-30875982d0af" } ], "status": "in-progress", "location": { "display": "WP ACQUISITION SUB LLC" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:46dea221-304a-c2ab-1e95-e2254ab54a91", "resource": { "resourceType": "DiagnosticReport", "id": "46dea221-304a-c2ab-1e95-e2254ab54a91", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:a2e48f33-b303-8bb5-2884-ef6651180550" }, "effectiveDateTime": "1996-07-12T02:33:04+02:00", "issued": "1996-07-12T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:30f8b8a1-4ce7-cbce-8537-e75f06e7eca1", "resource": { "resourceType": "DocumentReference", "id": "30f8b8a1-4ce7-cbce-8537-e75f06e7eca1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:46dea221-304a-c2ab-1e95-e2254ab54a91" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1996-07-12T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:a2e48f33-b303-8bb5-2884-ef6651180550" } ], "period": { "start": "1996-07-12T02:33:04+02:00", "end": "1996-07-12T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:7fe22329-ba47-0ed9-a20a-ebb351b8cbaa", "resource": { "resourceType": "Claim", "id": "7fe22329-ba47-0ed9-a20a-ebb351b8cbaa", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1996-07-12T02:33:04+02:00", "end": "1996-07-12T02:48:04+02:00" }, "created": "1996-07-12T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:41476d17-6fe3-6868-8524-30875982d0af" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem" } ], "text": "Encounter for problem" }, "encounter": [ { "reference": "urn:uuid:a2e48f33-b303-8bb5-2884-ef6651180550" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "24079001", "display": "Atopic dermatitis" } ], "text": "Atopic dermatitis" } } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e6feb591-7898-9ec0-3c35-f595ab60446f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e6feb591-7898-9ec0-3c35-f595ab60446f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "NO_INSURANCE" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "NO_INSURANCE" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "7fe22329-ba47-0ed9-a20a-ebb351b8cbaa" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1996-07-12T02:48:04+02:00", "end": "1997-07-12T02:48:04+02:00" }, "created": "1996-07-12T02:48:04+02:00", "insurer": { "display": "NO_INSURANCE" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:7fe22329-ba47-0ed9-a20a-ebb351b8cbaa" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:41476d17-6fe3-6868-8524-30875982d0af" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem" } ], "text": "Encounter for problem" }, "servicedPeriod": { "start": "1996-07-12T02:33:04+02:00", "end": "1996-07-12T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:a2e48f33-b303-8bb5-2884-ef6651180550" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "24079001", "display": "Atopic dermatitis" } ], "text": "Atopic dermatitis" }, "servicedPeriod": { "start": "1996-07-12T02:33:04+02:00", "end": "1996-07-12T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 85.55, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:687a0300-72ac-5ef5-5073-506b896c3012", "resource": { "resourceType": "Encounter", "id": "687a0300-72ac-5ef5-5073-506b896c3012", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "687a0300-72ac-5ef5-5073-506b896c3012" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1996-08-10T02:33:04+02:00", "end": "1996-08-10T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "1996-08-10T02:33:04+02:00", "end": "1996-08-10T02:48:04+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:87dfd607-7862-9f6d-7535-70dcdf29c2c1", "resource": { "resourceType": "Condition", "id": "87dfd607-7862-9f6d-7535-70dcdf29c2c1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:687a0300-72ac-5ef5-5073-506b896c3012" }, "onsetDateTime": "1996-08-10T02:33:04+02:00", "abatementDateTime": "1996-11-09T01:33:04+01:00", "recordedDate": "1996-08-10T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:4f0a2986-cd6b-97ae-4f4b-d02f4bc91322", "resource": { "resourceType": "DiagnosticReport", "id": "4f0a2986-cd6b-97ae-4f4b-d02f4bc91322", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:687a0300-72ac-5ef5-5073-506b896c3012" }, "effectiveDateTime": "1996-08-10T02:33:04+02:00", "issued": "1996-08-10T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:43575427-07c9-e4a1-2f32-f42914ff2894", "resource": { "resourceType": "DocumentReference", "id": "43575427-07c9-e4a1-2f32-f42914ff2894", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:4f0a2986-cd6b-97ae-4f4b-d02f4bc91322" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1996-08-10T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:687a0300-72ac-5ef5-5073-506b896c3012" } ], "period": { "start": "1996-08-10T02:33:04+02:00", "end": "1996-08-10T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:5e0005eb-7ef0-8121-ed05-d1dfba4e0c4e", "resource": { "resourceType": "Claim", "id": "5e0005eb-7ef0-8121-ed05-d1dfba4e0c4e", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1996-08-10T02:33:04+02:00", "end": "1996-08-10T02:48:04+02:00" }, "created": "1996-08-10T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:87dfd607-7862-9f6d-7535-70dcdf29c2c1" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:687a0300-72ac-5ef5-5073-506b896c3012" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 544.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:c06873d8-c8b7-d27f-17a8-780ba3088e55", "resource": { "resourceType": "ExplanationOfBenefit", "id": "c06873d8-c8b7-d27f-17a8-780ba3088e55", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "NO_INSURANCE" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "NO_INSURANCE" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "5e0005eb-7ef0-8121-ed05-d1dfba4e0c4e" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1996-08-10T02:48:04+02:00", "end": "1997-08-10T02:48:04+02:00" }, "created": "1996-08-10T02:48:04+02:00", "insurer": { "display": "NO_INSURANCE" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:5e0005eb-7ef0-8121-ed05-d1dfba4e0c4e" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:87dfd607-7862-9f6d-7535-70dcdf29c2c1" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "1996-08-10T02:33:04+02:00", "end": "1996-08-10T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:687a0300-72ac-5ef5-5073-506b896c3012" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "1996-08-10T02:33:04+02:00", "end": "1996-08-10T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 544.80, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:eb1978ad-7889-286b-997d-1964292d401d", "resource": { "resourceType": "Encounter", "id": "eb1978ad-7889-286b-997d-1964292d401d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "eb1978ad-7889-286b-997d-1964292d401d" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1997-02-08T01:33:04+01:00", "end": "1997-02-08T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "1997-02-08T01:33:04+01:00", "end": "1997-02-08T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:31206b55-aa52-6473-77cc-03a90be31ae4", "resource": { "resourceType": "Condition", "id": "31206b55-aa52-6473-77cc-03a90be31ae4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:eb1978ad-7889-286b-997d-1964292d401d" }, "onsetDateTime": "1997-02-08T01:33:04+01:00", "abatementDateTime": "1997-02-08T01:33:04+01:00", "recordedDate": "1997-02-08T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:ac1b6ac1-15eb-b30d-e0f0-7a8cc55a3315", "resource": { "resourceType": "DiagnosticReport", "id": "ac1b6ac1-15eb-b30d-e0f0-7a8cc55a3315", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:eb1978ad-7889-286b-997d-1964292d401d" }, "effectiveDateTime": "1997-02-08T01:33:04+01:00", "issued": "1997-02-08T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:8f1324cc-911c-c585-0313-6673399b2301", "resource": { "resourceType": "DocumentReference", "id": "8f1324cc-911c-c585-0313-6673399b2301", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:ac1b6ac1-15eb-b30d-e0f0-7a8cc55a3315" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1997-02-08T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:eb1978ad-7889-286b-997d-1964292d401d" } ], "period": { "start": "1997-02-08T01:33:04+01:00", "end": "1997-02-08T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:95cccb53-b867-da94-b69c-9f08d3e58bd4", "resource": { "resourceType": "Claim", "id": "95cccb53-b867-da94-b69c-9f08d3e58bd4", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1997-02-08T01:33:04+01:00", "end": "1997-02-08T01:48:04+01:00" }, "created": "1997-02-08T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:31206b55-aa52-6473-77cc-03a90be31ae4" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:eb1978ad-7889-286b-997d-1964292d401d" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 1405.86, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:2e2d3ff1-33bc-5a34-d89b-bff99a5b4d05", "resource": { "resourceType": "ExplanationOfBenefit", "id": "2e2d3ff1-33bc-5a34-d89b-bff99a5b4d05", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "NO_INSURANCE" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "NO_INSURANCE" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "95cccb53-b867-da94-b69c-9f08d3e58bd4" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1997-02-08T01:48:04+01:00", "end": "1998-02-08T01:48:04+01:00" }, "created": "1997-02-08T01:48:04+01:00", "insurer": { "display": "NO_INSURANCE" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:95cccb53-b867-da94-b69c-9f08d3e58bd4" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:31206b55-aa52-6473-77cc-03a90be31ae4" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "1997-02-08T01:33:04+01:00", "end": "1997-02-08T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:eb1978ad-7889-286b-997d-1964292d401d" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "1997-02-08T01:33:04+01:00", "end": "1997-02-08T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1405.86, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:967d1fd3-222e-0837-dcbf-728cbed5a831", "resource": { "resourceType": "Encounter", "id": "967d1fd3-222e-0837-dcbf-728cbed5a831", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "967d1fd3-222e-0837-dcbf-728cbed5a831" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1997-05-10T02:33:04+02:00", "end": "1997-05-10T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "1997-05-10T02:33:04+02:00", "end": "1997-05-10T02:48:04+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:d3253dad-be14-1020-e067-eccfd55a9aef", "resource": { "resourceType": "Condition", "id": "d3253dad-be14-1020-e067-eccfd55a9aef", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:967d1fd3-222e-0837-dcbf-728cbed5a831" }, "onsetDateTime": "1997-05-10T02:33:04+02:00", "abatementDateTime": "1997-11-08T01:33:04+01:00", "recordedDate": "1997-05-10T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:699325c7-f5e8-1bac-79fc-cfe78d4778ac", "resource": { "resourceType": "DiagnosticReport", "id": "699325c7-f5e8-1bac-79fc-cfe78d4778ac", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:967d1fd3-222e-0837-dcbf-728cbed5a831" }, "effectiveDateTime": "1997-05-10T02:33:04+02:00", "issued": "1997-05-10T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:f29478b2-2c99-cd28-e97c-793579eac9e3", "resource": { "resourceType": "DocumentReference", "id": "f29478b2-2c99-cd28-e97c-793579eac9e3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:699325c7-f5e8-1bac-79fc-cfe78d4778ac" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1997-05-10T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:967d1fd3-222e-0837-dcbf-728cbed5a831" } ], "period": { "start": "1997-05-10T02:33:04+02:00", "end": "1997-05-10T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:f481e11b-db5b-3cc1-5ce2-2ff65ff83e67", "resource": { "resourceType": "Claim", "id": "f481e11b-db5b-3cc1-5ce2-2ff65ff83e67", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1997-05-10T02:33:04+02:00", "end": "1997-05-10T02:48:04+02:00" }, "created": "1997-05-10T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:d3253dad-be14-1020-e067-eccfd55a9aef" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:967d1fd3-222e-0837-dcbf-728cbed5a831" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 272.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:5c27fd8e-29d1-c812-9ddf-e83511d24e83", "resource": { "resourceType": "ExplanationOfBenefit", "id": "5c27fd8e-29d1-c812-9ddf-e83511d24e83", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "NO_INSURANCE" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "NO_INSURANCE" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "f481e11b-db5b-3cc1-5ce2-2ff65ff83e67" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1997-05-10T02:48:04+02:00", "end": "1998-05-10T02:48:04+02:00" }, "created": "1997-05-10T02:48:04+02:00", "insurer": { "display": "NO_INSURANCE" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:f481e11b-db5b-3cc1-5ce2-2ff65ff83e67" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:d3253dad-be14-1020-e067-eccfd55a9aef" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "1997-05-10T02:33:04+02:00", "end": "1997-05-10T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:967d1fd3-222e-0837-dcbf-728cbed5a831" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "1997-05-10T02:33:04+02:00", "end": "1997-05-10T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 272.80, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:31dba6c7-d407-9552-ba7b-16c5ed04f71c", "resource": { "resourceType": "Encounter", "id": "31dba6c7-d407-9552-ba7b-16c5ed04f71c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "31dba6c7-d407-9552-ba7b-16c5ed04f71c" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1998-05-09T02:33:04+02:00", "end": "1998-05-09T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "1998-05-09T02:33:04+02:00", "end": "1998-05-09T02:48:04+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:49067cf2-f25b-ba76-75ca-d510e979f79f", "resource": { "resourceType": "Condition", "id": "49067cf2-f25b-ba76-75ca-d510e979f79f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:31dba6c7-d407-9552-ba7b-16c5ed04f71c" }, "onsetDateTime": "1998-05-09T02:33:04+02:00", "abatementDateTime": "1998-11-07T01:33:04+01:00", "recordedDate": "1998-05-09T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:1e2cbd94-79c2-43d0-cd9b-3d9cae97539b", "resource": { "resourceType": "DiagnosticReport", "id": "1e2cbd94-79c2-43d0-cd9b-3d9cae97539b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:31dba6c7-d407-9552-ba7b-16c5ed04f71c" }, "effectiveDateTime": "1998-05-09T02:33:04+02:00", "issued": "1998-05-09T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:c7e53dc7-9766-d691-7063-9b430b671838", "resource": { "resourceType": "DocumentReference", "id": "c7e53dc7-9766-d691-7063-9b430b671838", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:1e2cbd94-79c2-43d0-cd9b-3d9cae97539b" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1998-05-09T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:31dba6c7-d407-9552-ba7b-16c5ed04f71c" } ], "period": { "start": "1998-05-09T02:33:04+02:00", "end": "1998-05-09T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:c058933d-6279-c372-6983-834f52e2fe46", "resource": { "resourceType": "Claim", "id": "c058933d-6279-c372-6983-834f52e2fe46", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1998-05-09T02:33:04+02:00", "end": "1998-05-09T02:48:04+02:00" }, "created": "1998-05-09T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:49067cf2-f25b-ba76-75ca-d510e979f79f" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:31dba6c7-d407-9552-ba7b-16c5ed04f71c" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 408.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:111d2399-b4e3-ee10-1986-0c57e78e5c90", "resource": { "resourceType": "ExplanationOfBenefit", "id": "111d2399-b4e3-ee10-1986-0c57e78e5c90", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "NO_INSURANCE" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "NO_INSURANCE" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c058933d-6279-c372-6983-834f52e2fe46" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1998-05-09T02:48:04+02:00", "end": "1999-05-09T02:48:04+02:00" }, "created": "1998-05-09T02:48:04+02:00", "insurer": { "display": "NO_INSURANCE" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:c058933d-6279-c372-6983-834f52e2fe46" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:49067cf2-f25b-ba76-75ca-d510e979f79f" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "NO_INSURANCE" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "1998-05-09T02:33:04+02:00", "end": "1998-05-09T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:31dba6c7-d407-9552-ba7b-16c5ed04f71c" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "1998-05-09T02:33:04+02:00", "end": "1998-05-09T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 408.80, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:c789cf1f-67e1-5544-89d8-f8dffbe2f906", "resource": { "resourceType": "Encounter", "id": "c789cf1f-67e1-5544-89d8-f8dffbe2f906", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "c789cf1f-67e1-5544-89d8-f8dffbe2f906" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1999-05-08T02:33:04+02:00", "end": "1999-05-08T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "1999-05-08T02:33:04+02:00", "end": "1999-05-08T02:48:04+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:89303d6f-5c22-07f0-241b-8b6499884bb4", "resource": { "resourceType": "Condition", "id": "89303d6f-5c22-07f0-241b-8b6499884bb4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c789cf1f-67e1-5544-89d8-f8dffbe2f906" }, "onsetDateTime": "1999-05-08T02:33:04+02:00", "abatementDateTime": "2000-11-11T01:33:04+01:00", "recordedDate": "1999-05-08T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:c04dec9f-0fec-58ef-978d-f0b97a743ec7", "resource": { "resourceType": "DiagnosticReport", "id": "c04dec9f-0fec-58ef-978d-f0b97a743ec7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c789cf1f-67e1-5544-89d8-f8dffbe2f906" }, "effectiveDateTime": "1999-05-08T02:33:04+02:00", "issued": "1999-05-08T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:4625e95b-2a80-a25a-8554-a7152aa175ae", "resource": { "resourceType": "DocumentReference", "id": "4625e95b-2a80-a25a-8554-a7152aa175ae", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:c04dec9f-0fec-58ef-978d-f0b97a743ec7" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1999-05-08T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:c789cf1f-67e1-5544-89d8-f8dffbe2f906" } ], "period": { "start": "1999-05-08T02:33:04+02:00", "end": "1999-05-08T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:6ecde416-96c8-7f29-a4c8-530a17f3888e", "resource": { "resourceType": "Claim", "id": "6ecde416-96c8-7f29-a4c8-530a17f3888e", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1999-05-08T02:33:04+02:00", "end": "1999-05-08T02:48:04+02:00" }, "created": "1999-05-08T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:89303d6f-5c22-07f0-241b-8b6499884bb4" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:c789cf1f-67e1-5544-89d8-f8dffbe2f906" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 136.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:323045ba-e0f3-3e0c-89dc-629036c33f19", "resource": { "resourceType": "ExplanationOfBenefit", "id": "323045ba-e0f3-3e0c-89dc-629036c33f19", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "6ecde416-96c8-7f29-a4c8-530a17f3888e" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-05-08T02:48:04+02:00", "end": "2000-05-08T02:48:04+02:00" }, "created": "1999-05-08T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:6ecde416-96c8-7f29-a4c8-530a17f3888e" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:89303d6f-5c22-07f0-241b-8b6499884bb4" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "1999-05-08T02:33:04+02:00", "end": "1999-05-08T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:c789cf1f-67e1-5544-89d8-f8dffbe2f906" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "1999-05-08T02:33:04+02:00", "end": "1999-05-08T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 136.80, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d", "resource": { "resourceType": "Encounter", "id": "66c68d08-c01d-0100-2363-d77febb1b85d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "66c68d08-c01d-0100-2363-d77febb1b85d" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1999-10-01T02:33:04+02:00", "end": "1999-10-01T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "1999-10-01T02:33:04+02:00", "end": "1999-10-01T02:48:04+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "233678006", "display": "Childhood asthma" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "resource": { "resourceType": "Condition", "id": "a24f9d19-8796-1fe5-656d-9c88539e886b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "233678006", "display": "Childhood asthma" } ], "text": "Childhood asthma" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" }, "onsetDateTime": "1999-10-01T02:33:04+02:00", "abatementDateTime": "2015-01-27T01:33:04+01:00", "recordedDate": "1999-10-01T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:ccc3d555-3ba4-c06e-625b-b89b58456c90", "resource": { "resourceType": "MedicationRequest", "id": "ccc3d555-3ba4-c06e-625b-b89b58456c90", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" }, "authoredOn": "1999-10-01T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:512d43d1-961d-5532-1214-1c759259c781", "resource": { "resourceType": "Claim", "id": "512d43d1-961d-5532-1214-1c759259c781", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-10-01T02:33:04+02:00", "end": "1999-10-01T02:48:04+02:00" }, "created": "1999-10-01T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:ccc3d555-3ba4-c06e-625b-b89b58456c90" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:dc0f60d8-69f0-e519-fca4-b6a86afe5444", "resource": { "resourceType": "ExplanationOfBenefit", "id": "dc0f60d8-69f0-e519-fca4-b6a86afe5444", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "512d43d1-961d-5532-1214-1c759259c781" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-10-01T02:48:04+02:00", "end": "2000-10-01T02:48:04+02:00" }, "created": "1999-10-01T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:512d43d1-961d-5532-1214-1c759259c781" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "1999-10-01T02:33:04+02:00", "end": "1999-10-01T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:91f386ca-2f61-d51b-46ba-5a06e4a9d44a", "resource": { "resourceType": "MedicationRequest", "id": "91f386ca-2f61-d51b-46ba-5a06e4a9d44a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" }, "authoredOn": "1999-10-01T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:12f4c950-755b-90f4-6c70-cc60a8862998", "resource": { "resourceType": "Claim", "id": "12f4c950-755b-90f4-6c70-cc60a8862998", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-10-01T02:33:04+02:00", "end": "1999-10-01T02:48:04+02:00" }, "created": "1999-10-01T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:91f386ca-2f61-d51b-46ba-5a06e4a9d44a" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:8efe58a3-fbdf-186e-e435-98a8319bc4f0", "resource": { "resourceType": "ExplanationOfBenefit", "id": "8efe58a3-fbdf-186e-e435-98a8319bc4f0", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "12f4c950-755b-90f4-6c70-cc60a8862998" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-10-01T02:48:04+02:00", "end": "2000-10-01T02:48:04+02:00" }, "created": "1999-10-01T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:12f4c950-755b-90f4-6c70-cc60a8862998" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "1999-10-01T02:33:04+02:00", "end": "1999-10-01T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:c05111ad-c5c6-bc4f-1791-15e382733ea5", "resource": { "resourceType": "CareTeam", "id": "c05111ad-c5c6-bc4f-1791-15e382733ea5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "active", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" }, "period": { "start": "1999-10-01T02:33:04+02:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } } ], "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "233678006", "display": "Childhood asthma" } ], "text": "Childhood asthma" } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:ba6b4965-1518-55f1-a9d2-b8997eb66236", "resource": { "resourceType": "CarePlan", "id": "ba6b4965-1518-55f1-a9d2-b8997eb66236", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Asthma self management.
Care plan is meant to treat Childhood asthma.
Activities:
" }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "699728000", "display": "Asthma self management" } ], "text": "Asthma self management" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" }, "period": { "start": "1999-10-01T02:33:04+02:00" }, "careTeam": [ { "reference": "urn:uuid:c05111ad-c5c6-bc4f-1791-15e382733ea5" } ], "addresses": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710818004", "display": "Inhaled steroid therapy" } ], "text": "Inhaled steroid therapy" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b" } ], "status": "in-progress", "location": { "display": "WP ACQUISITION SUB LLC" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "708409001", "display": "Home nebulizer therapy" } ], "text": "Home nebulizer therapy" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b" } ], "status": "in-progress", "location": { "display": "WP ACQUISITION SUB LLC" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "229298005", "display": "Breathing control" } ], "text": "Breathing control" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b" } ], "status": "in-progress", "location": { "display": "WP ACQUISITION SUB LLC" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:f7c4d979-fdee-f80e-7338-d9bba497766c", "resource": { "resourceType": "DiagnosticReport", "id": "f7c4d979-fdee-f80e-7338-d9bba497766c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" }, "effectiveDateTime": "1999-10-01T02:33:04+02:00", "issued": "1999-10-01T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:25f65e66-b295-890d-69e9-4a4252979642", "resource": { "resourceType": "DocumentReference", "id": "25f65e66-b295-890d-69e9-4a4252979642", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:f7c4d979-fdee-f80e-7338-d9bba497766c" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1999-10-01T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjE5OTktMTAtMDEKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMyB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBtYWxlLiBQYXRpZW50IGhhcyBhIGhpc3Rvcnkgb2YgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgoKClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCk5vIEFjdGl2ZSBNZWRpY2F0aW9ucy4KCiMgQXNzZXNzbWVudCBhbmQgUGxhbgpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBjaGlsZGhvb2QgYXN0aG1hLiAKCiMjIFBsYW4KClRoZSBwYXRpZW50IHdhcyBwcmVzY3JpYmVkIHRoZSBmb2xsb3dpbmcgbWVkaWNhdGlvbnM6Ci0gYnVkZXNvbmlkZSAwLjEyNSBtZy9tbCBpbmhhbGF0aW9uIHN1c3BlbnNpb24KLSBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQpUaGUgcGF0aWVudCB3YXMgcGxhY2VkIG9uIGEgY2FyZXBsYW46Ci0gYXN0aG1hIHNlbGYgbWFuYWdlbWVudAo=" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" } ], "period": { "start": "1999-10-01T02:33:04+02:00", "end": "1999-10-01T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:a3aba56f-d564-32db-f3b0-949b334fde15", "resource": { "resourceType": "Claim", "id": "a3aba56f-d564-32db-f3b0-949b334fde15", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1999-10-01T02:33:04+02:00", "end": "1999-10-01T02:48:04+02:00" }, "created": "1999-10-01T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "encounter": [ { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "233678006", "display": "Childhood asthma" } ], "text": "Childhood asthma" } } ], "total": { "value": 516.95, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:2767a884-93e9-7e2e-4cbb-1c84d74548f6", "resource": { "resourceType": "ExplanationOfBenefit", "id": "2767a884-93e9-7e2e-4cbb-1c84d74548f6", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a3aba56f-d564-32db-f3b0-949b334fde15" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-10-01T02:48:04+02:00", "end": "2000-10-01T02:48:04+02:00" }, "created": "1999-10-01T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:a3aba56f-d564-32db-f3b0-949b334fde15" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "servicedPeriod": { "start": "1999-10-01T02:33:04+02:00", "end": "1999-10-01T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "233678006", "display": "Childhood asthma" } ], "text": "Childhood asthma" }, "servicedPeriod": { "start": "1999-10-01T02:33:04+02:00", "end": "1999-10-01T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 516.95, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99", "resource": { "resourceType": "Encounter", "id": "3723e3b4-b299-b089-27a6-8e28337beb99", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "3723e3b4-b299-b089-27a6-8e28337beb99" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1999-11-06T01:33:04+01:00", "end": "1999-11-06T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "1999-11-06T01:33:04+01:00", "end": "1999-11-06T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:93b64e54-7e59-9f4a-9628-08aa97a41f12", "resource": { "resourceType": "MedicationRequest", "id": "93b64e54-7e59-9f4a-9628-08aa97a41f12", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" }, "authoredOn": "1999-11-06T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:3c4e187d-0a23-b1cb-4e62-307edaad10fe", "resource": { "resourceType": "Claim", "id": "3c4e187d-0a23-b1cb-4e62-307edaad10fe", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-11-06T01:33:04+01:00", "end": "1999-11-06T01:48:04+01:00" }, "created": "1999-11-06T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:93b64e54-7e59-9f4a-9628-08aa97a41f12" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f5c58eb2-2c86-bf68-4939-8ef589c4516e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f5c58eb2-2c86-bf68-4939-8ef589c4516e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "3c4e187d-0a23-b1cb-4e62-307edaad10fe" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-11-06T01:48:04+01:00", "end": "2000-11-06T01:48:04+01:00" }, "created": "1999-11-06T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:3c4e187d-0a23-b1cb-4e62-307edaad10fe" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "1999-11-06T01:33:04+01:00", "end": "1999-11-06T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:e7e864a4-36b0-9399-d30a-981fa2d9a0be", "resource": { "resourceType": "MedicationRequest", "id": "e7e864a4-36b0-9399-d30a-981fa2d9a0be", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" }, "authoredOn": "1999-11-06T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:e9f09cad-f68c-ce5b-6c8a-0c79d0d04f2f", "resource": { "resourceType": "Claim", "id": "e9f09cad-f68c-ce5b-6c8a-0c79d0d04f2f", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-11-06T01:33:04+01:00", "end": "1999-11-06T01:48:04+01:00" }, "created": "1999-11-06T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:e7e864a4-36b0-9399-d30a-981fa2d9a0be" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:b4aa295d-1bae-c075-7dac-d3171bd06f14", "resource": { "resourceType": "ExplanationOfBenefit", "id": "b4aa295d-1bae-c075-7dac-d3171bd06f14", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e9f09cad-f68c-ce5b-6c8a-0c79d0d04f2f" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-11-06T01:48:04+01:00", "end": "2000-11-06T01:48:04+01:00" }, "created": "1999-11-06T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:e9f09cad-f68c-ce5b-6c8a-0c79d0d04f2f" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "1999-11-06T01:33:04+01:00", "end": "1999-11-06T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:8f19fa69-1873-0585-031a-3c0fc0f16301", "resource": { "resourceType": "DiagnosticReport", "id": "8f19fa69-1873-0585-031a-3c0fc0f16301", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" }, "effectiveDateTime": "1999-11-06T01:33:04+01:00", "issued": "1999-11-06T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:ce12d7df-01a0-a671-c0fe-b37f03addbb5", "resource": { "resourceType": "DocumentReference", "id": "ce12d7df-01a0-a671-c0fe-b37f03addbb5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:8f19fa69-1873-0585-031a-3c0fc0f16301" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "1999-11-06T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjE5OTktMTEtMDYKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMyB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBtYWxlLiBQYXRpZW50IGhhcyBhIGhpc3Rvcnkgb2YgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCBjaGlsZGhvb2QgYXN0aG1hLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgoKClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCmJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uOyBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgoKVGhlIHBhdGllbnQgd2FzIHByZXNjcmliZWQgdGhlIGZvbGxvd2luZyBtZWRpY2F0aW9uczoKLSBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQotIGJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uCg==" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" } ], "period": { "start": "1999-11-06T01:33:04+01:00", "end": "1999-11-06T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:62efa857-9c2e-1ed6-445e-dd0fc478c7ba", "resource": { "resourceType": "Claim", "id": "62efa857-9c2e-1ed6-445e-dd0fc478c7ba", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "1999-11-06T01:33:04+01:00", "end": "1999-11-06T01:48:04+01:00" }, "created": "1999-11-06T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" } ] } ], "total": { "value": 272.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:c8c6e97e-862c-4521-346e-9bbf309ac52a", "resource": { "resourceType": "ExplanationOfBenefit", "id": "c8c6e97e-862c-4521-346e-9bbf309ac52a", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "62efa857-9c2e-1ed6-445e-dd0fc478c7ba" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "1999-11-06T01:48:04+01:00", "end": "2000-11-06T01:48:04+01:00" }, "created": "1999-11-06T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:62efa857-9c2e-1ed6-445e-dd0fc478c7ba" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "1999-11-06T01:33:04+01:00", "end": "1999-11-06T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 272.80, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71", "resource": { "resourceType": "Encounter", "id": "03b5ddf2-f460-b95c-793c-2e220b272d71", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "03b5ddf2-f460-b95c-793c-2e220b272d71" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2000-11-11T01:33:04+01:00", "end": "2000-11-11T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2000-11-11T01:33:04+01:00", "end": "2000-11-11T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:18740303-6893-4a6f-38f0-dd30cf329690", "resource": { "resourceType": "MedicationRequest", "id": "18740303-6893-4a6f-38f0-dd30cf329690", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" }, "authoredOn": "2000-11-11T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:212148eb-824d-a647-00b8-be91883ef112", "resource": { "resourceType": "Claim", "id": "212148eb-824d-a647-00b8-be91883ef112", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2000-11-11T01:33:04+01:00", "end": "2000-11-11T01:48:04+01:00" }, "created": "2000-11-11T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:18740303-6893-4a6f-38f0-dd30cf329690" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:c9ee7f35-d7e4-4c3f-2b44-84a073844e5b", "resource": { "resourceType": "ExplanationOfBenefit", "id": "c9ee7f35-d7e4-4c3f-2b44-84a073844e5b", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "212148eb-824d-a647-00b8-be91883ef112" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2000-11-11T01:48:04+01:00", "end": "2001-11-11T01:48:04+01:00" }, "created": "2000-11-11T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:212148eb-824d-a647-00b8-be91883ef112" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2000-11-11T01:33:04+01:00", "end": "2000-11-11T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d23a3dff-f91c-86ac-c4a3-c5e9e953e5fb", "resource": { "resourceType": "MedicationRequest", "id": "d23a3dff-f91c-86ac-c4a3-c5e9e953e5fb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" }, "authoredOn": "2000-11-11T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:0b87c7de-3be6-3deb-9181-d799b973b5c9", "resource": { "resourceType": "Claim", "id": "0b87c7de-3be6-3deb-9181-d799b973b5c9", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2000-11-11T01:33:04+01:00", "end": "2000-11-11T01:48:04+01:00" }, "created": "2000-11-11T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:d23a3dff-f91c-86ac-c4a3-c5e9e953e5fb" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f0e73cda-99fa-62bf-5f67-45481f52786a", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f0e73cda-99fa-62bf-5f67-45481f52786a", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0b87c7de-3be6-3deb-9181-d799b973b5c9" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2000-11-11T01:48:04+01:00", "end": "2001-11-11T01:48:04+01:00" }, "created": "2000-11-11T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:0b87c7de-3be6-3deb-9181-d799b973b5c9" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2000-11-11T01:33:04+01:00", "end": "2000-11-11T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:6bec9650-a06c-fbb0-160c-2daffd6d0c1a", "resource": { "resourceType": "DiagnosticReport", "id": "6bec9650-a06c-fbb0-160c-2daffd6d0c1a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" }, "effectiveDateTime": "2000-11-11T01:33:04+01:00", "issued": "2000-11-11T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:76fa32ca-f22c-3266-777d-801beee7294e", "resource": { "resourceType": "DocumentReference", "id": "76fa32ca-f22c-3266-777d-801beee7294e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:6bec9650-a06c-fbb0-160c-2daffd6d0c1a" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2000-11-11T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" } ], "period": { "start": "2000-11-11T01:33:04+01:00", "end": "2000-11-11T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:58909f2d-3046-12f6-730a-0aab146338e6", "resource": { "resourceType": "Claim", "id": "58909f2d-3046-12f6-730a-0aab146338e6", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2000-11-11T01:33:04+01:00", "end": "2000-11-11T01:48:04+01:00" }, "created": "2000-11-11T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" } ] } ], "total": { "value": 1619.47, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:63d24f8a-e3f2-dd70-be79-378b6acb32f1", "resource": { "resourceType": "ExplanationOfBenefit", "id": "63d24f8a-e3f2-dd70-be79-378b6acb32f1", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "58909f2d-3046-12f6-730a-0aab146338e6" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2000-11-11T01:48:04+01:00", "end": "2001-11-11T01:48:04+01:00" }, "created": "2000-11-11T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:58909f2d-3046-12f6-730a-0aab146338e6" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2000-11-11T01:33:04+01:00", "end": "2000-11-11T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1619.47, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188", "resource": { "resourceType": "Encounter", "id": "9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2001-07-14T02:33:04+02:00", "end": "2001-07-14T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } } ], "period": { "start": "2001-07-14T02:33:04+02:00", "end": "2001-07-14T02:48:04+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:8fa4cf61-b62b-4ca6-326a-555a13434c11", "resource": { "resourceType": "Condition", "id": "8fa4cf61-b62b-4ca6-326a-555a13434c11", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" }, "onsetDateTime": "2001-07-14T02:33:04+02:00", "abatementDateTime": "2001-07-14T02:33:04+02:00", "recordedDate": "2001-07-14T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:9a26871a-2b2b-5787-0e07-5039b9300599", "resource": { "resourceType": "MedicationRequest", "id": "9a26871a-2b2b-5787-0e07-5039b9300599", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" }, "authoredOn": "2001-07-14T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:7d11ed0c-f5e6-96d7-39e2-82cc94bfb23e", "resource": { "resourceType": "Claim", "id": "7d11ed0c-f5e6-96d7-39e2-82cc94bfb23e", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-07-14T02:33:04+02:00", "end": "2001-07-14T02:48:04+02:00" }, "created": "2001-07-14T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:9a26871a-2b2b-5787-0e07-5039b9300599" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:45f507f1-ba22-7420-15f6-15c9d2d58976", "resource": { "resourceType": "ExplanationOfBenefit", "id": "45f507f1-ba22-7420-15f6-15c9d2d58976", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "7d11ed0c-f5e6-96d7-39e2-82cc94bfb23e" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-07-14T02:48:04+02:00", "end": "2002-07-14T02:48:04+02:00" }, "created": "2001-07-14T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:7d11ed0c-f5e6-96d7-39e2-82cc94bfb23e" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2001-07-14T02:33:04+02:00", "end": "2001-07-14T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f7ff57ca-326e-8e4c-55d8-8c57300fec03", "resource": { "resourceType": "MedicationRequest", "id": "f7ff57ca-326e-8e4c-55d8-8c57300fec03", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" }, "authoredOn": "2001-07-14T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:a4705689-8f90-f12b-bf1c-e60ae1617191", "resource": { "resourceType": "Claim", "id": "a4705689-8f90-f12b-bf1c-e60ae1617191", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-07-14T02:33:04+02:00", "end": "2001-07-14T02:48:04+02:00" }, "created": "2001-07-14T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:f7ff57ca-326e-8e4c-55d8-8c57300fec03" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:fac819da-f2de-0c09-3228-7ca748154c0e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "fac819da-f2de-0c09-3228-7ca748154c0e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a4705689-8f90-f12b-bf1c-e60ae1617191" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-07-14T02:48:04+02:00", "end": "2002-07-14T02:48:04+02:00" }, "created": "2001-07-14T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:a4705689-8f90-f12b-bf1c-e60ae1617191" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2001-07-14T02:33:04+02:00", "end": "2001-07-14T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b018b971-c6a8-7f34-b6b3-5b6b3c9e4f35", "resource": { "resourceType": "DiagnosticReport", "id": "b018b971-c6a8-7f34-b6b3-5b6b3c9e4f35", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" }, "effectiveDateTime": "2001-07-14T02:33:04+02:00", "issued": "2001-07-14T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:3168ba63-bc84-65d0-9fe8-c2989194317f", "resource": { "resourceType": "DocumentReference", "id": "3168ba63-bc84-65d0-9fe8-c2989194317f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:b018b971-c6a8-7f34-b6b3-5b6b3c9e4f35" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2001-07-14T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" } ], "period": { "start": "2001-07-14T02:33:04+02:00", "end": "2001-07-14T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:d0f59ff0-64a7-fea3-28db-dfb95cc9f4e5", "resource": { "resourceType": "Claim", "id": "d0f59ff0-64a7-fea3-28db-dfb95cc9f4e5", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2001-07-14T02:33:04+02:00", "end": "2001-07-14T02:48:04+02:00" }, "created": "2001-07-14T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:8fa4cf61-b62b-4ca6-326a-555a13434c11" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" }, "encounter": [ { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 786.24, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:2ece5178-0ca9-ae15-b975-39789395ba6e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "2ece5178-0ca9-ae15-b975-39789395ba6e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "d0f59ff0-64a7-fea3-28db-dfb95cc9f4e5" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-07-14T02:48:04+02:00", "end": "2002-07-14T02:48:04+02:00" }, "created": "2001-07-14T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:d0f59ff0-64a7-fea3-28db-dfb95cc9f4e5" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:8fa4cf61-b62b-4ca6-326a-555a13434c11" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" }, "servicedPeriod": { "start": "2001-07-14T02:33:04+02:00", "end": "2001-07-14T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2001-07-14T02:33:04+02:00", "end": "2001-07-14T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 786.24, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:264e1c01-b2f5-1c2a-76fa-748fb47aefb4", "resource": { "resourceType": "Encounter", "id": "264e1c01-b2f5-1c2a-76fa-748fb47aefb4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "264e1c01-b2f5-1c2a-76fa-748fb47aefb4" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2001-09-23T02:33:04+02:00", "end": "2001-09-23T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2001-09-23T02:33:04+02:00", "end": "2001-09-23T02:48:04+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "232353008", "display": "Perennial allergic rhinitis with seasonal variation" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:18adf5c9-1f2e-73c1-e319-252ed4db9c21", "resource": { "resourceType": "Condition", "id": "18adf5c9-1f2e-73c1-e319-252ed4db9c21", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "232353008", "display": "Perennial allergic rhinitis with seasonal variation" } ], "text": "Perennial allergic rhinitis with seasonal variation" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:264e1c01-b2f5-1c2a-76fa-748fb47aefb4" }, "onsetDateTime": "2001-09-23T02:33:04+02:00", "abatementDateTime": "2014-12-06T01:33:04+01:00", "recordedDate": "2001-09-23T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:25599b16-cc27-da92-e444-04d05aedfc55", "resource": { "resourceType": "MedicationRequest", "id": "25599b16-cc27-da92-e444-04d05aedfc55", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "997488", "display": "Fexofenadine hydrochloride 30 MG Oral Tablet" } ], "text": "Fexofenadine hydrochloride 30 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:264e1c01-b2f5-1c2a-76fa-748fb47aefb4" }, "authoredOn": "2001-09-23T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:033db5f1-091b-5075-515d-0237bcf9f3dc", "resource": { "resourceType": "Claim", "id": "033db5f1-091b-5075-515d-0237bcf9f3dc", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-09-23T02:33:04+02:00", "end": "2001-09-23T02:48:04+02:00" }, "created": "2001-09-23T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:25599b16-cc27-da92-e444-04d05aedfc55" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "997488", "display": "Fexofenadine hydrochloride 30 MG Oral Tablet" } ], "text": "Fexofenadine hydrochloride 30 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:264e1c01-b2f5-1c2a-76fa-748fb47aefb4" } ] } ], "total": { "value": 297.82, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:fa63cba7-08e7-a4a4-a41d-cbc8c5585e8b", "resource": { "resourceType": "ExplanationOfBenefit", "id": "fa63cba7-08e7-a4a4-a41d-cbc8c5585e8b", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "033db5f1-091b-5075-515d-0237bcf9f3dc" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-09-23T02:48:04+02:00", "end": "2002-09-23T02:48:04+02:00" }, "created": "2001-09-23T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:033db5f1-091b-5075-515d-0237bcf9f3dc" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "997488", "display": "Fexofenadine hydrochloride 30 MG Oral Tablet" } ], "text": "Fexofenadine hydrochloride 30 MG Oral Tablet" }, "servicedPeriod": { "start": "2001-09-23T02:33:04+02:00", "end": "2001-09-23T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:264e1c01-b2f5-1c2a-76fa-748fb47aefb4" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 297.82, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3920e9eb-1368-fb2a-48ec-995993712fff", "resource": { "resourceType": "DiagnosticReport", "id": "3920e9eb-1368-fb2a-48ec-995993712fff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:264e1c01-b2f5-1c2a-76fa-748fb47aefb4" }, "effectiveDateTime": "2001-09-23T02:33:04+02:00", "issued": "2001-09-23T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "CjIwMDEtMDktMjMKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgNSB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBtYWxlLiBQYXRpZW50IGhhcyBhIGhpc3Rvcnkgb2YgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCBjaGlsZGhvb2QgYXN0aG1hLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgoKClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCmJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uOyBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuClBhdGllbnQgaXMgcHJlc2VudGluZyB3aXRoIHBlcmVubmlhbCBhbGxlcmdpYyByaGluaXRpcyB3aXRoIHNlYXNvbmFsIHZhcmlhdGlvbi4gCgojIyBQbGFuCgpUaGUgcGF0aWVudCB3YXMgcHJlc2NyaWJlZCB0aGUgZm9sbG93aW5nIG1lZGljYXRpb25zOgotIGZleG9mZW5hZGluZSBoeWRyb2NobG9yaWRlIDMwIG1nIG9yYWwgdGFibGV0Cg==" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:7e91078f-c425-a211-c037-b00e21a11611", "resource": { "resourceType": "DocumentReference", "id": "7e91078f-c425-a211-c037-b00e21a11611", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:3920e9eb-1368-fb2a-48ec-995993712fff" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2001-09-23T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:264e1c01-b2f5-1c2a-76fa-748fb47aefb4" } ], "period": { "start": "2001-09-23T02:33:04+02:00", "end": "2001-09-23T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:faaf08b6-f262-f618-fbe2-7e9fc1fa0da7", "resource": { "resourceType": "Claim", "id": "faaf08b6-f262-f618-fbe2-7e9fc1fa0da7", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2001-09-23T02:33:04+02:00", "end": "2001-09-23T02:48:04+02:00" }, "created": "2001-09-23T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:18adf5c9-1f2e-73c1-e319-252ed4db9c21" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "encounter": [ { "reference": "urn:uuid:264e1c01-b2f5-1c2a-76fa-748fb47aefb4" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "232353008", "display": "Perennial allergic rhinitis with seasonal variation" } ], "text": "Perennial allergic rhinitis with seasonal variation" } } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e841bf6b-ef5a-909b-83e1-c187b6662f06", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e841bf6b-ef5a-909b-83e1-c187b6662f06", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "faaf08b6-f262-f618-fbe2-7e9fc1fa0da7" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-09-23T02:48:04+02:00", "end": "2002-09-23T02:48:04+02:00" }, "created": "2001-09-23T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:faaf08b6-f262-f618-fbe2-7e9fc1fa0da7" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:18adf5c9-1f2e-73c1-e319-252ed4db9c21" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "servicedPeriod": { "start": "2001-09-23T02:33:04+02:00", "end": "2001-09-23T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:264e1c01-b2f5-1c2a-76fa-748fb47aefb4" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "232353008", "display": "Perennial allergic rhinitis with seasonal variation" } ], "text": "Perennial allergic rhinitis with seasonal variation" }, "servicedPeriod": { "start": "2001-09-23T02:33:04+02:00", "end": "2001-09-23T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 85.55, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a", "resource": { "resourceType": "Encounter", "id": "31784a9d-90f0-2ea6-c235-fcd69952ed8a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "31784a9d-90f0-2ea6-c235-fcd69952ed8a" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem" } ], "text": "Encounter for problem" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2001-10-05T07:33:04+02:00", "end": "2001-10-05T07:55:26+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2001-10-05T07:33:04+02:00", "end": "2001-10-05T07:55:26+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "419199007", "display": "Allergy to substance (finding)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:abc15507-401b-e7ba-690c-c9f6003aaebb", "resource": { "resourceType": "AllergyIntolerance", "id": "abc15507-401b-e7ba-690c-c9f6003aaebb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", "code": "confirmed" } ] }, "type": "allergy", "category": [ "environment" ], "criticality": "low", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "419199007", "display": "Allergy to substance (finding)" } ], "text": "Allergy to substance (finding)" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "recordedDate": "2001-10-05T07:33:04+02:00" }, "request": { "method": "POST", "url": "AllergyIntolerance" } }, { "fullUrl": "urn:uuid:e74ebbbb-22fd-b4ef-012e-4b7769049a44", "resource": { "resourceType": "AllergyIntolerance", "id": "e74ebbbb-22fd-b4ef-012e-4b7769049a44", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", "code": "confirmed" } ] }, "type": "allergy", "category": [ "environment" ], "criticality": "low", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "84489001", "display": "Mold (organism)" } ], "text": "Mold (organism)" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "recordedDate": "2001-10-05T07:33:04+02:00", "reaction": [ { "manifestation": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "21626009", "display": "Allergic skin rash" } ], "text": "Allergic skin rash" } ] }, { "manifestation": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "267101005", "display": "Nose running" } ], "text": "Nose running" } ] } ] }, "request": { "method": "POST", "url": "AllergyIntolerance" } }, { "fullUrl": "urn:uuid:40fd4231-9b3a-101b-2fff-0921d47444cd", "resource": { "resourceType": "AllergyIntolerance", "id": "40fd4231-9b3a-101b-2fff-0921d47444cd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", "code": "confirmed" } ] }, "type": "allergy", "category": [ "environment" ], "criticality": "low", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "260147004", "display": "House dust mite (organism)" } ], "text": "House dust mite (organism)" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "recordedDate": "2001-10-05T07:33:04+02:00" }, "request": { "method": "POST", "url": "AllergyIntolerance" } }, { "fullUrl": "urn:uuid:12f85cb2-b2ca-1c86-90bc-34b4d0ab9018", "resource": { "resourceType": "AllergyIntolerance", "id": "12f85cb2-b2ca-1c86-90bc-34b4d0ab9018", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", "code": "confirmed" } ] }, "type": "allergy", "category": [ "environment" ], "criticality": "low", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "264287008", "display": "Animal dander (substance)" } ], "text": "Animal dander (substance)" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "recordedDate": "2001-10-05T07:33:04+02:00", "reaction": [ { "manifestation": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "271807003", "display": "Eruption of skin (disorder)" } ], "text": "Eruption of skin (disorder)" } ] }, { "manifestation": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "878820003", "display": "Rhinoconjunctivitis (disorder)" } ], "text": "Rhinoconjunctivitis (disorder)" } ] } ] }, "request": { "method": "POST", "url": "AllergyIntolerance" } }, { "fullUrl": "urn:uuid:b462dbf8-926f-ceab-1b77-b71ca53ef471", "resource": { "resourceType": "AllergyIntolerance", "id": "b462dbf8-926f-ceab-1b77-b71ca53ef471", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", "code": "confirmed" } ] }, "type": "allergy", "category": [ "environment" ], "criticality": "low", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "256277009", "display": "Grass pollen (substance)" } ], "text": "Grass pollen (substance)" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "recordedDate": "2001-10-05T07:33:04+02:00" }, "request": { "method": "POST", "url": "AllergyIntolerance" } }, { "fullUrl": "urn:uuid:f3d91d50-f61d-6088-8e9a-e0b8869fb85d", "resource": { "resourceType": "AllergyIntolerance", "id": "f3d91d50-f61d-6088-8e9a-e0b8869fb85d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", "code": "confirmed" } ] }, "type": "allergy", "category": [ "environment" ], "criticality": "low", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "782576004", "display": "Tree pollen (substance)" } ], "text": "Tree pollen (substance)" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "recordedDate": "2001-10-05T07:33:04+02:00" }, "request": { "method": "POST", "url": "AllergyIntolerance" } }, { "fullUrl": "urn:uuid:2e5f1a9e-4bf2-f0aa-4ef3-f8175bd3e144", "resource": { "resourceType": "MedicationRequest", "id": "2e5f1a9e-4bf2-f0aa-4ef3-f8175bd3e144", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "1870230", "display": "NDA020800 0.3 ML Epinephrine 1 MG/ML Auto-Injector" } ], "text": "NDA020800 0.3 ML Epinephrine 1 MG/ML Auto-Injector" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a" }, "authoredOn": "2001-10-05T07:55:26+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:324b079f-bb86-524b-ada2-98338cc7c380", "resource": { "resourceType": "Claim", "id": "324b079f-bb86-524b-ada2-98338cc7c380", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-10-05T07:33:04+02:00", "end": "2001-10-05T07:55:26+02:00" }, "created": "2001-10-05T07:55:26+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:2e5f1a9e-4bf2-f0aa-4ef3-f8175bd3e144" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "1870230", "display": "NDA020800 0.3 ML Epinephrine 1 MG/ML Auto-Injector" } ], "text": "NDA020800 0.3 ML Epinephrine 1 MG/ML Auto-Injector" }, "encounter": [ { "reference": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a" } ] } ], "total": { "value": 57.07, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:062bef58-1d8c-e77e-0847-ba52f322831e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "062bef58-1d8c-e77e-0847-ba52f322831e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "324b079f-bb86-524b-ada2-98338cc7c380" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-10-05T07:55:26+02:00", "end": "2002-10-05T07:55:26+02:00" }, "created": "2001-10-05T07:55:26+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:324b079f-bb86-524b-ada2-98338cc7c380" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "1870230", "display": "NDA020800 0.3 ML Epinephrine 1 MG/ML Auto-Injector" } ], "text": "NDA020800 0.3 ML Epinephrine 1 MG/ML Auto-Injector" }, "servicedPeriod": { "start": "2001-10-05T07:33:04+02:00", "end": "2001-10-05T07:55:26+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 57.07, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a52ad7c8-1728-a668-7ac0-736819447163", "resource": { "resourceType": "CareTeam", "id": "a52ad7c8-1728-a668-7ac0-736819447163", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "active", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a" }, "period": { "start": "2001-10-05T07:55:26+02:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:034b4457-2110-43d0-4920-3c84a46fbd89", "resource": { "resourceType": "CarePlan", "id": "034b4457-2110-43d0-4920-3c84a46fbd89", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Self-care interventions (procedure).
Activities:
" }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "384758001", "display": "Self-care interventions (procedure)" } ], "text": "Self-care interventions (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a" }, "period": { "start": "2001-10-05T07:55:26+02:00" }, "careTeam": [ { "reference": "urn:uuid:a52ad7c8-1728-a668-7ac0-736819447163" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "58332002", "display": "Allergy education" } ], "text": "Allergy education" }, "status": "in-progress", "location": { "display": "WP ACQUISITION SUB LLC" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:19a34113-e01d-8f36-842b-26ebb75d9350", "resource": { "resourceType": "DiagnosticReport", "id": "19a34113-e01d-8f36-842b-26ebb75d9350", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a" }, "effectiveDateTime": "2001-10-05T07:33:04+02:00", "issued": "2001-10-05T07:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:a91b6ca7-fd67-0959-a93c-3ffc3c95c713", "resource": { "resourceType": "DocumentReference", "id": "a91b6ca7-fd67-0959-a93c-3ffc3c95c713", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:19a34113-e01d-8f36-842b-26ebb75d9350" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2001-10-05T07:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a" } ], "period": { "start": "2001-10-05T07:33:04+02:00", "end": "2001-10-05T07:55:26+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:555471b9-f194-69fc-9b6e-1cca01c18f15", "resource": { "resourceType": "Claim", "id": "555471b9-f194-69fc-9b6e-1cca01c18f15", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2001-10-05T07:33:04+02:00", "end": "2001-10-05T07:55:26+02:00" }, "created": "2001-10-05T07:55:26+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem" } ], "text": "Encounter for problem" }, "encounter": [ { "reference": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a" } ] } ], "total": { "value": 516.95, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:5a189ea3-cc1f-7a2f-c9ad-fba3dcfdd1fb", "resource": { "resourceType": "ExplanationOfBenefit", "id": "5a189ea3-cc1f-7a2f-c9ad-fba3dcfdd1fb", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "555471b9-f194-69fc-9b6e-1cca01c18f15" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-10-05T07:55:26+02:00", "end": "2002-10-05T07:55:26+02:00" }, "created": "2001-10-05T07:55:26+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:555471b9-f194-69fc-9b6e-1cca01c18f15" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem" } ], "text": "Encounter for problem" }, "servicedPeriod": { "start": "2001-10-05T07:33:04+02:00", "end": "2001-10-05T07:55:26+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 516.95, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7", "resource": { "resourceType": "Encounter", "id": "dfe23694-5d6e-947d-3f4f-65dfdfbe9af7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2001-11-17T01:33:04+01:00", "end": "2001-11-17T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2001-11-17T01:33:04+01:00", "end": "2001-11-17T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:b7248dd9-e8b1-7f02-29e7-3b1296646750", "resource": { "resourceType": "Condition", "id": "b7248dd9-e8b1-7f02-29e7-3b1296646750", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" }, "onsetDateTime": "2001-11-17T01:33:04+01:00", "abatementDateTime": "2001-11-17T01:33:04+01:00", "recordedDate": "2001-11-17T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:4ae8f427-4835-f569-b753-2b1b9f3ed551", "resource": { "resourceType": "MedicationRequest", "id": "4ae8f427-4835-f569-b753-2b1b9f3ed551", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" }, "authoredOn": "2001-11-17T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:716ed276-789f-dd12-2056-f75b5e7afc87", "resource": { "resourceType": "Claim", "id": "716ed276-789f-dd12-2056-f75b5e7afc87", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-11-17T01:33:04+01:00", "end": "2001-11-17T01:48:04+01:00" }, "created": "2001-11-17T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:4ae8f427-4835-f569-b753-2b1b9f3ed551" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:60af4343-cbb4-3267-6136-3973aa5ed94f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "60af4343-cbb4-3267-6136-3973aa5ed94f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "716ed276-789f-dd12-2056-f75b5e7afc87" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-11-17T01:48:04+01:00", "end": "2002-11-17T01:48:04+01:00" }, "created": "2001-11-17T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:716ed276-789f-dd12-2056-f75b5e7afc87" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2001-11-17T01:33:04+01:00", "end": "2001-11-17T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:6cdb7345-1bd7-4872-5f68-9edbd5e48d76", "resource": { "resourceType": "MedicationRequest", "id": "6cdb7345-1bd7-4872-5f68-9edbd5e48d76", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" }, "authoredOn": "2001-11-17T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:41686bf5-eb9c-3eb0-66d5-c2c939216d02", "resource": { "resourceType": "Claim", "id": "41686bf5-eb9c-3eb0-66d5-c2c939216d02", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-11-17T01:33:04+01:00", "end": "2001-11-17T01:48:04+01:00" }, "created": "2001-11-17T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:6cdb7345-1bd7-4872-5f68-9edbd5e48d76" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:1849a4ca-16e9-4a56-186b-62560e93f410", "resource": { "resourceType": "ExplanationOfBenefit", "id": "1849a4ca-16e9-4a56-186b-62560e93f410", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "41686bf5-eb9c-3eb0-66d5-c2c939216d02" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-11-17T01:48:04+01:00", "end": "2002-11-17T01:48:04+01:00" }, "created": "2001-11-17T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:41686bf5-eb9c-3eb0-66d5-c2c939216d02" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2001-11-17T01:33:04+01:00", "end": "2001-11-17T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f705dfac-eb17-93ab-dcdd-96ecef31fe33", "resource": { "resourceType": "DiagnosticReport", "id": "f705dfac-eb17-93ab-dcdd-96ecef31fe33", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" }, "effectiveDateTime": "2001-11-17T01:33:04+01:00", "issued": "2001-11-17T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:60784316-9960-a220-33cc-8245571aa241", "resource": { "resourceType": "DocumentReference", "id": "60784316-9960-a220-33cc-8245571aa241", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:f705dfac-eb17-93ab-dcdd-96ecef31fe33" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2001-11-17T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" } ], "period": { "start": "2001-11-17T01:33:04+01:00", "end": "2001-11-17T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:ecacf1bc-a8bf-4b77-eb99-6d302bce20c4", "resource": { "resourceType": "Claim", "id": "ecacf1bc-a8bf-4b77-eb99-6d302bce20c4", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2001-11-17T01:33:04+01:00", "end": "2001-11-17T01:48:04+01:00" }, "created": "2001-11-17T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:b7248dd9-e8b1-7f02-29e7-3b1296646750" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 645.09, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:728380fa-6e82-db5f-68b3-5fa5156adbe6", "resource": { "resourceType": "ExplanationOfBenefit", "id": "728380fa-6e82-db5f-68b3-5fa5156adbe6", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "ecacf1bc-a8bf-4b77-eb99-6d302bce20c4" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2001-11-17T01:48:04+01:00", "end": "2002-11-17T01:48:04+01:00" }, "created": "2001-11-17T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:ecacf1bc-a8bf-4b77-eb99-6d302bce20c4" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:b7248dd9-e8b1-7f02-29e7-3b1296646750" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2001-11-17T01:33:04+01:00", "end": "2001-11-17T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2001-11-17T01:33:04+01:00", "end": "2001-11-17T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 645.09, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b", "resource": { "resourceType": "Encounter", "id": "da466a64-2755-7239-8496-4668c24a794b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "da466a64-2755-7239-8496-4668c24a794b" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2002-11-23T01:33:04+01:00", "end": "2002-11-23T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2002-11-23T01:33:04+01:00", "end": "2002-11-23T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:2174178a-cf33-cb7d-508b-67bff9052732", "resource": { "resourceType": "Condition", "id": "2174178a-cf33-cb7d-508b-67bff9052732", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" }, "onsetDateTime": "2002-11-23T01:33:04+01:00", "abatementDateTime": "2002-11-23T01:33:04+01:00", "recordedDate": "2002-11-23T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:0ef87740-99de-ba77-93cf-7b2dabc0cfc2", "resource": { "resourceType": "MedicationRequest", "id": "0ef87740-99de-ba77-93cf-7b2dabc0cfc2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" }, "authoredOn": "2002-11-23T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:57e7e426-fb74-2445-bf9d-2096160393ca", "resource": { "resourceType": "Claim", "id": "57e7e426-fb74-2445-bf9d-2096160393ca", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2002-11-23T01:33:04+01:00", "end": "2002-11-23T01:48:04+01:00" }, "created": "2002-11-23T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:0ef87740-99de-ba77-93cf-7b2dabc0cfc2" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:4ddf5959-936b-97ae-4e22-e35eb168eb22", "resource": { "resourceType": "ExplanationOfBenefit", "id": "4ddf5959-936b-97ae-4e22-e35eb168eb22", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "57e7e426-fb74-2445-bf9d-2096160393ca" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2002-11-23T01:48:04+01:00", "end": "2003-11-23T01:48:04+01:00" }, "created": "2002-11-23T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:57e7e426-fb74-2445-bf9d-2096160393ca" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2002-11-23T01:33:04+01:00", "end": "2002-11-23T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:c5710de5-9da5-c71c-e074-9491ca9216dd", "resource": { "resourceType": "MedicationRequest", "id": "c5710de5-9da5-c71c-e074-9491ca9216dd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" }, "authoredOn": "2002-11-23T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:d2045137-c939-ddc5-31e0-9d143fedc09d", "resource": { "resourceType": "Claim", "id": "d2045137-c939-ddc5-31e0-9d143fedc09d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2002-11-23T01:33:04+01:00", "end": "2002-11-23T01:48:04+01:00" }, "created": "2002-11-23T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:c5710de5-9da5-c71c-e074-9491ca9216dd" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:42eb6ad9-0194-5c28-12ec-7901160c517e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "42eb6ad9-0194-5c28-12ec-7901160c517e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "d2045137-c939-ddc5-31e0-9d143fedc09d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2002-11-23T01:48:04+01:00", "end": "2003-11-23T01:48:04+01:00" }, "created": "2002-11-23T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:d2045137-c939-ddc5-31e0-9d143fedc09d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2002-11-23T01:33:04+01:00", "end": "2002-11-23T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:9c1ad13e-b12c-1d0b-fb77-d14f1ad63ca2", "resource": { "resourceType": "DiagnosticReport", "id": "9c1ad13e-b12c-1d0b-fb77-d14f1ad63ca2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" }, "effectiveDateTime": "2002-11-23T01:33:04+01:00", "issued": "2002-11-23T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:cc75d68e-3094-6838-1d72-91851894eb86", "resource": { "resourceType": "DocumentReference", "id": "cc75d68e-3094-6838-1d72-91851894eb86", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:9c1ad13e-b12c-1d0b-fb77-d14f1ad63ca2" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2002-11-23T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" } ], "period": { "start": "2002-11-23T01:33:04+01:00", "end": "2002-11-23T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:06def112-151b-e3e3-5798-75b515b74a8b", "resource": { "resourceType": "Claim", "id": "06def112-151b-e3e3-5798-75b515b74a8b", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2002-11-23T01:33:04+01:00", "end": "2002-11-23T01:48:04+01:00" }, "created": "2002-11-23T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:2174178a-cf33-cb7d-508b-67bff9052732" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 710.45, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:c2cc5c33-82e8-7229-42d4-cd7426a81c98", "resource": { "resourceType": "ExplanationOfBenefit", "id": "c2cc5c33-82e8-7229-42d4-cd7426a81c98", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "06def112-151b-e3e3-5798-75b515b74a8b" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2002-11-23T01:48:04+01:00", "end": "2003-11-23T01:48:04+01:00" }, "created": "2002-11-23T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:06def112-151b-e3e3-5798-75b515b74a8b" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:2174178a-cf33-cb7d-508b-67bff9052732" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2002-11-23T01:33:04+01:00", "end": "2002-11-23T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2002-11-23T01:33:04+01:00", "end": "2002-11-23T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 710.45, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea", "resource": { "resourceType": "Encounter", "id": "c98100bf-b598-0df9-d251-59f3ab049bea", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "c98100bf-b598-0df9-d251-59f3ab049bea" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2003-11-29T01:33:04+01:00", "end": "2003-11-29T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2003-11-29T01:33:04+01:00", "end": "2003-11-29T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:ea693a0b-2b8c-59b7-84de-0ece5f5ba2e8", "resource": { "resourceType": "Condition", "id": "ea693a0b-2b8c-59b7-84de-0ece5f5ba2e8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" }, "onsetDateTime": "2003-11-29T01:33:04+01:00", "abatementDateTime": "2008-12-27T01:33:04+01:00", "recordedDate": "2003-11-29T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:1d660c9f-eb80-0294-c601-4b1523432192", "resource": { "resourceType": "MedicationRequest", "id": "1d660c9f-eb80-0294-c601-4b1523432192", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" }, "authoredOn": "2003-11-29T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:1164e257-dd31-8eaf-5148-abf7fbcd53cb", "resource": { "resourceType": "Claim", "id": "1164e257-dd31-8eaf-5148-abf7fbcd53cb", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2003-11-29T01:33:04+01:00", "end": "2003-11-29T01:48:04+01:00" }, "created": "2003-11-29T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:1d660c9f-eb80-0294-c601-4b1523432192" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f5c68465-80eb-1627-493a-84a919dd62cd", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f5c68465-80eb-1627-493a-84a919dd62cd", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "1164e257-dd31-8eaf-5148-abf7fbcd53cb" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2003-11-29T01:48:04+01:00", "end": "2004-11-29T01:48:04+01:00" }, "created": "2003-11-29T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:1164e257-dd31-8eaf-5148-abf7fbcd53cb" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2003-11-29T01:33:04+01:00", "end": "2003-11-29T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:c69f1162-cf7c-326f-3a35-def3c7d84b00", "resource": { "resourceType": "MedicationRequest", "id": "c69f1162-cf7c-326f-3a35-def3c7d84b00", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" }, "authoredOn": "2003-11-29T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:b8772386-bce8-c9fe-ceac-b7e22e2168f6", "resource": { "resourceType": "Claim", "id": "b8772386-bce8-c9fe-ceac-b7e22e2168f6", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2003-11-29T01:33:04+01:00", "end": "2003-11-29T01:48:04+01:00" }, "created": "2003-11-29T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:c69f1162-cf7c-326f-3a35-def3c7d84b00" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:6102e266-d3ad-180d-f368-0d0273af34d4", "resource": { "resourceType": "ExplanationOfBenefit", "id": "6102e266-d3ad-180d-f368-0d0273af34d4", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b8772386-bce8-c9fe-ceac-b7e22e2168f6" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2003-11-29T01:48:04+01:00", "end": "2004-11-29T01:48:04+01:00" }, "created": "2003-11-29T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:b8772386-bce8-c9fe-ceac-b7e22e2168f6" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2003-11-29T01:33:04+01:00", "end": "2003-11-29T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:1efe7cfd-80e0-de1d-f6b5-bd019b4b6602", "resource": { "resourceType": "DiagnosticReport", "id": "1efe7cfd-80e0-de1d-f6b5-bd019b4b6602", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" }, "effectiveDateTime": "2003-11-29T01:33:04+01:00", "issued": "2003-11-29T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:e1d44762-4a6e-a798-3613-7620046ec86c", "resource": { "resourceType": "DocumentReference", "id": "e1d44762-4a6e-a798-3613-7620046ec86c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:1efe7cfd-80e0-de1d-f6b5-bd019b4b6602" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2003-11-29T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" } ], "period": { "start": "2003-11-29T01:33:04+01:00", "end": "2003-11-29T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:544f5a28-f501-ed6b-2e0c-943bc280b6c6", "resource": { "resourceType": "Claim", "id": "544f5a28-f501-ed6b-2e0c-943bc280b6c6", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2003-11-29T01:33:04+01:00", "end": "2003-11-29T01:48:04+01:00" }, "created": "2003-11-29T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:ea693a0b-2b8c-59b7-84de-0ece5f5ba2e8" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 272.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:d8530964-254a-dde3-73f3-0b80ecdd430e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "d8530964-254a-dde3-73f3-0b80ecdd430e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "544f5a28-f501-ed6b-2e0c-943bc280b6c6" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2003-11-29T01:48:04+01:00", "end": "2004-11-29T01:48:04+01:00" }, "created": "2003-11-29T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:544f5a28-f501-ed6b-2e0c-943bc280b6c6" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:ea693a0b-2b8c-59b7-84de-0ece5f5ba2e8" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2003-11-29T01:33:04+01:00", "end": "2003-11-29T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2003-11-29T01:33:04+01:00", "end": "2003-11-29T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 272.80, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3", "resource": { "resourceType": "Encounter", "id": "903e8c98-6b8a-b6e8-275d-110c1b5610a3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "903e8c98-6b8a-b6e8-275d-110c1b5610a3" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2004-12-04T01:33:04+01:00", "end": "2004-12-04T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2004-12-04T01:33:04+01:00", "end": "2004-12-04T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:c856614d-e193-d3e3-9f3c-8eaa722e3da0", "resource": { "resourceType": "MedicationRequest", "id": "c856614d-e193-d3e3-9f3c-8eaa722e3da0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" }, "authoredOn": "2004-12-04T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:02b19754-d8f2-1363-b265-991b1715c641", "resource": { "resourceType": "Claim", "id": "02b19754-d8f2-1363-b265-991b1715c641", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2004-12-04T01:33:04+01:00", "end": "2004-12-04T01:48:04+01:00" }, "created": "2004-12-04T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:c856614d-e193-d3e3-9f3c-8eaa722e3da0" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:06deae69-1c93-2af4-dc15-ee6d571122a8", "resource": { "resourceType": "ExplanationOfBenefit", "id": "06deae69-1c93-2af4-dc15-ee6d571122a8", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "02b19754-d8f2-1363-b265-991b1715c641" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2004-12-04T01:48:04+01:00", "end": "2005-12-04T01:48:04+01:00" }, "created": "2004-12-04T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:02b19754-d8f2-1363-b265-991b1715c641" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2004-12-04T01:33:04+01:00", "end": "2004-12-04T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3af36b65-94e7-85a9-64c3-ce48005378df", "resource": { "resourceType": "MedicationRequest", "id": "3af36b65-94e7-85a9-64c3-ce48005378df", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" }, "authoredOn": "2004-12-04T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:171ddc65-854c-656d-6345-322467b41b1a", "resource": { "resourceType": "Claim", "id": "171ddc65-854c-656d-6345-322467b41b1a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2004-12-04T01:33:04+01:00", "end": "2004-12-04T01:48:04+01:00" }, "created": "2004-12-04T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:3af36b65-94e7-85a9-64c3-ce48005378df" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e1233bf3-8375-d5bd-36f3-3d0222f3c2f3", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e1233bf3-8375-d5bd-36f3-3d0222f3c2f3", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "171ddc65-854c-656d-6345-322467b41b1a" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2004-12-04T01:48:04+01:00", "end": "2005-12-04T01:48:04+01:00" }, "created": "2004-12-04T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:171ddc65-854c-656d-6345-322467b41b1a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2004-12-04T01:33:04+01:00", "end": "2004-12-04T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:5aecd128-6898-c947-fce6-471e3899cfe1", "resource": { "resourceType": "DiagnosticReport", "id": "5aecd128-6898-c947-fce6-471e3899cfe1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" }, "effectiveDateTime": "2004-12-04T01:33:04+01:00", "issued": "2004-12-04T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:f8213190-3e24-2e38-0056-06a009d39cb9", "resource": { "resourceType": "DocumentReference", "id": "f8213190-3e24-2e38-0056-06a009d39cb9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:5aecd128-6898-c947-fce6-471e3899cfe1" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2004-12-04T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" } ], "period": { "start": "2004-12-04T01:33:04+01:00", "end": "2004-12-04T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:69939375-3e77-d219-2790-19f4fd6037a2", "resource": { "resourceType": "Claim", "id": "69939375-3e77-d219-2790-19f4fd6037a2", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2004-12-04T01:33:04+01:00", "end": "2004-12-04T01:48:04+01:00" }, "created": "2004-12-04T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" } ] } ], "total": { "value": 272.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:3bfae7c7-72ba-cacf-1665-836774d809cb", "resource": { "resourceType": "ExplanationOfBenefit", "id": "3bfae7c7-72ba-cacf-1665-836774d809cb", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "69939375-3e77-d219-2790-19f4fd6037a2" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2004-12-04T01:48:04+01:00", "end": "2005-12-04T01:48:04+01:00" }, "created": "2004-12-04T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:69939375-3e77-d219-2790-19f4fd6037a2" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2004-12-04T01:33:04+01:00", "end": "2004-12-04T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 272.80, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3", "resource": { "resourceType": "Encounter", "id": "b0715590-981e-cbfd-987d-2d48204f3bd3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "b0715590-981e-cbfd-987d-2d48204f3bd3" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2005-12-10T01:33:04+01:00", "end": "2005-12-10T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2005-12-10T01:33:04+01:00", "end": "2005-12-10T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:7d1d9382-7d74-65d7-e3ff-3d8a758fc365", "resource": { "resourceType": "MedicationRequest", "id": "7d1d9382-7d74-65d7-e3ff-3d8a758fc365", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" }, "authoredOn": "2005-12-10T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:7d2b0830-9286-fe5d-c832-2148748012cb", "resource": { "resourceType": "Claim", "id": "7d2b0830-9286-fe5d-c832-2148748012cb", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2005-12-10T01:33:04+01:00", "end": "2005-12-10T01:48:04+01:00" }, "created": "2005-12-10T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:7d1d9382-7d74-65d7-e3ff-3d8a758fc365" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:782557b9-057c-41b6-221a-ab2d05bff883", "resource": { "resourceType": "ExplanationOfBenefit", "id": "782557b9-057c-41b6-221a-ab2d05bff883", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "7d2b0830-9286-fe5d-c832-2148748012cb" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2005-12-10T01:48:04+01:00", "end": "2006-12-10T01:48:04+01:00" }, "created": "2005-12-10T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:7d2b0830-9286-fe5d-c832-2148748012cb" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2005-12-10T01:33:04+01:00", "end": "2005-12-10T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:bf6bb1c7-e489-4ec1-e08d-f05ede245003", "resource": { "resourceType": "MedicationRequest", "id": "bf6bb1c7-e489-4ec1-e08d-f05ede245003", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" }, "authoredOn": "2005-12-10T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:465c5569-39ec-f7c0-212e-734a78b44ea4", "resource": { "resourceType": "Claim", "id": "465c5569-39ec-f7c0-212e-734a78b44ea4", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2005-12-10T01:33:04+01:00", "end": "2005-12-10T01:48:04+01:00" }, "created": "2005-12-10T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:bf6bb1c7-e489-4ec1-e08d-f05ede245003" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:1e92ad90-11c6-c494-1ea3-9b433c4419f1", "resource": { "resourceType": "ExplanationOfBenefit", "id": "1e92ad90-11c6-c494-1ea3-9b433c4419f1", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "465c5569-39ec-f7c0-212e-734a78b44ea4" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2005-12-10T01:48:04+01:00", "end": "2006-12-10T01:48:04+01:00" }, "created": "2005-12-10T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:465c5569-39ec-f7c0-212e-734a78b44ea4" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2005-12-10T01:33:04+01:00", "end": "2005-12-10T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:4c963acb-dfd4-0dc9-b71e-20a3971411e3", "resource": { "resourceType": "DiagnosticReport", "id": "4c963acb-dfd4-0dc9-b71e-20a3971411e3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" }, "effectiveDateTime": "2005-12-10T01:33:04+01:00", "issued": "2005-12-10T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:c60af63f-9534-c957-c62b-c993d4638711", "resource": { "resourceType": "DocumentReference", "id": "c60af63f-9534-c957-c62b-c993d4638711", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:4c963acb-dfd4-0dc9-b71e-20a3971411e3" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2005-12-10T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" } ], "period": { "start": "2005-12-10T01:33:04+01:00", "end": "2005-12-10T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:bb2660f1-23cf-7296-3b31-c06f5c0d3bbb", "resource": { "resourceType": "Claim", "id": "bb2660f1-23cf-7296-3b31-c06f5c0d3bbb", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2005-12-10T01:33:04+01:00", "end": "2005-12-10T01:48:04+01:00" }, "created": "2005-12-10T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" } ] } ], "total": { "value": 272.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:fcafae6d-6973-c1bd-509a-555569fb2f57", "resource": { "resourceType": "ExplanationOfBenefit", "id": "fcafae6d-6973-c1bd-509a-555569fb2f57", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "bb2660f1-23cf-7296-3b31-c06f5c0d3bbb" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2005-12-10T01:48:04+01:00", "end": "2006-12-10T01:48:04+01:00" }, "created": "2005-12-10T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:bb2660f1-23cf-7296-3b31-c06f5c0d3bbb" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2005-12-10T01:33:04+01:00", "end": "2005-12-10T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 272.80, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69", "resource": { "resourceType": "Encounter", "id": "d238ca71-aa51-e758-bd5f-deb98b744c69", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "d238ca71-aa51-e758-bd5f-deb98b744c69" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2006-12-16T01:33:04+01:00", "end": "2006-12-16T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2006-12-16T01:33:04+01:00", "end": "2006-12-16T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:d2ebe8ce-2ef8-2377-d98b-a77e0e984539", "resource": { "resourceType": "MedicationRequest", "id": "d2ebe8ce-2ef8-2377-d98b-a77e0e984539", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" }, "authoredOn": "2006-12-16T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:ce4420ba-d4ed-4702-3425-5ecfee9cb6fe", "resource": { "resourceType": "Claim", "id": "ce4420ba-d4ed-4702-3425-5ecfee9cb6fe", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2006-12-16T01:33:04+01:00", "end": "2006-12-16T01:48:04+01:00" }, "created": "2006-12-16T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:d2ebe8ce-2ef8-2377-d98b-a77e0e984539" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:7b5a9834-1521-ff3d-7f96-f3d19ef7367d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "7b5a9834-1521-ff3d-7f96-f3d19ef7367d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "ce4420ba-d4ed-4702-3425-5ecfee9cb6fe" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2006-12-16T01:48:04+01:00", "end": "2007-12-16T01:48:04+01:00" }, "created": "2006-12-16T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:ce4420ba-d4ed-4702-3425-5ecfee9cb6fe" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2006-12-16T01:33:04+01:00", "end": "2006-12-16T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:2cc6f626-c557-5d07-1eaa-f36339c8d44c", "resource": { "resourceType": "MedicationRequest", "id": "2cc6f626-c557-5d07-1eaa-f36339c8d44c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" }, "authoredOn": "2006-12-16T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:309a3b3c-12aa-6105-8022-c31dba8142d9", "resource": { "resourceType": "Claim", "id": "309a3b3c-12aa-6105-8022-c31dba8142d9", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2006-12-16T01:33:04+01:00", "end": "2006-12-16T01:48:04+01:00" }, "created": "2006-12-16T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:2cc6f626-c557-5d07-1eaa-f36339c8d44c" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:1c8c34dd-8134-7cc9-ba16-0a14c138b924", "resource": { "resourceType": "ExplanationOfBenefit", "id": "1c8c34dd-8134-7cc9-ba16-0a14c138b924", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "309a3b3c-12aa-6105-8022-c31dba8142d9" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2006-12-16T01:48:04+01:00", "end": "2007-12-16T01:48:04+01:00" }, "created": "2006-12-16T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:309a3b3c-12aa-6105-8022-c31dba8142d9" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2006-12-16T01:33:04+01:00", "end": "2006-12-16T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f0e32901-91b9-00bf-5f63-313666c8cc6f", "resource": { "resourceType": "DiagnosticReport", "id": "f0e32901-91b9-00bf-5f63-313666c8cc6f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" }, "effectiveDateTime": "2006-12-16T01:33:04+01:00", "issued": "2006-12-16T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "CjIwMDYtMTItMTYKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMTEgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKSwgcGVyZW5uaWFsIGFsbGVyZ2ljIHJoaW5pdGlzIHdpdGggc2Vhc29uYWwgdmFyaWF0aW9uLCBjaGlsZGhvb2QgYXN0aG1hLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgoKClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCmJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uOyBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgoKVGhlIHBhdGllbnQgd2FzIHByZXNjcmliZWQgdGhlIGZvbGxvd2luZyBtZWRpY2F0aW9uczoKLSBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQotIGJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uCg==" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:8ec2d7b4-127f-3643-0d20-532812c0dcec", "resource": { "resourceType": "DocumentReference", "id": "8ec2d7b4-127f-3643-0d20-532812c0dcec", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:f0e32901-91b9-00bf-5f63-313666c8cc6f" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2006-12-16T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" } ], "period": { "start": "2006-12-16T01:33:04+01:00", "end": "2006-12-16T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:e59a7d75-aa7a-588a-1569-f740e43efb60", "resource": { "resourceType": "Claim", "id": "e59a7d75-aa7a-588a-1569-f740e43efb60", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2006-12-16T01:33:04+01:00", "end": "2006-12-16T01:48:04+01:00" }, "created": "2006-12-16T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" } ] } ], "total": { "value": 755.38, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e55bee88-d332-215d-f906-5d08dbaad898", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e55bee88-d332-215d-f906-5d08dbaad898", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e59a7d75-aa7a-588a-1569-f740e43efb60" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2006-12-16T01:48:04+01:00", "end": "2007-12-16T01:48:04+01:00" }, "created": "2006-12-16T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:e59a7d75-aa7a-588a-1569-f740e43efb60" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2006-12-16T01:33:04+01:00", "end": "2006-12-16T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 755.38, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98", "resource": { "resourceType": "Encounter", "id": "f883d9af-7a54-b912-a7cf-5223efebdf98", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "f883d9af-7a54-b912-a7cf-5223efebdf98" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2007-12-22T01:33:04+01:00", "end": "2007-12-22T02:01:46+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2007-12-22T01:33:04+01:00", "end": "2007-12-22T02:01:46+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:79031ad1-246e-7948-724f-7aa102f595c2", "resource": { "resourceType": "MedicationRequest", "id": "79031ad1-246e-7948-724f-7aa102f595c2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" }, "authoredOn": "2007-12-22T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:1ad6d316-2501-0a62-e395-ed2fb1785c9b", "resource": { "resourceType": "Claim", "id": "1ad6d316-2501-0a62-e395-ed2fb1785c9b", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2007-12-22T01:33:04+01:00", "end": "2007-12-22T02:01:46+01:00" }, "created": "2007-12-22T02:01:46+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:79031ad1-246e-7948-724f-7aa102f595c2" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e915eda7-a5fb-6473-3ee5-eeb6f8978189", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e915eda7-a5fb-6473-3ee5-eeb6f8978189", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "1ad6d316-2501-0a62-e395-ed2fb1785c9b" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2007-12-22T02:01:46+01:00", "end": "2008-12-22T02:01:46+01:00" }, "created": "2007-12-22T02:01:46+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:1ad6d316-2501-0a62-e395-ed2fb1785c9b" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2007-12-22T01:33:04+01:00", "end": "2007-12-22T02:01:46+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:4a28e785-6f09-a8b3-6fbd-4afb26e4c77e", "resource": { "resourceType": "MedicationRequest", "id": "4a28e785-6f09-a8b3-6fbd-4afb26e4c77e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" }, "authoredOn": "2007-12-22T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:ecf7fa07-e2d2-c942-ff48-9f2fc8e09f0d", "resource": { "resourceType": "Claim", "id": "ecf7fa07-e2d2-c942-ff48-9f2fc8e09f0d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2007-12-22T01:33:04+01:00", "end": "2007-12-22T02:01:46+01:00" }, "created": "2007-12-22T02:01:46+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:4a28e785-6f09-a8b3-6fbd-4afb26e4c77e" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:89882515-ad56-f90e-a82d-5d4fd7f29910", "resource": { "resourceType": "ExplanationOfBenefit", "id": "89882515-ad56-f90e-a82d-5d4fd7f29910", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "ecf7fa07-e2d2-c942-ff48-9f2fc8e09f0d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2007-12-22T02:01:46+01:00", "end": "2008-12-22T02:01:46+01:00" }, "created": "2007-12-22T02:01:46+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:ecf7fa07-e2d2-c942-ff48-9f2fc8e09f0d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2007-12-22T01:33:04+01:00", "end": "2007-12-22T02:01:46+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:7ec7cfb3-e62c-1fe7-b39c-df7f959a9fef", "resource": { "resourceType": "DiagnosticReport", "id": "7ec7cfb3-e62c-1fe7-b39c-df7f959a9fef", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" }, "effectiveDateTime": "2007-12-22T01:33:04+01:00", "issued": "2007-12-22T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "CjIwMDctMTItMjIKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMTIgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKSwgcGVyZW5uaWFsIGFsbGVyZ2ljIHJoaW5pdGlzIHdpdGggc2Vhc29uYWwgdmFyaWF0aW9uLCBjaGlsZGhvb2QgYXN0aG1hLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgoKClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCmJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uOyBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgoKVGhlIHBhdGllbnQgd2FzIHByZXNjcmliZWQgdGhlIGZvbGxvd2luZyBtZWRpY2F0aW9uczoKLSBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQotIGJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uCg==" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:9274cb3d-f444-5c07-0675-0ce49cc2b983", "resource": { "resourceType": "DocumentReference", "id": "9274cb3d-f444-5c07-0675-0ce49cc2b983", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:7ec7cfb3-e62c-1fe7-b39c-df7f959a9fef" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2007-12-22T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" } ], "period": { "start": "2007-12-22T01:33:04+01:00", "end": "2007-12-22T02:01:46+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:b2848d01-81b6-69e4-d4be-d84d4db1957d", "resource": { "resourceType": "Claim", "id": "b2848d01-81b6-69e4-d4be-d84d4db1957d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2007-12-22T01:33:04+01:00", "end": "2007-12-22T02:01:46+01:00" }, "created": "2007-12-22T02:01:46+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" } ] } ], "total": { "value": 840.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:0772b320-550c-9ed3-a38f-c876250dae25", "resource": { "resourceType": "ExplanationOfBenefit", "id": "0772b320-550c-9ed3-a38f-c876250dae25", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b2848d01-81b6-69e4-d4be-d84d4db1957d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2007-12-22T02:01:46+01:00", "end": "2008-12-22T02:01:46+01:00" }, "created": "2007-12-22T02:01:46+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:b2848d01-81b6-69e4-d4be-d84d4db1957d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2007-12-22T01:33:04+01:00", "end": "2007-12-22T02:01:46+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 840.20, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384", "resource": { "resourceType": "Encounter", "id": "f2f546b7-fede-1840-91a7-2cf97710b384", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "f2f546b7-fede-1840-91a7-2cf97710b384" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2008-12-27T01:33:04+01:00", "end": "2008-12-27T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2008-12-27T01:33:04+01:00", "end": "2008-12-27T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:f21a3485-8136-ab7e-c444-bbf73a71e3e3", "resource": { "resourceType": "MedicationRequest", "id": "f21a3485-8136-ab7e-c444-bbf73a71e3e3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" }, "authoredOn": "2008-12-27T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:f9f4ef77-ec4e-ee0f-af76-3c742eea1bd3", "resource": { "resourceType": "Claim", "id": "f9f4ef77-ec4e-ee0f-af76-3c742eea1bd3", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2008-12-27T01:33:04+01:00", "end": "2008-12-27T01:48:04+01:00" }, "created": "2008-12-27T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:f21a3485-8136-ab7e-c444-bbf73a71e3e3" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:0b4d95d3-dd11-ff1d-0f8b-cf173be7365d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "0b4d95d3-dd11-ff1d-0f8b-cf173be7365d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "f9f4ef77-ec4e-ee0f-af76-3c742eea1bd3" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2008-12-27T01:48:04+01:00", "end": "2009-12-27T01:48:04+01:00" }, "created": "2008-12-27T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:f9f4ef77-ec4e-ee0f-af76-3c742eea1bd3" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2008-12-27T01:33:04+01:00", "end": "2008-12-27T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:074b6590-38da-19e9-8004-ec4276a378c7", "resource": { "resourceType": "MedicationRequest", "id": "074b6590-38da-19e9-8004-ec4276a378c7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" }, "authoredOn": "2008-12-27T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:475e27cc-df8f-fad7-defd-bffcb987f4c4", "resource": { "resourceType": "Claim", "id": "475e27cc-df8f-fad7-defd-bffcb987f4c4", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2008-12-27T01:33:04+01:00", "end": "2008-12-27T01:48:04+01:00" }, "created": "2008-12-27T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:074b6590-38da-19e9-8004-ec4276a378c7" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f7c48473-3974-3626-4b38-84b71d086c14", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f7c48473-3974-3626-4b38-84b71d086c14", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "475e27cc-df8f-fad7-defd-bffcb987f4c4" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2008-12-27T01:48:04+01:00", "end": "2009-12-27T01:48:04+01:00" }, "created": "2008-12-27T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:475e27cc-df8f-fad7-defd-bffcb987f4c4" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2008-12-27T01:33:04+01:00", "end": "2008-12-27T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3da0a375-6a53-21a2-b396-737670edc39b", "resource": { "resourceType": "DiagnosticReport", "id": "3da0a375-6a53-21a2-b396-737670edc39b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" }, "effectiveDateTime": "2008-12-27T01:33:04+01:00", "issued": "2008-12-27T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:8fc5e987-f04a-d27d-64d5-b5375ecadab2", "resource": { "resourceType": "DocumentReference", "id": "8fc5e987-f04a-d27d-64d5-b5375ecadab2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:3da0a375-6a53-21a2-b396-737670edc39b" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2008-12-27T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMDgtMTItMjcKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMTMgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKSwgcGVyZW5uaWFsIGFsbGVyZ2ljIHJoaW5pdGlzIHdpdGggc2Vhc29uYWwgdmFyaWF0aW9uLCBjaGlsZGhvb2QgYXN0aG1hLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgoKClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCmJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uOyBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgoKVGhlIHBhdGllbnQgd2FzIHByZXNjcmliZWQgdGhlIGZvbGxvd2luZyBtZWRpY2F0aW9uczoKLSBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQotIGJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uCg==" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" } ], "period": { "start": "2008-12-27T01:33:04+01:00", "end": "2008-12-27T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:f1ea7661-f774-7cb8-6134-e2c9997675d9", "resource": { "resourceType": "Claim", "id": "f1ea7661-f774-7cb8-6134-e2c9997675d9", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2008-12-27T01:33:04+01:00", "end": "2008-12-27T01:48:04+01:00" }, "created": "2008-12-27T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" } ] } ], "total": { "value": 1167.64, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:ec7e033c-7286-ff73-b3a6-6f17196efffb", "resource": { "resourceType": "ExplanationOfBenefit", "id": "ec7e033c-7286-ff73-b3a6-6f17196efffb", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "f1ea7661-f774-7cb8-6134-e2c9997675d9" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2008-12-27T01:48:04+01:00", "end": "2009-12-27T01:48:04+01:00" }, "created": "2008-12-27T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:f1ea7661-f774-7cb8-6134-e2c9997675d9" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2008-12-27T01:33:04+01:00", "end": "2008-12-27T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1167.64, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b", "resource": { "resourceType": "Encounter", "id": "c78dc1cb-ab8d-7766-95eb-28c7d489cb8b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2010-01-02T01:33:04+01:00", "end": "2010-01-02T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2010-01-02T01:33:04+01:00", "end": "2010-01-02T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:89aa883f-f263-95d7-d8b1-e92b17ad48fb", "resource": { "resourceType": "Condition", "id": "89aa883f-f263-95d7-d8b1-e92b17ad48fb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" }, "onsetDateTime": "2010-01-02T01:33:04+01:00", "abatementDateTime": "2011-01-08T01:33:04+01:00", "recordedDate": "2010-01-02T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:88a71dd4-d656-c75c-b055-da30fcd17258", "resource": { "resourceType": "MedicationRequest", "id": "88a71dd4-d656-c75c-b055-da30fcd17258", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" }, "authoredOn": "2010-01-02T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:c717ad7c-6a81-4482-ad01-575f535cba0d", "resource": { "resourceType": "Claim", "id": "c717ad7c-6a81-4482-ad01-575f535cba0d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2010-01-02T01:33:04+01:00", "end": "2010-01-02T01:48:04+01:00" }, "created": "2010-01-02T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:88a71dd4-d656-c75c-b055-da30fcd17258" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:75c80c92-ec7c-2e63-c93c-0cd6defd92f8", "resource": { "resourceType": "ExplanationOfBenefit", "id": "75c80c92-ec7c-2e63-c93c-0cd6defd92f8", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c717ad7c-6a81-4482-ad01-575f535cba0d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2010-01-02T01:48:04+01:00", "end": "2011-01-02T01:48:04+01:00" }, "created": "2010-01-02T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:c717ad7c-6a81-4482-ad01-575f535cba0d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2010-01-02T01:33:04+01:00", "end": "2010-01-02T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3bfa3c3a-f353-39f8-d7f2-11a5d785d85b", "resource": { "resourceType": "MedicationRequest", "id": "3bfa3c3a-f353-39f8-d7f2-11a5d785d85b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" }, "authoredOn": "2010-01-02T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:858d5757-15a2-4491-bb68-3e0fe757da0f", "resource": { "resourceType": "Claim", "id": "858d5757-15a2-4491-bb68-3e0fe757da0f", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2010-01-02T01:33:04+01:00", "end": "2010-01-02T01:48:04+01:00" }, "created": "2010-01-02T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:3bfa3c3a-f353-39f8-d7f2-11a5d785d85b" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:3a5a34c6-e715-15b1-3a9e-27484baa6925", "resource": { "resourceType": "ExplanationOfBenefit", "id": "3a5a34c6-e715-15b1-3a9e-27484baa6925", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "858d5757-15a2-4491-bb68-3e0fe757da0f" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2010-01-02T01:48:04+01:00", "end": "2011-01-02T01:48:04+01:00" }, "created": "2010-01-02T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:858d5757-15a2-4491-bb68-3e0fe757da0f" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2010-01-02T01:33:04+01:00", "end": "2010-01-02T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:fc99b5c3-9d8d-eb53-5bf6-b5d407380aeb", "resource": { "resourceType": "DiagnosticReport", "id": "fc99b5c3-9d8d-eb53-5bf6-b5d407380aeb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" }, "effectiveDateTime": "2010-01-02T01:33:04+01:00", "issued": "2010-01-02T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:dae81992-2ab1-f9fb-2be4-d48912b27d49", "resource": { "resourceType": "DocumentReference", "id": "dae81992-2ab1-f9fb-2be4-d48912b27d49", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:fc99b5c3-9d8d-eb53-5bf6-b5d407380aeb" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2010-01-02T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" } ], "period": { "start": "2010-01-02T01:33:04+01:00", "end": "2010-01-02T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:c92a83b9-f2bb-f263-1e84-61efcf5ca794", "resource": { "resourceType": "Claim", "id": "c92a83b9-f2bb-f263-1e84-61efcf5ca794", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2010-01-02T01:33:04+01:00", "end": "2010-01-02T01:48:04+01:00" }, "created": "2010-01-02T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:89aa883f-f263-95d7-d8b1-e92b17ad48fb" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 704.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:649c2ea0-c61f-2d97-f746-9d20ce9d7dc3", "resource": { "resourceType": "ExplanationOfBenefit", "id": "649c2ea0-c61f-2d97-f746-9d20ce9d7dc3", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c92a83b9-f2bb-f263-1e84-61efcf5ca794" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2010-01-02T01:48:04+01:00", "end": "2011-01-02T01:48:04+01:00" }, "created": "2010-01-02T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:c92a83b9-f2bb-f263-1e84-61efcf5ca794" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:89aa883f-f263-95d7-d8b1-e92b17ad48fb" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2010-01-02T01:33:04+01:00", "end": "2010-01-02T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2010-01-02T01:33:04+01:00", "end": "2010-01-02T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 704.20, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9", "resource": { "resourceType": "Encounter", "id": "b55fc5dd-3f2a-2c16-d67e-d065b02be1e9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2011-01-08T01:33:04+01:00", "end": "2011-01-08T02:01:02+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2011-01-08T01:33:04+01:00", "end": "2011-01-08T02:01:02+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:4ae63bd1-ba15-4781-8453-7771b82ae682", "resource": { "resourceType": "MedicationRequest", "id": "4ae63bd1-ba15-4781-8453-7771b82ae682", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" }, "authoredOn": "2011-01-08T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:800c0f43-821c-9cfd-5079-6a845aef49cb", "resource": { "resourceType": "Claim", "id": "800c0f43-821c-9cfd-5079-6a845aef49cb", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2011-01-08T01:33:04+01:00", "end": "2011-01-08T02:01:02+01:00" }, "created": "2011-01-08T02:01:02+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:4ae63bd1-ba15-4781-8453-7771b82ae682" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:d0316d28-61d4-0d18-8a7e-627e31d51d1e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "d0316d28-61d4-0d18-8a7e-627e31d51d1e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "800c0f43-821c-9cfd-5079-6a845aef49cb" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2011-01-08T02:01:02+01:00", "end": "2012-01-08T02:01:02+01:00" }, "created": "2011-01-08T02:01:02+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:800c0f43-821c-9cfd-5079-6a845aef49cb" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2011-01-08T01:33:04+01:00", "end": "2011-01-08T02:01:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:396dbd3f-1d9c-7d76-64f4-bf0aa49b0d21", "resource": { "resourceType": "MedicationRequest", "id": "396dbd3f-1d9c-7d76-64f4-bf0aa49b0d21", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" }, "authoredOn": "2011-01-08T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:c40e117b-4cec-79d2-697d-a023f9d113db", "resource": { "resourceType": "Claim", "id": "c40e117b-4cec-79d2-697d-a023f9d113db", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2011-01-08T01:33:04+01:00", "end": "2011-01-08T02:01:02+01:00" }, "created": "2011-01-08T02:01:02+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:396dbd3f-1d9c-7d76-64f4-bf0aa49b0d21" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:7f7ad461-4ac0-3cf8-36c4-730b04c05ef9", "resource": { "resourceType": "ExplanationOfBenefit", "id": "7f7ad461-4ac0-3cf8-36c4-730b04c05ef9", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c40e117b-4cec-79d2-697d-a023f9d113db" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2011-01-08T02:01:02+01:00", "end": "2012-01-08T02:01:02+01:00" }, "created": "2011-01-08T02:01:02+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:c40e117b-4cec-79d2-697d-a023f9d113db" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2011-01-08T01:33:04+01:00", "end": "2011-01-08T02:01:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:12703cb1-7028-1b78-22d9-e6d107877878", "resource": { "resourceType": "DiagnosticReport", "id": "12703cb1-7028-1b78-22d9-e6d107877878", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" }, "effectiveDateTime": "2011-01-08T01:33:04+01:00", "issued": "2011-01-08T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:ee92da01-0951-18fa-e57a-da8456a215b5", "resource": { "resourceType": "DocumentReference", "id": "ee92da01-0951-18fa-e57a-da8456a215b5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:12703cb1-7028-1b78-22d9-e6d107877878" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2011-01-08T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" } ], "period": { "start": "2011-01-08T01:33:04+01:00", "end": "2011-01-08T02:01:02+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:95acc6c4-a47d-4ec4-5eb8-0c467b5d8c7d", "resource": { "resourceType": "Claim", "id": "95acc6c4-a47d-4ec4-5eb8-0c467b5d8c7d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2011-01-08T01:33:04+01:00", "end": "2011-01-08T02:01:02+01:00" }, "created": "2011-01-08T02:01:02+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" } ] } ], "total": { "value": 1135.12, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:975653f0-6527-a10d-db57-c283a27b150d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "975653f0-6527-a10d-db57-c283a27b150d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "95acc6c4-a47d-4ec4-5eb8-0c467b5d8c7d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2011-01-08T02:01:02+01:00", "end": "2012-01-08T02:01:02+01:00" }, "created": "2011-01-08T02:01:02+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:95acc6c4-a47d-4ec4-5eb8-0c467b5d8c7d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2011-01-08T01:33:04+01:00", "end": "2011-01-08T02:01:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1135.12, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747", "resource": { "resourceType": "Encounter", "id": "bbd7fdbe-1242-cd18-91b8-e5d342f4d747", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "bbd7fdbe-1242-cd18-91b8-e5d342f4d747" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2012-01-14T01:33:04+01:00", "end": "2012-01-14T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2012-01-14T01:33:04+01:00", "end": "2012-01-14T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:0ea15043-529a-c15e-f49d-007f90419a06", "resource": { "resourceType": "Condition", "id": "0ea15043-529a-c15e-f49d-007f90419a06", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" }, "onsetDateTime": "2012-01-14T01:33:04+01:00", "abatementDateTime": "2013-01-19T01:33:04+01:00", "recordedDate": "2012-01-14T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:037171f5-1c8a-2074-48bd-9240596f18fb", "resource": { "resourceType": "MedicationRequest", "id": "037171f5-1c8a-2074-48bd-9240596f18fb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" }, "authoredOn": "2012-01-14T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:2c1e30ed-676b-a6aa-cc20-98de276ac2fc", "resource": { "resourceType": "Claim", "id": "2c1e30ed-676b-a6aa-cc20-98de276ac2fc", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2012-01-14T01:33:04+01:00", "end": "2012-01-14T01:48:04+01:00" }, "created": "2012-01-14T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:037171f5-1c8a-2074-48bd-9240596f18fb" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:d2c404d9-b2a0-7531-e305-73e147f64532", "resource": { "resourceType": "ExplanationOfBenefit", "id": "d2c404d9-b2a0-7531-e305-73e147f64532", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "2c1e30ed-676b-a6aa-cc20-98de276ac2fc" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2012-01-14T01:48:04+01:00", "end": "2013-01-14T01:48:04+01:00" }, "created": "2012-01-14T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:2c1e30ed-676b-a6aa-cc20-98de276ac2fc" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2012-01-14T01:33:04+01:00", "end": "2012-01-14T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a0ed82d5-d067-e83a-5cec-0a34c1191713", "resource": { "resourceType": "MedicationRequest", "id": "a0ed82d5-d067-e83a-5cec-0a34c1191713", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" }, "authoredOn": "2012-01-14T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:5d134820-525e-d9fd-8a3e-c6b3d9338d54", "resource": { "resourceType": "Claim", "id": "5d134820-525e-d9fd-8a3e-c6b3d9338d54", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2012-01-14T01:33:04+01:00", "end": "2012-01-14T01:48:04+01:00" }, "created": "2012-01-14T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:a0ed82d5-d067-e83a-5cec-0a34c1191713" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f84638d0-3454-2d7f-00c8-444870fe9c00", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f84638d0-3454-2d7f-00c8-444870fe9c00", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "5d134820-525e-d9fd-8a3e-c6b3d9338d54" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2012-01-14T01:48:04+01:00", "end": "2013-01-14T01:48:04+01:00" }, "created": "2012-01-14T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:5d134820-525e-d9fd-8a3e-c6b3d9338d54" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2012-01-14T01:33:04+01:00", "end": "2012-01-14T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a1b2e7d9-276b-0cda-949e-c3792978421e", "resource": { "resourceType": "DiagnosticReport", "id": "a1b2e7d9-276b-0cda-949e-c3792978421e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" }, "effectiveDateTime": "2012-01-14T01:33:04+01:00", "issued": "2012-01-14T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:365446bc-cc18-0a89-9ffe-66542b750a99", "resource": { "resourceType": "DocumentReference", "id": "365446bc-cc18-0a89-9ffe-66542b750a99", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:a1b2e7d9-276b-0cda-949e-c3792978421e" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2012-01-14T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMTItMDEtMTQKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMTYgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKSwgcGVyZW5uaWFsIGFsbGVyZ2ljIHJoaW5pdGlzIHdpdGggc2Vhc29uYWwgdmFyaWF0aW9uLCBjaGlsZGhvb2QgYXN0aG1hLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgogUGF0aWVudCBpZGVudGlmaWVzIGFzIGhldGVyb3NleHVhbC4KClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCmJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uOyBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuClBhdGllbnQgaXMgcHJlc2VudGluZyB3aXRoIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKS4gCgojIyBQbGFuCgpUaGUgcGF0aWVudCB3YXMgcHJlc2NyaWJlZCB0aGUgZm9sbG93aW5nIG1lZGljYXRpb25zOgotIG5kYTAyMDk4MyAyMDAgYWN0dWF0IGFsYnV0ZXJvbCAwLjA5IG1nL2FjdHVhdCBtZXRlcmVkIGRvc2UgaW5oYWxlciBbdmVudG9saW5dCi0gYnVkZXNvbmlkZSAwLjEyNSBtZy9tbCBpbmhhbGF0aW9uIHN1c3BlbnNpb24K" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" } ], "period": { "start": "2012-01-14T01:33:04+01:00", "end": "2012-01-14T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:5b52ac3b-9f74-8efe-5420-c3c3e913da19", "resource": { "resourceType": "Claim", "id": "5b52ac3b-9f74-8efe-5420-c3c3e913da19", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2012-01-14T01:33:04+01:00", "end": "2012-01-14T01:48:04+01:00" }, "created": "2012-01-14T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:0ea15043-529a-c15e-f49d-007f90419a06" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 914.78, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:a3df1496-9ba0-6c70-9458-69f39bb17087", "resource": { "resourceType": "ExplanationOfBenefit", "id": "a3df1496-9ba0-6c70-9458-69f39bb17087", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "5b52ac3b-9f74-8efe-5420-c3c3e913da19" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2012-01-14T01:48:04+01:00", "end": "2013-01-14T01:48:04+01:00" }, "created": "2012-01-14T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:5b52ac3b-9f74-8efe-5420-c3c3e913da19" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:0ea15043-529a-c15e-f49d-007f90419a06" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2012-01-14T01:33:04+01:00", "end": "2012-01-14T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2012-01-14T01:33:04+01:00", "end": "2012-01-14T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 914.78, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76", "resource": { "resourceType": "Encounter", "id": "0cb316fa-986e-8408-bd70-41a74538bf76", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "0cb316fa-986e-8408-bd70-41a74538bf76" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2013-01-19T01:33:04+01:00", "end": "2013-01-19T01:58:40+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2013-01-19T01:33:04+01:00", "end": "2013-01-19T01:58:40+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:6d81b2ae-4cb5-4f47-a46e-833d28ba6a6e", "resource": { "resourceType": "MedicationRequest", "id": "6d81b2ae-4cb5-4f47-a46e-833d28ba6a6e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" }, "authoredOn": "2013-01-19T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:1cda2019-0319-6241-121e-5a71429d489d", "resource": { "resourceType": "Claim", "id": "1cda2019-0319-6241-121e-5a71429d489d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-01-19T01:33:04+01:00", "end": "2013-01-19T01:58:40+01:00" }, "created": "2013-01-19T01:58:40+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:6d81b2ae-4cb5-4f47-a46e-833d28ba6a6e" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f963ba98-7e36-5e2e-a31d-baba8ddad675", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f963ba98-7e36-5e2e-a31d-baba8ddad675", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "1cda2019-0319-6241-121e-5a71429d489d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-01-19T01:58:40+01:00", "end": "2014-01-19T01:58:40+01:00" }, "created": "2013-01-19T01:58:40+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:1cda2019-0319-6241-121e-5a71429d489d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2013-01-19T01:33:04+01:00", "end": "2013-01-19T01:58:40+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:05958608-47b9-08c9-9c68-cb8c727f56e0", "resource": { "resourceType": "MedicationRequest", "id": "05958608-47b9-08c9-9c68-cb8c727f56e0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" }, "authoredOn": "2013-01-19T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:17334b25-b98a-1739-2cf1-0a151f29b4e8", "resource": { "resourceType": "Claim", "id": "17334b25-b98a-1739-2cf1-0a151f29b4e8", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-01-19T01:33:04+01:00", "end": "2013-01-19T01:58:40+01:00" }, "created": "2013-01-19T01:58:40+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:05958608-47b9-08c9-9c68-cb8c727f56e0" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:a8c055ba-e34f-3c73-994d-a92ee3935bbc", "resource": { "resourceType": "ExplanationOfBenefit", "id": "a8c055ba-e34f-3c73-994d-a92ee3935bbc", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "17334b25-b98a-1739-2cf1-0a151f29b4e8" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-01-19T01:58:40+01:00", "end": "2014-01-19T01:58:40+01:00" }, "created": "2013-01-19T01:58:40+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:17334b25-b98a-1739-2cf1-0a151f29b4e8" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2013-01-19T01:33:04+01:00", "end": "2013-01-19T01:58:40+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:fc19a867-6928-dbed-5b76-a877d2d2fb85", "resource": { "resourceType": "DiagnosticReport", "id": "fc19a867-6928-dbed-5b76-a877d2d2fb85", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" }, "effectiveDateTime": "2013-01-19T01:33:04+01:00", "issued": "2013-01-19T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:b26ce98e-2a58-e8b8-0369-a48512596c06", "resource": { "resourceType": "DocumentReference", "id": "b26ce98e-2a58-e8b8-0369-a48512596c06", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:fc19a867-6928-dbed-5b76-a877d2d2fb85" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2013-01-19T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" } ], "period": { "start": "2013-01-19T01:33:04+01:00", "end": "2013-01-19T01:58:40+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:c08a84ff-6242-871d-d119-9d7ca7e09934", "resource": { "resourceType": "Claim", "id": "c08a84ff-6242-871d-d119-9d7ca7e09934", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2013-01-19T01:33:04+01:00", "end": "2013-01-19T01:58:40+01:00" }, "created": "2013-01-19T01:58:40+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "encounter": [ { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" } ] } ], "total": { "value": 1151.75, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f2975ba9-aca2-46f4-997f-5c31eb34280f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f2975ba9-aca2-46f4-997f-5c31eb34280f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c08a84ff-6242-871d-d119-9d7ca7e09934" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-01-19T01:58:40+01:00", "end": "2014-01-19T01:58:40+01:00" }, "created": "2013-01-19T01:58:40+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:c08a84ff-6242-871d-d119-9d7ca7e09934" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410620009", "display": "Well child visit (procedure)" } ], "text": "Well child visit (procedure)" }, "servicedPeriod": { "start": "2013-01-19T01:33:04+01:00", "end": "2013-01-19T01:58:40+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1151.75, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca", "resource": { "resourceType": "Encounter", "id": "c7c040cd-f23e-215c-f056-b8c24a0244ca", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "c7c040cd-f23e-215c-f056-b8c24a0244ca" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2013-06-08T02:33:04+02:00", "end": "2013-06-08T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } } ], "period": { "start": "2013-06-08T02:33:04+02:00", "end": "2013-06-08T02:48:04+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:dc990ee2-51b1-ee70-41fd-47ef56ebce49", "resource": { "resourceType": "Condition", "id": "dc990ee2-51b1-ee70-41fd-47ef56ebce49", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" }, "onsetDateTime": "2013-06-08T02:33:04+02:00", "abatementDateTime": "2013-06-08T02:33:04+02:00", "recordedDate": "2013-06-08T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:e603ef74-4e55-88d4-621c-596d8b3032a2", "resource": { "resourceType": "MedicationRequest", "id": "e603ef74-4e55-88d4-621c-596d8b3032a2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" }, "authoredOn": "2013-06-08T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:b5ac4ae4-b72e-a795-6645-db10a4570256", "resource": { "resourceType": "Claim", "id": "b5ac4ae4-b72e-a795-6645-db10a4570256", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-08T02:33:04+02:00", "end": "2013-06-08T02:48:04+02:00" }, "created": "2013-06-08T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:e603ef74-4e55-88d4-621c-596d8b3032a2" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e11307a3-5343-4abb-36e3-08b3e6eedf71", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e11307a3-5343-4abb-36e3-08b3e6eedf71", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b5ac4ae4-b72e-a795-6645-db10a4570256" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-08T02:48:04+02:00", "end": "2014-06-08T02:48:04+02:00" }, "created": "2013-06-08T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:b5ac4ae4-b72e-a795-6645-db10a4570256" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2013-06-08T02:33:04+02:00", "end": "2013-06-08T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:960824c8-aef3-8c55-d012-9336e370fb0b", "resource": { "resourceType": "MedicationRequest", "id": "960824c8-aef3-8c55-d012-9336e370fb0b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" }, "authoredOn": "2013-06-08T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:860a12dc-4376-1081-b940-b8707845f876", "resource": { "resourceType": "Claim", "id": "860a12dc-4376-1081-b940-b8707845f876", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-08T02:33:04+02:00", "end": "2013-06-08T02:48:04+02:00" }, "created": "2013-06-08T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:960824c8-aef3-8c55-d012-9336e370fb0b" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:9cd80bc9-d468-5056-3cda-2cf12b91baf2", "resource": { "resourceType": "ExplanationOfBenefit", "id": "9cd80bc9-d468-5056-3cda-2cf12b91baf2", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "860a12dc-4376-1081-b940-b8707845f876" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-08T02:48:04+02:00", "end": "2014-06-08T02:48:04+02:00" }, "created": "2013-06-08T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:860a12dc-4376-1081-b940-b8707845f876" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2013-06-08T02:33:04+02:00", "end": "2013-06-08T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a95ef813-f452-4ec4-ca32-4c53231008c4", "resource": { "resourceType": "DiagnosticReport", "id": "a95ef813-f452-4ec4-ca32-4c53231008c4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" }, "effectiveDateTime": "2013-06-08T02:33:04+02:00", "issued": "2013-06-08T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:e9240a60-8697-ba95-def4-0b672139b40b", "resource": { "resourceType": "DocumentReference", "id": "e9240a60-8697-ba95-def4-0b672139b40b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:a95ef813-f452-4ec4-ca32-4c53231008c4" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2013-06-08T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" } ], "period": { "start": "2013-06-08T02:33:04+02:00", "end": "2013-06-08T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:6b3f700e-5844-310d-110b-bb3ac973722a", "resource": { "resourceType": "Claim", "id": "6b3f700e-5844-310d-110b-bb3ac973722a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2013-06-08T02:33:04+02:00", "end": "2013-06-08T02:48:04+02:00" }, "created": "2013-06-08T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:dc990ee2-51b1-ee70-41fd-47ef56ebce49" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" }, "encounter": [ { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 1286.31, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:a3cfab61-4a5b-4f4c-1942-420b045b715f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "a3cfab61-4a5b-4f4c-1942-420b045b715f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "6b3f700e-5844-310d-110b-bb3ac973722a" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-08T02:48:04+02:00", "end": "2014-06-08T02:48:04+02:00" }, "created": "2013-06-08T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:6b3f700e-5844-310d-110b-bb3ac973722a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:dc990ee2-51b1-ee70-41fd-47ef56ebce49" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" }, "servicedPeriod": { "start": "2013-06-08T02:33:04+02:00", "end": "2013-06-08T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2013-06-08T02:33:04+02:00", "end": "2013-06-08T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1286.31, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a", "resource": { "resourceType": "Encounter", "id": "1ece4b19-047f-b285-ad09-2526ef4c686a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "1ece4b19-047f-b285-ad09-2526ef4c686a" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2013-06-15T02:33:04+02:00", "end": "2013-06-15T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } } ], "period": { "start": "2013-06-15T02:33:04+02:00", "end": "2013-06-15T02:48:04+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:7344d321-7633-9c07-5db8-8235010e80e6", "resource": { "resourceType": "Condition", "id": "7344d321-7633-9c07-5db8-8235010e80e6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" }, "onsetDateTime": "2013-06-15T02:33:04+02:00", "abatementDateTime": "2013-06-15T02:33:04+02:00", "recordedDate": "2013-06-15T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:e80bb321-894d-0fe3-cc4e-7ca7d5ed3921", "resource": { "resourceType": "MedicationRequest", "id": "e80bb321-894d-0fe3-cc4e-7ca7d5ed3921", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" }, "authoredOn": "2013-06-15T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:17dd4d95-86d5-e0d6-0d94-e6540e8c1e21", "resource": { "resourceType": "Claim", "id": "17dd4d95-86d5-e0d6-0d94-e6540e8c1e21", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-15T02:33:04+02:00", "end": "2013-06-15T02:48:04+02:00" }, "created": "2013-06-15T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:e80bb321-894d-0fe3-cc4e-7ca7d5ed3921" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:49f5c9d0-7118-8101-03f5-ebe30a979bab", "resource": { "resourceType": "ExplanationOfBenefit", "id": "49f5c9d0-7118-8101-03f5-ebe30a979bab", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "17dd4d95-86d5-e0d6-0d94-e6540e8c1e21" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-15T02:48:04+02:00", "end": "2014-06-15T02:48:04+02:00" }, "created": "2013-06-15T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:17dd4d95-86d5-e0d6-0d94-e6540e8c1e21" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2013-06-15T02:33:04+02:00", "end": "2013-06-15T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d5aeee24-30da-9760-68bb-caec9f4daf29", "resource": { "resourceType": "MedicationRequest", "id": "d5aeee24-30da-9760-68bb-caec9f4daf29", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" }, "authoredOn": "2013-06-15T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:5415f38b-927f-8d43-88d2-08030a9dc158", "resource": { "resourceType": "Claim", "id": "5415f38b-927f-8d43-88d2-08030a9dc158", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-15T02:33:04+02:00", "end": "2013-06-15T02:48:04+02:00" }, "created": "2013-06-15T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:d5aeee24-30da-9760-68bb-caec9f4daf29" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:83a097e4-77d2-fdb0-58f6-67e58867c9a9", "resource": { "resourceType": "ExplanationOfBenefit", "id": "83a097e4-77d2-fdb0-58f6-67e58867c9a9", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "5415f38b-927f-8d43-88d2-08030a9dc158" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-15T02:48:04+02:00", "end": "2014-06-15T02:48:04+02:00" }, "created": "2013-06-15T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:5415f38b-927f-8d43-88d2-08030a9dc158" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2013-06-15T02:33:04+02:00", "end": "2013-06-15T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:191afb88-6e84-217a-666b-f843656c21fd", "resource": { "resourceType": "DiagnosticReport", "id": "191afb88-6e84-217a-666b-f843656c21fd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" }, "effectiveDateTime": "2013-06-15T02:33:04+02:00", "issued": "2013-06-15T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1eccdb64-3448-10fd-5ed0-f5cebc2de8b4", "resource": { "resourceType": "DocumentReference", "id": "1eccdb64-3448-10fd-5ed0-f5cebc2de8b4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:191afb88-6e84-217a-666b-f843656c21fd" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2013-06-15T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" } ], "period": { "start": "2013-06-15T02:33:04+02:00", "end": "2013-06-15T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:84b23dab-955e-fb4c-44b6-05adc0547b5a", "resource": { "resourceType": "Claim", "id": "84b23dab-955e-fb4c-44b6-05adc0547b5a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2013-06-15T02:33:04+02:00", "end": "2013-06-15T02:48:04+02:00" }, "created": "2013-06-15T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:7344d321-7633-9c07-5db8-8235010e80e6" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" }, "encounter": [ { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 432.75, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:8c169fa1-4c73-8934-2595-ba4b0673ab47", "resource": { "resourceType": "ExplanationOfBenefit", "id": "8c169fa1-4c73-8934-2595-ba4b0673ab47", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "84b23dab-955e-fb4c-44b6-05adc0547b5a" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-15T02:48:04+02:00", "end": "2014-06-15T02:48:04+02:00" }, "created": "2013-06-15T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:84b23dab-955e-fb4c-44b6-05adc0547b5a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:7344d321-7633-9c07-5db8-8235010e80e6" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" }, "servicedPeriod": { "start": "2013-06-15T02:33:04+02:00", "end": "2013-06-15T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2013-06-15T02:33:04+02:00", "end": "2013-06-15T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 432.75, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04", "resource": { "resourceType": "Encounter", "id": "3582656c-571d-ac54-ce70-c6d6a3014f04", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "3582656c-571d-ac54-ce70-c6d6a3014f04" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2013-06-22T02:33:04+02:00", "end": "2013-06-22T02:52:02+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } } ], "period": { "start": "2013-06-22T02:33:04+02:00", "end": "2013-06-22T02:52:02+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:3b018fbb-c729-61cc-85ec-9a99d0f3b31a", "resource": { "resourceType": "Condition", "id": "3b018fbb-c729-61cc-85ec-9a99d0f3b31a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" }, "onsetDateTime": "2013-06-22T02:33:04+02:00", "abatementDateTime": "2016-02-06T01:33:04+01:00", "recordedDate": "2013-06-22T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:31e2c466-e35c-c2a4-5cd3-6f75b3176591", "resource": { "resourceType": "MedicationRequest", "id": "31e2c466-e35c-c2a4-5cd3-6f75b3176591", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" }, "authoredOn": "2013-06-22T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:e41911e1-b32d-d40c-2038-a12ec41b65f6", "resource": { "resourceType": "Claim", "id": "e41911e1-b32d-d40c-2038-a12ec41b65f6", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-22T02:33:04+02:00", "end": "2013-06-22T02:52:02+02:00" }, "created": "2013-06-22T02:52:02+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:31e2c466-e35c-c2a4-5cd3-6f75b3176591" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:17af66e2-4ba9-5703-d53b-058c05a97915", "resource": { "resourceType": "ExplanationOfBenefit", "id": "17af66e2-4ba9-5703-d53b-058c05a97915", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e41911e1-b32d-d40c-2038-a12ec41b65f6" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-22T02:52:02+02:00", "end": "2014-06-22T02:52:02+02:00" }, "created": "2013-06-22T02:52:02+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:e41911e1-b32d-d40c-2038-a12ec41b65f6" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2013-06-22T02:33:04+02:00", "end": "2013-06-22T02:52:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f8f4f305-8de6-2144-f8c4-9f289d35b706", "resource": { "resourceType": "MedicationRequest", "id": "f8f4f305-8de6-2144-f8c4-9f289d35b706", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" }, "authoredOn": "2013-06-22T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:251b6f17-858f-a76a-c861-82067335f233", "resource": { "resourceType": "Claim", "id": "251b6f17-858f-a76a-c861-82067335f233", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-22T02:33:04+02:00", "end": "2013-06-22T02:52:02+02:00" }, "created": "2013-06-22T02:52:02+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:f8f4f305-8de6-2144-f8c4-9f289d35b706" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:3d1eca2b-656a-fa3a-a006-7499e5737ee9", "resource": { "resourceType": "ExplanationOfBenefit", "id": "3d1eca2b-656a-fa3a-a006-7499e5737ee9", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "251b6f17-858f-a76a-c861-82067335f233" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-22T02:52:02+02:00", "end": "2014-06-22T02:52:02+02:00" }, "created": "2013-06-22T02:52:02+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:251b6f17-858f-a76a-c861-82067335f233" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2013-06-22T02:33:04+02:00", "end": "2013-06-22T02:52:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3e380b28-5061-fb26-e031-811e206301c0", "resource": { "resourceType": "DiagnosticReport", "id": "3e380b28-5061-fb26-e031-811e206301c0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" }, "effectiveDateTime": "2013-06-22T02:33:04+02:00", "issued": "2013-06-22T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:5da728aa-97f3-eddc-65db-fdba63a35c5c", "resource": { "resourceType": "DocumentReference", "id": "5da728aa-97f3-eddc-65db-fdba63a35c5c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:3e380b28-5061-fb26-e031-811e206301c0" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2013-06-22T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199", "display": "Dr. Josefina523 Portillo767" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" } ], "period": { "start": "2013-06-22T02:33:04+02:00", "end": "2013-06-22T02:52:02+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:ddb1e3a9-fe76-0d64-885a-23f225198dce", "resource": { "resourceType": "Claim", "id": "ddb1e3a9-fe76-0d64-885a-23f225198dce", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2013-06-22T02:33:04+02:00", "end": "2013-06-22T02:52:02+02:00" }, "created": "2013-06-22T02:52:02+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:3b018fbb-c729-61cc-85ec-9a99d0f3b31a" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" }, "encounter": [ { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 573.98, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:7ad89e12-00c3-8302-4a2d-fb1211cce1c8", "resource": { "resourceType": "ExplanationOfBenefit", "id": "7ad89e12-00c3-8302-4a2d-fb1211cce1c8", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "ddb1e3a9-fe76-0d64-885a-23f225198dce" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-22T02:52:02+02:00", "end": "2014-06-22T02:52:02+02:00" }, "created": "2013-06-22T02:52:02+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287", "display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC" }, "claim": { "reference": "urn:uuid:ddb1e3a9-fe76-0d64-885a-23f225198dce" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:3b018fbb-c729-61cc-85ec-9a99d0f3b31a" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "702927004", "display": "Urgent care clinic (environment)" } ], "text": "Urgent care clinic (environment)" }, "servicedPeriod": { "start": "2013-06-22T02:33:04+02:00", "end": "2013-06-22T02:52:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2013-06-22T02:33:04+02:00", "end": "2013-06-22T02:52:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 573.98, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0", "resource": { "resourceType": "Encounter", "id": "74dcaf44-b692-6c71-ad08-2ac21c0894c0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "74dcaf44-b692-6c71-ad08-2ac21c0894c0" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up (procedure)" } ], "text": "Encounter for check up (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2013-06-29T02:33:04+02:00", "end": "2013-06-29T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2013-06-29T02:33:04+02:00", "end": "2013-06-29T02:48:04+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:4b367749-9c5e-7603-7392-ad0f4cfeae84", "resource": { "resourceType": "MedicationRequest", "id": "4b367749-9c5e-7603-7392-ad0f4cfeae84", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" }, "authoredOn": "2013-06-29T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:a45eb327-99c6-1f18-8eb7-683f0c107165", "resource": { "resourceType": "Claim", "id": "a45eb327-99c6-1f18-8eb7-683f0c107165", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-29T02:33:04+02:00", "end": "2013-06-29T02:48:04+02:00" }, "created": "2013-06-29T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:4b367749-9c5e-7603-7392-ad0f4cfeae84" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:7f8a25a5-8f0c-d77f-81ab-53bf1137731f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "7f8a25a5-8f0c-d77f-81ab-53bf1137731f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a45eb327-99c6-1f18-8eb7-683f0c107165" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-29T02:48:04+02:00", "end": "2014-06-29T02:48:04+02:00" }, "created": "2013-06-29T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:a45eb327-99c6-1f18-8eb7-683f0c107165" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2013-06-29T02:33:04+02:00", "end": "2013-06-29T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:fb59fa40-2902-25ca-f388-37194d8891ce", "resource": { "resourceType": "MedicationRequest", "id": "fb59fa40-2902-25ca-f388-37194d8891ce", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" }, "authoredOn": "2013-06-29T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:4a80f8b1-b385-78ec-4aa8-72412644c128", "resource": { "resourceType": "Claim", "id": "4a80f8b1-b385-78ec-4aa8-72412644c128", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-29T02:33:04+02:00", "end": "2013-06-29T02:48:04+02:00" }, "created": "2013-06-29T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:fb59fa40-2902-25ca-f388-37194d8891ce" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:cdbc6eff-40e8-9b86-dec5-dfcb523df886", "resource": { "resourceType": "ExplanationOfBenefit", "id": "cdbc6eff-40e8-9b86-dec5-dfcb523df886", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "4a80f8b1-b385-78ec-4aa8-72412644c128" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-29T02:48:04+02:00", "end": "2014-06-29T02:48:04+02:00" }, "created": "2013-06-29T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:4a80f8b1-b385-78ec-4aa8-72412644c128" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2013-06-29T02:33:04+02:00", "end": "2013-06-29T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f456ca82-7cb4-d765-f663-ffc66fa0b305", "resource": { "resourceType": "DiagnosticReport", "id": "f456ca82-7cb4-d765-f663-ffc66fa0b305", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" }, "effectiveDateTime": "2013-06-29T02:33:04+02:00", "issued": "2013-06-29T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:dc1a0d19-0c41-8594-3b77-0d2975eba52c", "resource": { "resourceType": "DocumentReference", "id": "dc1a0d19-0c41-8594-3b77-0d2975eba52c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:f456ca82-7cb4-d765-f663-ffc66fa0b305" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2013-06-29T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" } ], "period": { "start": "2013-06-29T02:33:04+02:00", "end": "2013-06-29T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:dfbd5f89-855f-811d-9231-7080ea49613d", "resource": { "resourceType": "Claim", "id": "dfbd5f89-855f-811d-9231-7080ea49613d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2013-06-29T02:33:04+02:00", "end": "2013-06-29T02:48:04+02:00" }, "created": "2013-06-29T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up (procedure)" } ], "text": "Encounter for check up (procedure)" }, "encounter": [ { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" } ] } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:007a7495-e1f0-9c6e-cc8b-c9f2e201a5de", "resource": { "resourceType": "ExplanationOfBenefit", "id": "007a7495-e1f0-9c6e-cc8b-c9f2e201a5de", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "dfbd5f89-855f-811d-9231-7080ea49613d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-06-29T02:48:04+02:00", "end": "2014-06-29T02:48:04+02:00" }, "created": "2013-06-29T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:dfbd5f89-855f-811d-9231-7080ea49613d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up (procedure)" } ], "text": "Encounter for check up (procedure)" }, "servicedPeriod": { "start": "2013-06-29T02:33:04+02:00", "end": "2013-06-29T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 85.55, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a545e785-9ef8-f019-6bd1-92c395244acf", "resource": { "resourceType": "Encounter", "id": "a545e785-9ef8-f019-6bd1-92c395244acf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "a545e785-9ef8-f019-6bd1-92c395244acf" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2013-07-06T02:33:04+02:00", "end": "2013-07-06T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2013-07-06T02:33:04+02:00", "end": "2013-07-06T02:48:04+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "10509002", "display": "Acute bronchitis (disorder)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:e1119624-03b3-40eb-36e1-97349be06621", "resource": { "resourceType": "CareTeam", "id": "e1119624-03b3-40eb-36e1-97349be06621", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "inactive", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:a545e785-9ef8-f019-6bd1-92c395244acf" }, "period": { "start": "2013-07-06T02:33:04+02:00", "end": "2014-01-25T01:33:04+01:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:f8d50aed-e7a1-42c1-5229-e6b1d55dd85f", "resource": { "resourceType": "CarePlan", "id": "f8d50aed-e7a1-42c1-5229-e6b1d55dd85f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Respiratory therapy.
Activities:
" }, "status": "completed", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "53950000", "display": "Respiratory therapy" } ], "text": "Respiratory therapy" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:a545e785-9ef8-f019-6bd1-92c395244acf" }, "period": { "start": "2013-07-06T02:33:04+02:00", "end": "2014-01-25T01:33:04+01:00" }, "careTeam": [ { "reference": "urn:uuid:e1119624-03b3-40eb-36e1-97349be06621" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "304510005", "display": "Recommendation to avoid exercise" } ], "text": "Recommendation to avoid exercise" }, "status": "completed", "location": { "display": "WP ACQUISITION SUB LLC" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "371605008", "display": "Deep breathing and coughing exercises" } ], "text": "Deep breathing and coughing exercises" }, "status": "completed", "location": { "display": "WP ACQUISITION SUB LLC" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:14ce573a-a762-0451-cfc5-3f3b2aaf554d", "resource": { "resourceType": "DiagnosticReport", "id": "14ce573a-a762-0451-cfc5-3f3b2aaf554d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:a545e785-9ef8-f019-6bd1-92c395244acf" }, "effectiveDateTime": "2013-07-06T02:33:04+02:00", "issued": "2013-07-06T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:4b7ef473-c009-6967-b606-da4b97496d81", "resource": { "resourceType": "DocumentReference", "id": "4b7ef473-c009-6967-b606-da4b97496d81", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:14ce573a-a762-0451-cfc5-3f3b2aaf554d" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2013-07-06T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:a545e785-9ef8-f019-6bd1-92c395244acf" } ], "period": { "start": "2013-07-06T02:33:04+02:00", "end": "2013-07-06T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:daafa72d-1008-2123-2cab-e4189f310590", "resource": { "resourceType": "Claim", "id": "daafa72d-1008-2123-2cab-e4189f310590", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2013-07-06T02:33:04+02:00", "end": "2013-07-06T02:48:04+02:00" }, "created": "2013-07-06T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "encounter": [ { "reference": "urn:uuid:a545e785-9ef8-f019-6bd1-92c395244acf" } ] } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:ee932b5d-38bf-8092-957b-2be584d6132d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "ee932b5d-38bf-8092-957b-2be584d6132d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "daafa72d-1008-2123-2cab-e4189f310590" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2013-07-06T02:48:04+02:00", "end": "2014-07-06T02:48:04+02:00" }, "created": "2013-07-06T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:daafa72d-1008-2123-2cab-e4189f310590" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "servicedPeriod": { "start": "2013-07-06T02:33:04+02:00", "end": "2013-07-06T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:a545e785-9ef8-f019-6bd1-92c395244acf" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 85.55, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec", "resource": { "resourceType": "Encounter", "id": "262a30d0-9292-3d96-7b60-fcf4abc226ec", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "262a30d0-9292-3d96-7b60-fcf4abc226ec" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:046e0179-0aa0-d8a2-e299-56a4359c88c7", "resource": { "resourceType": "Condition", "id": "046e0179-0aa0-d8a2-e299-56a4359c88c7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "5251000175109", "display": "Received certificate of high school equivalency (finding)" } ], "text": "Received certificate of high school equivalency (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "onsetDateTime": "2014-01-25T02:28:54+01:00", "recordedDate": "2014-01-25T02:28:54+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:2c5d1ddf-cfdd-4487-d94a-8235b3ac1a15", "resource": { "resourceType": "Condition", "id": "2c5d1ddf-cfdd-4487-d94a-8235b3ac1a15", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "onsetDateTime": "2014-01-25T02:28:54+01:00", "abatementDateTime": "2015-01-31T02:17:57+01:00", "recordedDate": "2014-01-25T02:28:54+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:30faef0e-e991-1dd1-c3bf-595854a7cfd7", "resource": { "resourceType": "Observation", "id": "30faef0e-e991-1dd1-c3bf-595854a7cfd7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T01:33:04+01:00", "issued": "2014-01-25T01:33:04.492+01:00", "valueQuantity": { "value": 168.1, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:65d7390b-20ae-2d5f-96e1-9f2550164dec", "resource": { "resourceType": "Observation", "id": "65d7390b-20ae-2d5f-96e1-9f2550164dec", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T01:33:04+01:00", "issued": "2014-01-25T01:33:04.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:13c606d9-5a5b-7e1d-7698-e2cf514b2cbf", "resource": { "resourceType": "Observation", "id": "13c606d9-5a5b-7e1d-7698-e2cf514b2cbf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T01:33:04+01:00", "issued": "2014-01-25T01:33:04.492+01:00", "valueQuantity": { "value": 65.6, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bb4f85d4-d3b1-d85e-8a5c-17b0f4e02f25", "resource": { "resourceType": "Observation", "id": "bb4f85d4-d3b1-d85e-8a5c-17b0f4e02f25", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T01:33:04+01:00", "issued": "2014-01-25T01:33:04.492+01:00", "valueQuantity": { "value": 23.2, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:49015e38-0a60-5acd-eb36-f56256850f9b", "resource": { "resourceType": "Observation", "id": "49015e38-0a60-5acd-eb36-f56256850f9b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "59576-9", "display": "Body mass index (BMI) [Percentile] Per age and sex" } ], "text": "Body mass index (BMI) [Percentile] Per age and sex" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T01:33:04+01:00", "issued": "2014-01-25T01:33:04.492+01:00", "valueQuantity": { "value": 65.533, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8d66ca95-b4b9-f4d0-a07c-9ee6c03d090d", "resource": { "resourceType": "Observation", "id": "8d66ca95-b4b9-f4d0-a07c-9ee6c03d090d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T01:33:04+01:00", "issued": "2014-01-25T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 80, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 139, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a2ee65b2-692b-6c1f-df6e-75a752be7298", "resource": { "resourceType": "Observation", "id": "a2ee65b2-692b-6c1f-df6e-75a752be7298", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T01:33:04+01:00", "issued": "2014-01-25T01:33:04.492+01:00", "valueQuantity": { "value": 88, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d3e0b8ef-9807-c242-e222-2d4cd5f8c7a6", "resource": { "resourceType": "Observation", "id": "d3e0b8ef-9807-c242-e222-2d4cd5f8c7a6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T01:33:04+01:00", "issued": "2014-01-25T01:33:04.492+01:00", "valueQuantity": { "value": 15, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:604eb6fb-f479-6c20-cfcd-de335af44729", "resource": { "resourceType": "Observation", "id": "604eb6fb-f479-6c20-cfcd-de335af44729", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T01:33:04+01:00", "issued": "2014-01-25T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:434d5505-c320-1768-89ca-b7ceac226c7c", "resource": { "resourceType": "Observation", "id": "434d5505-c320-1768-89ca-b7ceac226c7c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T02:28:54+01:00", "issued": "2014-01-25T02:28:54.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30132-7", "display": "5 or more times a week" } ], "text": "5 or more times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30126-9", "display": "Clothing" } ], "text": "Clothing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30138-4", "display": "Part-time or temporary work" } ], "text": "Part-time or temporary work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e228ddf3-b5e0-3319-a637-c4390d6e976a", "resource": { "resourceType": "Observation", "id": "e228ddf3-b5e0-3319-a637-c4390d6e976a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "70274-6", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ], "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T02:54:45+01:00", "issued": "2014-01-25T02:54:45.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e6ffe6ed-3a80-9646-f9d9-b19c84453793", "resource": { "resourceType": "Observation", "id": "e6ffe6ed-3a80-9646-f9d9-b19c84453793", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T03:29:21+01:00", "issued": "2014-01-25T03:29:21.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:590c20c4-5316-547a-30d8-943cabee60c7", "resource": { "resourceType": "Observation", "id": "590c20c4-5316-547a-30d8-943cabee60c7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "75626-2", "display": "Total score [AUDIT-C]" } ], "text": "Total score [AUDIT-C]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T04:03:08+01:00", "issued": "2014-01-25T04:03:08.492+01:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3f635952-45e9-22d6-9b26-d384fea51e2c", "resource": { "resourceType": "Procedure", "id": "3f635952-45e9-22d6-9b26-d384fea51e2c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "performedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:80c3b30a-ada3-fd88-73bf-86b60f98c143", "resource": { "resourceType": "Procedure", "id": "80c3b30a-ada3-fd88-73bf-86b60f98c143", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "performedPeriod": { "start": "2014-01-25T02:28:54+01:00", "end": "2014-01-25T02:54:45+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c6ddcc02-2387-5154-654f-5bcdbda252e1", "resource": { "resourceType": "Procedure", "id": "c6ddcc02-2387-5154-654f-5bcdbda252e1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "performedPeriod": { "start": "2014-01-25T02:54:45+01:00", "end": "2014-01-25T03:07:50+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:3149d091-8258-2f49-af61-0bfe702b61a1", "resource": { "resourceType": "Procedure", "id": "3149d091-8258-2f49-af61-0bfe702b61a1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "performedPeriod": { "start": "2014-01-25T03:07:50+01:00", "end": "2014-01-25T03:29:21+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:d19df28d-3679-09e2-f8d7-376bc5ab8135", "resource": { "resourceType": "Procedure", "id": "d19df28d-3679-09e2-f8d7-376bc5ab8135", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "performedPeriod": { "start": "2014-01-25T03:29:21+01:00", "end": "2014-01-25T03:40:37+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:84f396ab-295d-8145-b317-683c06d9f281", "resource": { "resourceType": "Procedure", "id": "84f396ab-295d-8145-b317-683c06d9f281", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "performedPeriod": { "start": "2014-01-25T03:40:37+01:00", "end": "2014-01-25T04:03:08+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:a771a92f-4934-3bf5-f792-73dea3c54fae", "resource": { "resourceType": "MedicationRequest", "id": "a771a92f-4934-3bf5-f792-73dea3c54fae", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "authoredOn": "2014-01-25T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:8b9de190-2497-6e6b-a9f7-e6b9375a53af", "resource": { "resourceType": "Claim", "id": "8b9de190-2497-6e6b-a9f7-e6b9375a53af", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "created": "2014-01-25T02:28:54+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:a771a92f-4934-3bf5-f792-73dea3c54fae" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:7f65a8ed-e14c-9493-b4b9-1cee257acab2", "resource": { "resourceType": "ExplanationOfBenefit", "id": "7f65a8ed-e14c-9493-b4b9-1cee257acab2", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "8b9de190-2497-6e6b-a9f7-e6b9375a53af" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-01-25T02:28:54+01:00", "end": "2015-01-25T02:28:54+01:00" }, "created": "2014-01-25T02:28:54+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:8b9de190-2497-6e6b-a9f7-e6b9375a53af" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:46f71ac3-bde1-f074-af0b-e9960e944ee1", "resource": { "resourceType": "MedicationRequest", "id": "46f71ac3-bde1-f074-af0b-e9960e944ee1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "authoredOn": "2014-01-25T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:224f35a3-b2fd-1009-d6c3-a5dd85317159", "resource": { "resourceType": "Claim", "id": "224f35a3-b2fd-1009-d6c3-a5dd85317159", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "created": "2014-01-25T02:28:54+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:46f71ac3-bde1-f074-af0b-e9960e944ee1" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:703cbaa3-2c17-5706-7bca-427081745717", "resource": { "resourceType": "ExplanationOfBenefit", "id": "703cbaa3-2c17-5706-7bca-427081745717", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "224f35a3-b2fd-1009-d6c3-a5dd85317159" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-01-25T02:28:54+01:00", "end": "2015-01-25T02:28:54+01:00" }, "created": "2014-01-25T02:28:54+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:224f35a3-b2fd-1009-d6c3-a5dd85317159" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:6f678998-6b75-f595-aaa6-b56f2f2974d0", "resource": { "resourceType": "DiagnosticReport", "id": "6f678998-6b75-f595-aaa6-b56f2f2974d0", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T02:54:45+01:00", "issued": "2014-01-25T02:54:45.492+01:00", "result": [ { "reference": "urn:uuid:e228ddf3-b5e0-3319-a637-c4390d6e976a", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:6168dc9e-39dc-6870-d6ea-0b4ddd3d855e", "resource": { "resourceType": "DiagnosticReport", "id": "6168dc9e-39dc-6870-d6ea-0b4ddd3d855e", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T03:29:21+01:00", "issued": "2014-01-25T03:29:21.492+01:00", "result": [ { "reference": "urn:uuid:e6ffe6ed-3a80-9646-f9d9-b19c84453793", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:55052f52-3853-0581-fb39-267f446bff4b", "resource": { "resourceType": "DiagnosticReport", "id": "55052f52-3853-0581-fb39-267f446bff4b", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T04:03:08+01:00", "issued": "2014-01-25T04:03:08.492+01:00", "result": [ { "reference": "urn:uuid:590c20c4-5316-547a-30d8-943cabee60c7", "display": "Total score [AUDIT-C]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:daf7a5dc-c880-d796-dd04-db20bb6cb336", "resource": { "resourceType": "DiagnosticReport", "id": "daf7a5dc-c880-d796-dd04-db20bb6cb336", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, "effectiveDateTime": "2014-01-25T01:33:04+01:00", "issued": "2014-01-25T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:3c19546b-2f1c-57f3-9b76-547b98c6778a", "resource": { "resourceType": "DocumentReference", "id": "3c19546b-2f1c-57f3-9b76-547b98c6778a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:daf7a5dc-c880-d796-dd04-db20bb6cb336" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2014-01-25T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" } ], "period": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:34e3fbc7-34b5-3f8f-e8a9-5aafee561706", "resource": { "resourceType": "Claim", "id": "34e3fbc7-34b5-3f8f-e8a9-5aafee561706", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "created": "2014-01-25T02:28:54+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:046e0179-0aa0-d8a2-e299-56a4359c88c7" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:2c5d1ddf-cfdd-4487-d94a-8235b3ac1a15" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:3f635952-45e9-22d6-9b26-d384fea51e2c" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:80c3b30a-ada3-fd88-73bf-86b60f98c143" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:c6ddcc02-2387-5154-654f-5bcdbda252e1" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:3149d091-8258-2f49-af61-0bfe702b61a1" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:d19df28d-3679-09e2-f8d7-376bc5ab8135" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:84f396ab-295d-8145-b317-683c06d9f281" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" } ] }, { "sequence": 2, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 3, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "5251000175109", "display": "Received certificate of high school equivalency (finding)" } ], "text": "Received certificate of high school equivalency (finding)" } }, { "sequence": 4, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" } }, { "sequence": 5, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 10, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 568.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:631ec407-1034-60c5-642f-7cdf8d09b695", "resource": { "resourceType": "ExplanationOfBenefit", "id": "631ec407-1034-60c5-642f-7cdf8d09b695", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "34e3fbc7-34b5-3f8f-e8a9-5aafee561706" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-01-25T02:28:54+01:00", "end": "2015-01-25T02:28:54+01:00" }, "created": "2014-01-25T02:28:54+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:34e3fbc7-34b5-3f8f-e8a9-5aafee561706" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:046e0179-0aa0-d8a2-e299-56a4359c88c7" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:2c5d1ddf-cfdd-4487-d94a-8235b3ac1a15" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" } ] }, { "sequence": 2, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "5251000175109", "display": "Received certificate of high school equivalency (finding)" } ], "text": "Received certificate of high school equivalency (finding)" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 4, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "servicedPeriod": { "start": "2014-01-25T01:33:04+01:00", "end": "2014-01-25T02:28:54+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 568.20, "currency": "USD" } } ], "payment": { "amount": { "value": 2249.712, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:407d13d3-8132-5919-7efc-075309d51880", "resource": { "resourceType": "Encounter", "id": "407d13d3-8132-5919-7efc-075309d51880", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "407d13d3-8132-5919-7efc-075309d51880" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2014-02-01T01:33:04+01:00", "end": "2014-02-01T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2014-02-01T01:33:04+01:00", "end": "2014-02-01T01:48:04+01:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "233678006", "display": "Childhood asthma" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:c0a2598a-920f-0347-97e2-5da4fc96e91f", "resource": { "resourceType": "DiagnosticReport", "id": "c0a2598a-920f-0347-97e2-5da4fc96e91f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:407d13d3-8132-5919-7efc-075309d51880" }, "effectiveDateTime": "2014-02-01T01:33:04+01:00", "issued": "2014-02-01T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:5b78a95c-e539-2a6b-9aa7-6716e559fdbf", "resource": { "resourceType": "DocumentReference", "id": "5b78a95c-e539-2a6b-9aa7-6716e559fdbf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:c0a2598a-920f-0347-97e2-5da4fc96e91f" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2014-02-01T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:407d13d3-8132-5919-7efc-075309d51880" } ], "period": { "start": "2014-02-01T01:33:04+01:00", "end": "2014-02-01T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:a38dd887-d142-4b75-136a-60022187b5a9", "resource": { "resourceType": "Claim", "id": "a38dd887-d142-4b75-136a-60022187b5a9", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2014-02-01T01:33:04+01:00", "end": "2014-02-01T01:48:04+01:00" }, "created": "2014-02-01T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" }, "encounter": [ { "reference": "urn:uuid:407d13d3-8132-5919-7efc-075309d51880" } ] } ], "total": { "value": 142.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:cb2aef4b-e5ec-1e87-50fa-b653905a9e90", "resource": { "resourceType": "ExplanationOfBenefit", "id": "cb2aef4b-e5ec-1e87-50fa-b653905a9e90", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a38dd887-d142-4b75-136a-60022187b5a9" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-02-01T01:48:04+01:00", "end": "2015-02-01T01:48:04+01:00" }, "created": "2014-02-01T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:a38dd887-d142-4b75-136a-60022187b5a9" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" }, "servicedPeriod": { "start": "2014-02-01T01:33:04+01:00", "end": "2014-02-01T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:407d13d3-8132-5919-7efc-075309d51880" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 142.58, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0", "resource": { "resourceType": "Encounter", "id": "9fed52ae-9835-3c06-1047-9fd3cf15c6b0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "9fed52ae-9835-3c06-1047-9fd3cf15c6b0" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem (procedure)" } ], "text": "Encounter for problem (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2014-02-03T01:33:04+01:00", "end": "2014-02-03T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2014-02-03T01:33:04+01:00", "end": "2014-02-03T01:48:04+01:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "82423001", "display": "Chronic pain (finding)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:70dc6a81-705b-6d09-d090-2b178dc5f7a5", "resource": { "resourceType": "Condition", "id": "70dc6a81-705b-6d09-d090-2b178dc5f7a5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "82423001", "display": "Chronic pain (finding)" } ], "text": "Chronic pain (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" }, "onsetDateTime": "2014-02-03T01:33:04+01:00", "recordedDate": "2014-02-03T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:f1683473-ecaf-0b84-3c38-37812e43e18e", "resource": { "resourceType": "Condition", "id": "f1683473-ecaf-0b84-3c38-37812e43e18e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "278860009", "display": "Chronic low back pain (finding)" } ], "text": "Chronic low back pain (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" }, "onsetDateTime": "2014-02-03T01:33:04+01:00", "recordedDate": "2014-02-03T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:50495af7-5c4b-8296-49bd-e750b0f206ab", "resource": { "resourceType": "Observation", "id": "50495af7-5c4b-8296-49bd-e750b0f206ab", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "91148-7", "display": "Pain intensity, Enjoyment of life, General activity (PEG) 3 item pain scale" } ], "text": "Pain intensity, Enjoyment of life, General activity (PEG) 3 item pain scale" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" }, "effectiveDateTime": "2014-02-03T01:33:04+01:00", "issued": "2014-02-03T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "91146-1", "display": "What number best describes how pain has interfered with your general activity during the past week" } ], "text": "What number best describes how pain has interfered with your general activity during the past week" }, "valueQuantity": { "value": 6.7375, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "91145-3", "display": "What number best describes how pain has interfered with your enjoyment of life during the past week" } ], "text": "What number best describes how pain has interfered with your enjoyment of life during the past week" }, "valueQuantity": { "value": 4.2034, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "75893-8", "display": "Pain severity in the past week - 0-10 numeric rating [Reported]" } ], "text": "Pain severity in the past week - 0-10 numeric rating [Reported]" }, "valueQuantity": { "value": 6.2874, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:07b09a7d-1531-f1b5-e61a-1076ba00c28d", "resource": { "resourceType": "Observation", "id": "07b09a7d-1531-f1b5-e61a-1076ba00c28d", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "65750-2", "display": "Drugs of abuse 5 panel - Urine by Screen method" } ], "text": "Drugs of abuse 5 panel - Urine by Screen method" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" }, "effectiveDateTime": "2014-02-03T01:33:04+01:00", "issued": "2014-02-03T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "260385009", "display": "Negative (qualifier value)" } ], "text": "Negative (qualifier value)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4ef70bef-b3eb-fba2-2c71-d50cf4517267", "resource": { "resourceType": "MedicationRequest", "id": "4ef70bef-b3eb-fba2-2c71-d50cf4517267", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" }, "authoredOn": "2014-02-03T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:1d63fed8-6ea8-69b3-9947-7ebcf49be884", "resource": { "resourceType": "Claim", "id": "1d63fed8-6ea8-69b3-9947-7ebcf49be884", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-02-03T01:33:04+01:00", "end": "2014-02-03T01:48:04+01:00" }, "created": "2014-02-03T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:4ef70bef-b3eb-fba2-2c71-d50cf4517267" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:2e99261f-9fa8-1b3b-3fa4-cad40afd783b", "resource": { "resourceType": "ExplanationOfBenefit", "id": "2e99261f-9fa8-1b3b-3fa4-cad40afd783b", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "1d63fed8-6ea8-69b3-9947-7ebcf49be884" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-02-03T01:48:04+01:00", "end": "2015-02-03T01:48:04+01:00" }, "created": "2014-02-03T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:1d63fed8-6ea8-69b3-9947-7ebcf49be884" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2014-02-03T01:33:04+01:00", "end": "2014-02-03T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:49110d8c-b235-5a02-0311-2e60067488c0", "resource": { "resourceType": "DiagnosticReport", "id": "49110d8c-b235-5a02-0311-2e60067488c0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" }, "effectiveDateTime": "2014-02-03T01:33:04+01:00", "issued": "2014-02-03T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:c5c360d7-3e4d-a468-bf39-56a73f543f0a", "resource": { "resourceType": "DocumentReference", "id": "c5c360d7-3e4d-a468-bf39-56a73f543f0a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:49110d8c-b235-5a02-0311-2e60067488c0" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2014-02-03T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" } ], "period": { "start": "2014-02-03T01:33:04+01:00", "end": "2014-02-03T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:e5543a48-945c-90eb-09a4-50454065ca01", "resource": { "resourceType": "Claim", "id": "e5543a48-945c-90eb-09a4-50454065ca01", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2014-02-03T01:33:04+01:00", "end": "2014-02-03T01:48:04+01:00" }, "created": "2014-02-03T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:70dc6a81-705b-6d09-d090-2b178dc5f7a5" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:f1683473-ecaf-0b84-3c38-37812e43e18e" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem (procedure)" } ], "text": "Encounter for problem (procedure)" }, "encounter": [ { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "82423001", "display": "Chronic pain (finding)" } ], "text": "Chronic pain (finding)" } }, { "sequence": 3, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "278860009", "display": "Chronic low back pain (finding)" } ], "text": "Chronic low back pain (finding)" } } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:09d24a3b-db7b-e6a7-6479-323c63d90c4a", "resource": { "resourceType": "ExplanationOfBenefit", "id": "09d24a3b-db7b-e6a7-6479-323c63d90c4a", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e5543a48-945c-90eb-09a4-50454065ca01" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-02-03T01:48:04+01:00", "end": "2015-02-03T01:48:04+01:00" }, "created": "2014-02-03T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:e5543a48-945c-90eb-09a4-50454065ca01" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:70dc6a81-705b-6d09-d090-2b178dc5f7a5" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:f1683473-ecaf-0b84-3c38-37812e43e18e" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185347001", "display": "Encounter for problem (procedure)" } ], "text": "Encounter for problem (procedure)" }, "servicedPeriod": { "start": "2014-02-03T01:33:04+01:00", "end": "2014-02-03T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "82423001", "display": "Chronic pain (finding)" } ], "text": "Chronic pain (finding)" }, "servicedPeriod": { "start": "2014-02-03T01:33:04+01:00", "end": "2014-02-03T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 3, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "278860009", "display": "Chronic low back pain (finding)" } ], "text": "Chronic low back pain (finding)" }, "servicedPeriod": { "start": "2014-02-03T01:33:04+01:00", "end": "2014-02-03T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 85.55, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b", "resource": { "resourceType": "Encounter", "id": "4d4de237-1c9d-ab2d-8689-7167ab12f07b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "390906007", "display": "Follow-up encounter (procedure)" } ], "text": "Follow-up encounter (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "82423001", "display": "Chronic pain (finding)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:39a0b7e0-b9cb-4d03-6f3d-243f8fbc92f1", "resource": { "resourceType": "Observation", "id": "39a0b7e0-b9cb-4d03-6f3d-243f8fbc92f1", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "65750-2", "display": "Drugs of abuse 5 panel - Urine by Screen method" } ], "text": "Drugs of abuse 5 panel - Urine by Screen method" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" }, "effectiveDateTime": "2014-03-27T10:33:04+01:00", "issued": "2014-03-27T10:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "260385009", "display": "Negative (qualifier value)" } ], "text": "Negative (qualifier value)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:528d5e2c-6f19-b65e-c9e3-db9a8df20041", "resource": { "resourceType": "Observation", "id": "528d5e2c-6f19-b65e-c9e3-db9a8df20041", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "91148-7", "display": "Pain intensity, Enjoyment of life, General activity (PEG) 3 item pain scale" } ], "text": "Pain intensity, Enjoyment of life, General activity (PEG) 3 item pain scale" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" }, "effectiveDateTime": "2014-03-27T10:33:04+01:00", "issued": "2014-03-27T10:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "91146-1", "display": "What number best describes how pain has interfered with your general activity during the past week" } ], "text": "What number best describes how pain has interfered with your general activity during the past week" }, "valueQuantity": { "value": 9.5819, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "91145-3", "display": "What number best describes how pain has interfered with your enjoyment of life during the past week" } ], "text": "What number best describes how pain has interfered with your enjoyment of life during the past week" }, "valueQuantity": { "value": 6.644, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "75893-8", "display": "Pain severity in the past week - 0-10 numeric rating [Reported]" } ], "text": "Pain severity in the past week - 0-10 numeric rating [Reported]" }, "valueQuantity": { "value": 8.6224, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d6d1261b-d0c7-eea0-1951-0ed54bd56dff", "resource": { "resourceType": "MedicationRequest", "id": "d6d1261b-d0c7-eea0-1951-0ed54bd56dff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "856987", "display": "Acetaminophen 300 MG / Hydrocodone Bitartrate 5 MG Oral Tablet" } ], "text": "Acetaminophen 300 MG / Hydrocodone Bitartrate 5 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" }, "authoredOn": "2014-03-27T10:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "dosageInstruction": [ { "sequence": 1, "text": "Every four to six hours (qualifier value)", "additionalInstruction": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "225757006", "display": "Every four to six hours (qualifier value)" } ], "text": "Every four to six hours (qualifier value)" } ], "timing": { "repeat": { "frequency": 4, "period": 1.0, "periodUnit": "d" } }, "asNeededBoolean": false, "doseAndRate": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type", "code": "ordered", "display": "Ordered" } ] }, "doseQuantity": { "value": 1.0 } } ] } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:291d5ddb-d7bc-4ab3-ed40-5c138247773b", "resource": { "resourceType": "Claim", "id": "291d5ddb-d7bc-4ab3-ed40-5c138247773b", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "created": "2014-03-27T10:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:d6d1261b-d0c7-eea0-1951-0ed54bd56dff" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "856987", "display": "Acetaminophen 300 MG / Hydrocodone Bitartrate 5 MG Oral Tablet" } ], "text": "Acetaminophen 300 MG / Hydrocodone Bitartrate 5 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ] } ], "total": { "value": 59.85, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:99b7d2f7-efd7-9602-af80-4d425e579e88", "resource": { "resourceType": "ExplanationOfBenefit", "id": "99b7d2f7-efd7-9602-af80-4d425e579e88", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "291d5ddb-d7bc-4ab3-ed40-5c138247773b" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-03-27T10:48:04+01:00", "end": "2015-03-27T10:48:04+01:00" }, "created": "2014-03-27T10:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:291d5ddb-d7bc-4ab3-ed40-5c138247773b" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "856987", "display": "Acetaminophen 300 MG / Hydrocodone Bitartrate 5 MG Oral Tablet" } ], "text": "Acetaminophen 300 MG / Hydrocodone Bitartrate 5 MG Oral Tablet" }, "servicedPeriod": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 59.85, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a6828307-ec10-d684-d1c6-3bc415583302", "resource": { "resourceType": "MedicationRequest", "id": "a6828307-ec10-d684-d1c6-3bc415583302", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" }, "authoredOn": "2015-01-27T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:5cec0788-4686-8c1a-4dba-e43426f9d36e", "resource": { "resourceType": "Claim", "id": "5cec0788-4686-8c1a-4dba-e43426f9d36e", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "created": "2014-03-27T10:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:a6828307-ec10-d684-d1c6-3bc415583302" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:b3725247-352c-ac2b-321c-0c47574b2939", "resource": { "resourceType": "ExplanationOfBenefit", "id": "b3725247-352c-ac2b-321c-0c47574b2939", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "5cec0788-4686-8c1a-4dba-e43426f9d36e" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-03-27T10:48:04+01:00", "end": "2015-03-27T10:48:04+01:00" }, "created": "2014-03-27T10:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:5cec0788-4686-8c1a-4dba-e43426f9d36e" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:cde8666c-a1d1-6c71-eef1-126b20281379", "resource": { "resourceType": "MedicationRequest", "id": "cde8666c-a1d1-6c71-eef1-126b20281379", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" }, "authoredOn": "2015-01-27T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:e759143e-b8f6-543a-9c56-5dca5411ec4f", "resource": { "resourceType": "Claim", "id": "e759143e-b8f6-543a-9c56-5dca5411ec4f", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "created": "2014-03-27T10:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:cde8666c-a1d1-6c71-eef1-126b20281379" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:8f789dd9-2c5f-7aaf-4ecd-fad93d6eb936", "resource": { "resourceType": "ExplanationOfBenefit", "id": "8f789dd9-2c5f-7aaf-4ecd-fad93d6eb936", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e759143e-b8f6-543a-9c56-5dca5411ec4f" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-03-27T10:48:04+01:00", "end": "2015-03-27T10:48:04+01:00" }, "created": "2014-03-27T10:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:e759143e-b8f6-543a-9c56-5dca5411ec4f" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:088e8dec-1fa2-aac3-70ae-c3be60094bb1", "resource": { "resourceType": "MedicationRequest", "id": "088e8dec-1fa2-aac3-70ae-c3be60094bb1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" }, "authoredOn": "2015-01-27T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:8f7d71d8-8cc0-077a-2fd6-b8ed68091f1d", "resource": { "resourceType": "Claim", "id": "8f7d71d8-8cc0-077a-2fd6-b8ed68091f1d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "created": "2014-03-27T10:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:088e8dec-1fa2-aac3-70ae-c3be60094bb1" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:ddb25430-01f6-ff04-5c5c-0e3024157c12", "resource": { "resourceType": "ExplanationOfBenefit", "id": "ddb25430-01f6-ff04-5c5c-0e3024157c12", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "8f7d71d8-8cc0-077a-2fd6-b8ed68091f1d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-03-27T10:48:04+01:00", "end": "2015-03-27T10:48:04+01:00" }, "created": "2014-03-27T10:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:8f7d71d8-8cc0-077a-2fd6-b8ed68091f1d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:90e5a5dc-1f54-d39a-6339-19dc638581de", "resource": { "resourceType": "CareTeam", "id": "90e5a5dc-1f54-d39a-6339-19dc638581de", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "active", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" }, "period": { "start": "2014-03-27T10:33:04+01:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:92889598-bde5-706f-802a-42cfe4ff9526", "resource": { "resourceType": "CarePlan", "id": "92889598-bde5-706f-802a-42cfe4ff9526", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Therapy (regime/therapy).
Activities:
" }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "276239002", "display": "Therapy (regime/therapy)" } ], "text": "Therapy (regime/therapy)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" }, "period": { "start": "2014-03-27T10:33:04+01:00" }, "careTeam": [ { "reference": "urn:uuid:90e5a5dc-1f54-d39a-6339-19dc638581de" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "status": "in-progress", "location": { "display": "WP ACQUISITION SUB LLC" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "228557008", "display": "Cognitive and behavioral therapy (regime/therapy)" } ], "text": "Cognitive and behavioral therapy (regime/therapy)" }, "status": "in-progress", "location": { "display": "WP ACQUISITION SUB LLC" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:7decc9fd-1d8f-9a39-2d5b-4a055264aa05", "resource": { "resourceType": "DiagnosticReport", "id": "7decc9fd-1d8f-9a39-2d5b-4a055264aa05", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" }, "effectiveDateTime": "2014-03-27T10:33:04+01:00", "issued": "2014-03-27T10:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:329888c7-959d-61c6-db16-e643099da36c", "resource": { "resourceType": "DocumentReference", "id": "329888c7-959d-61c6-db16-e643099da36c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:7decc9fd-1d8f-9a39-2d5b-4a055264aa05" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2014-03-27T10:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ], "period": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:91bcf393-5cbc-e102-4062-109951c5e86d", "resource": { "resourceType": "Claim", "id": "91bcf393-5cbc-e102-4062-109951c5e86d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "created": "2014-03-27T10:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "390906007", "display": "Follow-up encounter (procedure)" } ], "text": "Follow-up encounter (procedure)" }, "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ] } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:015fe9c5-9789-acb1-afa3-bc190b89f0e1", "resource": { "resourceType": "ExplanationOfBenefit", "id": "015fe9c5-9789-acb1-afa3-bc190b89f0e1", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "91bcf393-5cbc-e102-4062-109951c5e86d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2014-03-27T10:48:04+01:00", "end": "2015-03-27T10:48:04+01:00" }, "created": "2014-03-27T10:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:91bcf393-5cbc-e102-4062-109951c5e86d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "390906007", "display": "Follow-up encounter (procedure)" } ], "text": "Follow-up encounter (procedure)" }, "servicedPeriod": { "start": "2014-03-27T10:33:04+01:00", "end": "2014-03-27T10:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 85.55, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f", "resource": { "resourceType": "Encounter", "id": "d8fd69c3-2fa5-abb9-685a-7a204f2b722f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "d8fd69c3-2fa5-abb9-685a-7a204f2b722f" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:c205eec1-1c25-55e1-cc23-6e51a3727441", "resource": { "resourceType": "Condition", "id": "c205eec1-1c25-55e1-cc23-6e51a3727441", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "741062008", "display": "Not in labor force (finding)" } ], "text": "Not in labor force (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "onsetDateTime": "2015-01-31T02:17:57+01:00", "abatementDateTime": "2016-02-06T02:32:17+01:00", "recordedDate": "2015-01-31T02:17:57+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:8b83a26a-9d28-a46e-ed2e-e3fea4d82d04", "resource": { "resourceType": "Condition", "id": "8b83a26a-9d28-a46e-ed2e-e3fea4d82d04", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "onsetDateTime": "2015-01-31T02:17:57+01:00", "abatementDateTime": "2016-02-06T02:32:17+01:00", "recordedDate": "2015-01-31T02:17:57+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:41684e5a-fd4b-103c-bb5c-08713356a1a6", "resource": { "resourceType": "Observation", "id": "41684e5a-fd4b-103c-bb5c-08713356a1a6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T01:33:04+01:00", "issued": "2015-01-31T01:33:04.492+01:00", "valueQuantity": { "value": 168.6, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:af4dcf9c-6b6c-3dc7-7cbd-c4aa7daba5a1", "resource": { "resourceType": "Observation", "id": "af4dcf9c-6b6c-3dc7-7cbd-c4aa7daba5a1", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T01:33:04+01:00", "issued": "2015-01-31T01:33:04.492+01:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3d982016-8efc-e91d-b594-de42b779b18e", "resource": { "resourceType": "Observation", "id": "3d982016-8efc-e91d-b594-de42b779b18e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T01:33:04+01:00", "issued": "2015-01-31T01:33:04.492+01:00", "valueQuantity": { "value": 74.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8148f1c3-4eca-9cd8-f77f-dbb9db29c7b8", "resource": { "resourceType": "Observation", "id": "8148f1c3-4eca-9cd8-f77f-dbb9db29c7b8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T01:33:04+01:00", "issued": "2015-01-31T01:33:04.492+01:00", "valueQuantity": { "value": 26.09, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2e7a993c-0170-3c8d-b870-f50956e8785f", "resource": { "resourceType": "Observation", "id": "2e7a993c-0170-3c8d-b870-f50956e8785f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "59576-9", "display": "Body mass index (BMI) [Percentile] Per age and sex" } ], "text": "Body mass index (BMI) [Percentile] Per age and sex" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T01:33:04+01:00", "issued": "2015-01-31T01:33:04.492+01:00", "valueQuantity": { "value": 83.266, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d45e34ed-5bfe-61b1-8de8-b346cc841461", "resource": { "resourceType": "Observation", "id": "d45e34ed-5bfe-61b1-8de8-b346cc841461", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T01:33:04+01:00", "issued": "2015-01-31T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 81, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 142, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4389dfcd-297b-4f94-9c24-21786cab00f6", "resource": { "resourceType": "Observation", "id": "4389dfcd-297b-4f94-9c24-21786cab00f6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T01:33:04+01:00", "issued": "2015-01-31T01:33:04.492+01:00", "valueQuantity": { "value": 68, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d44ba5d0-86c7-cb11-6983-15aa16ced2ad", "resource": { "resourceType": "Observation", "id": "d44ba5d0-86c7-cb11-6983-15aa16ced2ad", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T01:33:04+01:00", "issued": "2015-01-31T01:33:04.492+01:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2c162f64-97f3-3bf7-e3bf-4bd5a597ece9", "resource": { "resourceType": "Observation", "id": "2c162f64-97f3-3bf7-e3bf-4bd5a597ece9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T01:33:04+01:00", "issued": "2015-01-31T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6ff61344-2cb8-2c69-8345-19b0bae92082", "resource": { "resourceType": "Observation", "id": "6ff61344-2cb8-2c69-8345-19b0bae92082", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T02:17:57+01:00", "issued": "2015-01-31T02:17:57.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13863-8", "display": "A little bit" } ], "text": "A little bit" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30132-7", "display": "5 or more times a week" } ], "text": "5 or more times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30137-6", "display": "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)" } ], "text": "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ae169927-2db8-46f5-56d2-0c2a3650c082", "resource": { "resourceType": "Observation", "id": "ae169927-2db8-46f5-56d2-0c2a3650c082", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T02:58:41+01:00", "issued": "2015-01-31T02:58:41.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3044c879-566b-47b3-06c8-8dbc93251117", "resource": { "resourceType": "Observation", "id": "3044c879-566b-47b3-06c8-8dbc93251117", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "75626-2", "display": "Total score [AUDIT-C]" } ], "text": "Total score [AUDIT-C]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T03:36:30+01:00", "issued": "2015-01-31T03:36:30.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:edbaeb82-1ae4-f354-9ae4-0fe0d527a233", "resource": { "resourceType": "Procedure", "id": "edbaeb82-1ae4-f354-9ae4-0fe0d527a233", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "performedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:f1069fa8-1e79-fed8-5643-9f66aad94132", "resource": { "resourceType": "Procedure", "id": "f1069fa8-1e79-fed8-5643-9f66aad94132", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "performedPeriod": { "start": "2015-01-31T02:17:57+01:00", "end": "2015-01-31T02:32:41+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:aca55306-25bc-8d44-01de-06a928aa6789", "resource": { "resourceType": "Procedure", "id": "aca55306-25bc-8d44-01de-06a928aa6789", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "performedPeriod": { "start": "2015-01-31T02:32:41+01:00", "end": "2015-01-31T02:58:41+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:2c2f258b-8794-4583-4596-811328152055", "resource": { "resourceType": "Procedure", "id": "2c2f258b-8794-4583-4596-811328152055", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "performedPeriod": { "start": "2015-01-31T02:58:41+01:00", "end": "2015-01-31T03:09:40+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:11f2964d-ba08-bd4e-9d28-2cb3740dc077", "resource": { "resourceType": "Procedure", "id": "11f2964d-ba08-bd4e-9d28-2cb3740dc077", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "performedPeriod": { "start": "2015-01-31T03:09:40+01:00", "end": "2015-01-31T03:36:30+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:e66e3311-ccdf-6d4a-9970-c0fd6570cb16", "resource": { "resourceType": "MedicationRequest", "id": "e66e3311-ccdf-6d4a-9970-c0fd6570cb16", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "authoredOn": "2015-01-31T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:c8292466-5b40-e62b-d651-a4b2049cc431", "resource": { "resourceType": "Claim", "id": "c8292466-5b40-e62b-d651-a4b2049cc431", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "created": "2015-01-31T02:17:57+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:e66e3311-ccdf-6d4a-9970-c0fd6570cb16" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:cab2a7e8-4967-0cd9-ec9b-c2573402acdb", "resource": { "resourceType": "ExplanationOfBenefit", "id": "cab2a7e8-4967-0cd9-ec9b-c2573402acdb", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c8292466-5b40-e62b-d651-a4b2049cc431" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-01-31T02:17:57+01:00", "end": "2016-01-31T02:17:57+01:00" }, "created": "2015-01-31T02:17:57+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:c8292466-5b40-e62b-d651-a4b2049cc431" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:6e27ae47-cda4-bdd7-23f8-61de3c71e718", "resource": { "resourceType": "MedicationRequest", "id": "6e27ae47-cda4-bdd7-23f8-61de3c71e718", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "authoredOn": "2015-01-31T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:d14c8805-aefc-c01c-523e-b06800805389", "resource": { "resourceType": "Claim", "id": "d14c8805-aefc-c01c-523e-b06800805389", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "created": "2015-01-31T02:17:57+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:6e27ae47-cda4-bdd7-23f8-61de3c71e718" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:49f80747-4a2e-7028-19f9-183bd765e57e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "49f80747-4a2e-7028-19f9-183bd765e57e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "d14c8805-aefc-c01c-523e-b06800805389" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-01-31T02:17:57+01:00", "end": "2016-01-31T02:17:57+01:00" }, "created": "2015-01-31T02:17:57+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:d14c8805-aefc-c01c-523e-b06800805389" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:76b2a395-1e8c-f57d-7e10-df5139ca2e87", "resource": { "resourceType": "MedicationRequest", "id": "76b2a395-1e8c-f57d-7e10-df5139ca2e87", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "authoredOn": "2015-01-31T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:a473e8c4-80aa-105a-3dc0-a503f2a1ce15", "resource": { "resourceType": "Claim", "id": "a473e8c4-80aa-105a-3dc0-a503f2a1ce15", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "created": "2015-01-31T02:17:57+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:76b2a395-1e8c-f57d-7e10-df5139ca2e87" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:b7edff4e-e1ac-9906-95c3-368ee5f06b3b", "resource": { "resourceType": "ExplanationOfBenefit", "id": "b7edff4e-e1ac-9906-95c3-368ee5f06b3b", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a473e8c4-80aa-105a-3dc0-a503f2a1ce15" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-01-31T02:17:57+01:00", "end": "2016-01-31T02:17:57+01:00" }, "created": "2015-01-31T02:17:57+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:a473e8c4-80aa-105a-3dc0-a503f2a1ce15" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:4ac63cb8-5c4e-8986-a5cb-53ec9417b9ad", "resource": { "resourceType": "Immunization", "id": "4ac63cb8-5c4e-8986-a5cb-53ec9417b9ad", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "occurrenceDateTime": "2015-01-31T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:0af05330-16c6-6427-e7d9-049f61383c32", "resource": { "resourceType": "DiagnosticReport", "id": "0af05330-16c6-6427-e7d9-049f61383c32", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T02:58:41+01:00", "issued": "2015-01-31T02:58:41.492+01:00", "result": [ { "reference": "urn:uuid:ae169927-2db8-46f5-56d2-0c2a3650c082", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:15df45bb-d1e8-fc78-678d-668d94b05e0f", "resource": { "resourceType": "DiagnosticReport", "id": "15df45bb-d1e8-fc78-678d-668d94b05e0f", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T03:36:30+01:00", "issued": "2015-01-31T03:36:30.492+01:00", "result": [ { "reference": "urn:uuid:3044c879-566b-47b3-06c8-8dbc93251117", "display": "Total score [AUDIT-C]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:8debcb69-e80a-7be7-c32f-be55c3aa7df4", "resource": { "resourceType": "DiagnosticReport", "id": "8debcb69-e80a-7be7-c32f-be55c3aa7df4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, "effectiveDateTime": "2015-01-31T01:33:04+01:00", "issued": "2015-01-31T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:e16d6e5c-d00a-8494-e17d-d806efa1e3f1", "resource": { "resourceType": "DocumentReference", "id": "e16d6e5c-d00a-8494-e17d-d806efa1e3f1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:8debcb69-e80a-7be7-c32f-be55c3aa7df4" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2015-01-31T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" } ], "period": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:76e82552-e845-c39f-2af4-64e39fe6532d", "resource": { "resourceType": "Claim", "id": "76e82552-e845-c39f-2af4-64e39fe6532d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "created": "2015-01-31T02:17:57+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:4ac63cb8-5c4e-8986-a5cb-53ec9417b9ad" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:c205eec1-1c25-55e1-cc23-6e51a3727441" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:8b83a26a-9d28-a46e-ed2e-e3fea4d82d04" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:edbaeb82-1ae4-f354-9ae4-0fe0d527a233" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:f1069fa8-1e79-fed8-5643-9f66aad94132" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:aca55306-25bc-8d44-01de-06a928aa6789" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:2c2f258b-8794-4583-4596-811328152055" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:11f2964d-ba08-bd4e-9d28-2cb3740dc077" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 4, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "741062008", "display": "Not in labor force (finding)" } ], "text": "Not in labor force (finding)" } }, { "sequence": 5, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" } }, { "sequence": 6, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 9, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 704.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:614f7bc9-cd97-9456-0151-9db2e8067ef2", "resource": { "resourceType": "ExplanationOfBenefit", "id": "614f7bc9-cd97-9456-0151-9db2e8067ef2", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "76e82552-e845-c39f-2af4-64e39fe6532d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-01-31T02:17:57+01:00", "end": "2016-01-31T02:17:57+01:00" }, "created": "2015-01-31T02:17:57+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:76e82552-e845-c39f-2af4-64e39fe6532d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:c205eec1-1c25-55e1-cc23-6e51a3727441" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:8b83a26a-9d28-a46e-ed2e-e3fea4d82d04" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "741062008", "display": "Not in labor force (finding)" } ], "text": "Not in labor force (finding)" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 5, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "servicedPeriod": { "start": "2015-01-31T01:33:04+01:00", "end": "2015-01-31T02:17:57+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 704.20, "currency": "USD" } } ], "payment": { "amount": { "value": 1953.7279999999998, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828", "resource": { "resourceType": "Encounter", "id": "1fdea5a7-e6b1-914f-b018-cb1e3dede828", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "1fdea5a7-e6b1-914f-b018-cb1e3dede828" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "EMER" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "50849002", "display": "Emergency room admission (procedure)" } ], "text": "Emergency room admission (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:58:07+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } } ], "period": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:58:07+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "90460009", "display": "Injury of neck (disorder)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:27b60217-f7af-4b76-0511-bbb9db875915", "resource": { "resourceType": "Condition", "id": "27b60217-f7af-4b76-0511-bbb9db875915", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "90460009", "display": "Injury of neck (disorder)" } ], "text": "Injury of neck (disorder)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" }, "onsetDateTime": "2015-04-28T02:58:07+02:00", "abatementDateTime": "2015-07-09T02:58:07+02:00", "recordedDate": "2015-04-28T02:58:07+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:efb13ab0-b300-a321-374c-4d9028ebca64", "resource": { "resourceType": "Condition", "id": "efb13ab0-b300-a321-374c-4d9028ebca64", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "39848009", "display": "Whiplash injury to neck" } ], "text": "Whiplash injury to neck" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" }, "onsetDateTime": "2015-04-28T02:58:07+02:00", "abatementDateTime": "2015-07-09T02:58:07+02:00", "recordedDate": "2015-04-28T02:58:07+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:6c78417a-547b-423b-de52-697be7312daa", "resource": { "resourceType": "MedicationRequest", "id": "6c78417a-547b-423b-de52-697be7312daa", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310965", "display": "Ibuprofen 200 MG Oral Tablet" } ], "text": "Ibuprofen 200 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" }, "authoredOn": "2015-04-28T02:58:07+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:5867af22-7bdb-7d31-6a27-fe52b2690533", "resource": { "resourceType": "Claim", "id": "5867af22-7bdb-7d31-6a27-fe52b2690533", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:58:07+02:00" }, "created": "2015-04-28T03:58:07+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:6c78417a-547b-423b-de52-697be7312daa" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310965", "display": "Ibuprofen 200 MG Oral Tablet" } ], "text": "Ibuprofen 200 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" } ] } ], "total": { "value": 262.15, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f7a31f3e-e8fb-4521-fa31-584cfecb4632", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f7a31f3e-e8fb-4521-fa31-584cfecb4632", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "5867af22-7bdb-7d31-6a27-fe52b2690533" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-04-28T03:58:07+02:00", "end": "2016-04-28T03:58:07+02:00" }, "created": "2015-04-28T03:58:07+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" }, "claim": { "reference": "urn:uuid:5867af22-7bdb-7d31-6a27-fe52b2690533" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "310965", "display": "Ibuprofen 200 MG Oral Tablet" } ], "text": "Ibuprofen 200 MG Oral Tablet" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:58:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 262.15, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:5efe71f6-0595-8998-9735-b1fa499fc27c", "resource": { "resourceType": "CareTeam", "id": "5efe71f6-0595-8998-9735-b1fa499fc27c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "inactive", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" }, "period": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-07-09T02:58:07+02:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" } } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:6d340042-b394-4f64-eb02-ed7b42fd0132", "resource": { "resourceType": "CarePlan", "id": "6d340042-b394-4f64-eb02-ed7b42fd0132", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Musculoskeletal care.
Activities:
" }, "status": "completed", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "408869004", "display": "Musculoskeletal care" } ], "text": "Musculoskeletal care" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" }, "period": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-07-09T02:58:07+02:00" }, "careTeam": [ { "reference": "urn:uuid:5efe71f6-0595-8998-9735-b1fa499fc27c" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "266694003", "display": "Heat therapy" } ], "text": "Heat therapy" }, "status": "completed", "location": { "display": "PENACOOK PLACE, INC" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "183051005", "display": "Recommendation to rest" } ], "text": "Recommendation to rest" }, "status": "completed", "location": { "display": "PENACOOK PLACE, INC" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:3deddf4f-0ef6-919b-23c5-968f1310fc23", "resource": { "resourceType": "DiagnosticReport", "id": "3deddf4f-0ef6-919b-23c5-968f1310fc23", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" }, "effectiveDateTime": "2015-04-28T02:58:07+02:00", "issued": "2015-04-28T02:58:07.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:0a67bd4d-d95f-3e1f-ddbb-fc7c97193e3f", "resource": { "resourceType": "DocumentReference", "id": "0a67bd4d-d95f-3e1f-ddbb-fc7c97193e3f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:3deddf4f-0ef6-919b-23c5-968f1310fc23" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2015-04-28T02:58:07.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" } ], "period": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:58:07+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:7c7609a4-33e3-5544-7c85-15b5b8f10ca9", "resource": { "resourceType": "Claim", "id": "7c7609a4-33e3-5544-7c85-15b5b8f10ca9", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:58:07+02:00" }, "created": "2015-04-28T03:58:07+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:27b60217-f7af-4b76-0511-bbb9db875915" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:efb13ab0-b300-a321-374c-4d9028ebca64" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "50849002", "display": "Emergency room admission (procedure)" } ], "text": "Emergency room admission (procedure)" }, "encounter": [ { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "90460009", "display": "Injury of neck (disorder)" } ], "text": "Injury of neck (disorder)" } }, { "sequence": 3, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "39848009", "display": "Whiplash injury to neck" } ], "text": "Whiplash injury to neck" } } ], "total": { "value": 146.18, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:a1588d06-598e-af40-fe58-9e1682724021", "resource": { "resourceType": "ExplanationOfBenefit", "id": "a1588d06-598e-af40-fe58-9e1682724021", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "7c7609a4-33e3-5544-7c85-15b5b8f10ca9" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-04-28T03:58:07+02:00", "end": "2016-04-28T03:58:07+02:00" }, "created": "2015-04-28T03:58:07+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" }, "claim": { "reference": "urn:uuid:7c7609a4-33e3-5544-7c85-15b5b8f10ca9" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:27b60217-f7af-4b76-0511-bbb9db875915" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:efb13ab0-b300-a321-374c-4d9028ebca64" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "50849002", "display": "Emergency room admission (procedure)" } ], "text": "Emergency room admission (procedure)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:58:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "90460009", "display": "Injury of neck (disorder)" } ], "text": "Injury of neck (disorder)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:58:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] } }, { "sequence": 3, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "39848009", "display": "Whiplash injury to neck" } ], "text": "Whiplash injury to neck" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:58:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 146.18, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64", "resource": { "resourceType": "Encounter", "id": "1e94df21-b37f-785f-82de-1e3094f3be64", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "1e94df21-b37f-785f-82de-1e3094f3be64" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "IMP" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "449411000124106", "display": "Admission to skilled nursing facility (procedure)" } ], "text": "Admission to skilled nursing facility (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } } ], "period": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "25675004", "display": "Patient transfer to skilled nursing facility (procedure)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:5e03160f-5468-8f05-df53-028905c040f1", "resource": { "resourceType": "Condition", "id": "5e03160f-5468-8f05-df53-028905c040f1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "25675004", "display": "Patient transfer to skilled nursing facility (procedure)" } ], "text": "Patient transfer to skilled nursing facility (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "onsetDateTime": "2015-04-28T02:58:07+02:00", "abatementDateTime": "2015-06-05T02:58:07+02:00", "recordedDate": "2015-04-28T02:58:07+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:836e8548-9480-adf4-eaec-a897a9bbeec4", "resource": { "resourceType": "Procedure", "id": "836e8548-9480-adf4-eaec-a897a9bbeec4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "63332003", "display": "History AND physical examination (procedure)" } ], "text": "History AND physical examination (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b31417a4-ff4c-4a48-6c2d-55ec2107a133", "resource": { "resourceType": "Procedure", "id": "b31417a4-ff4c-4a48-6c2d-55ec2107a133", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "315639002", "display": "Initial patient assessment (procedure)" } ], "text": "Initial patient assessment (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:28233694-35f3-831c-258e-d27d9d84716b", "resource": { "resourceType": "Procedure", "id": "28233694-35f3-831c-258e-d27d9d84716b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "370789001", "display": "Development of individualized plan of care (procedure)" } ], "text": "Development of individualized plan of care (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c61ca3d5-994d-bf55-ccd9-9383d3fba0e4", "resource": { "resourceType": "Procedure", "id": "c61ca3d5-994d-bf55-ccd9-9383d3fba0e4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-04-28T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b3d58e45-fcd7-c663-6537-4f3b9bcccea6", "resource": { "resourceType": "Procedure", "id": "b3d58e45-fcd7-c663-6537-4f3b9bcccea6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-04-29T02:58:07+02:00", "end": "2015-04-29T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:76f72532-30f8-9e5c-05cb-bea69c6bc885", "resource": { "resourceType": "Procedure", "id": "76f72532-30f8-9e5c-05cb-bea69c6bc885", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-04-30T02:58:07+02:00", "end": "2015-04-30T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0c7d57b5-c0c3-09a7-de90-430363ed7385", "resource": { "resourceType": "Procedure", "id": "0c7d57b5-c0c3-09a7-de90-430363ed7385", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-01T02:58:07+02:00", "end": "2015-05-01T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:089c8fcf-76b9-e79d-44fe-33930de9aff7", "resource": { "resourceType": "Procedure", "id": "089c8fcf-76b9-e79d-44fe-33930de9aff7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-02T02:58:07+02:00", "end": "2015-05-02T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:9ecdea43-5c3e-8b7d-bf41-eb8317113002", "resource": { "resourceType": "Procedure", "id": "9ecdea43-5c3e-8b7d-bf41-eb8317113002", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-03T02:58:07+02:00", "end": "2015-05-03T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:7416a3a0-4f75-edf1-4ead-acef3b2d3a69", "resource": { "resourceType": "Procedure", "id": "7416a3a0-4f75-edf1-4ead-acef3b2d3a69", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-03T02:58:07+02:00", "end": "2015-05-03T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b2746a8d-1ae4-73af-e6bf-be4271d495a4", "resource": { "resourceType": "Procedure", "id": "b2746a8d-1ae4-73af-e6bf-be4271d495a4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-03T02:58:07+02:00", "end": "2015-05-03T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:2b374d80-b7de-2992-8094-0117322d8058", "resource": { "resourceType": "Procedure", "id": "2b374d80-b7de-2992-8094-0117322d8058", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-04T02:58:07+02:00", "end": "2015-05-04T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c9ea6d4e-680b-34e7-8809-0463d444b414", "resource": { "resourceType": "Procedure", "id": "c9ea6d4e-680b-34e7-8809-0463d444b414", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-04T02:58:07+02:00", "end": "2015-05-04T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1a9edf3b-2fc7-508b-84ff-eadb6773623f", "resource": { "resourceType": "Procedure", "id": "1a9edf3b-2fc7-508b-84ff-eadb6773623f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-05T02:58:07+02:00", "end": "2015-05-05T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:3d0279f7-a247-cd3a-f2f9-3cab3af2c43b", "resource": { "resourceType": "Procedure", "id": "3d0279f7-a247-cd3a-f2f9-3cab3af2c43b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-05T02:58:07+02:00", "end": "2015-05-05T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c43dc9bb-3181-e4f3-ef5a-f7ce228ca8be", "resource": { "resourceType": "Procedure", "id": "c43dc9bb-3181-e4f3-ef5a-f7ce228ca8be", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-06T02:58:07+02:00", "end": "2015-05-06T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:43da8f42-3f7f-a3a3-336a-1c274500ce61", "resource": { "resourceType": "Procedure", "id": "43da8f42-3f7f-a3a3-336a-1c274500ce61", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-06T02:58:07+02:00", "end": "2015-05-06T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:cba2cb0f-7578-ce69-e250-5c16cf937c18", "resource": { "resourceType": "Procedure", "id": "cba2cb0f-7578-ce69-e250-5c16cf937c18", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-07T02:58:07+02:00", "end": "2015-05-07T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:fe589937-de18-dbd8-7a00-f3ec171f2b14", "resource": { "resourceType": "Procedure", "id": "fe589937-de18-dbd8-7a00-f3ec171f2b14", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-08T02:58:07+02:00", "end": "2015-05-08T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:434437b5-9c8f-507d-c676-0a1a2fb180e8", "resource": { "resourceType": "Procedure", "id": "434437b5-9c8f-507d-c676-0a1a2fb180e8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-08T02:58:07+02:00", "end": "2015-05-08T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:4e852944-2175-f0ee-bd9d-5993f1cfcd5b", "resource": { "resourceType": "Procedure", "id": "4e852944-2175-f0ee-bd9d-5993f1cfcd5b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-09T02:58:07+02:00", "end": "2015-05-09T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:4411164d-e5de-61ee-b299-a9b61f7f67f4", "resource": { "resourceType": "Procedure", "id": "4411164d-e5de-61ee-b299-a9b61f7f67f4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-09T02:58:07+02:00", "end": "2015-05-09T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:2bc36078-0b35-b9ff-a2d1-cde1db7a774e", "resource": { "resourceType": "Procedure", "id": "2bc36078-0b35-b9ff-a2d1-cde1db7a774e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-09T02:58:07+02:00", "end": "2015-05-09T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1144a131-0347-9e9c-7d6b-5c04301aa272", "resource": { "resourceType": "Procedure", "id": "1144a131-0347-9e9c-7d6b-5c04301aa272", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-10T02:58:07+02:00", "end": "2015-05-10T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:3b758374-913c-3ef1-be81-bee693f08326", "resource": { "resourceType": "Procedure", "id": "3b758374-913c-3ef1-be81-bee693f08326", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-11T02:58:07+02:00", "end": "2015-05-11T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:cd979b24-3015-efaf-7dc7-3fbf0db3b3c2", "resource": { "resourceType": "Procedure", "id": "cd979b24-3015-efaf-7dc7-3fbf0db3b3c2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "311555007", "display": "Speech and language therapy regime (regime/therapy)" } ], "text": "Speech and language therapy regime (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-11T02:58:07+02:00", "end": "2015-05-11T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b4c05bc6-9c19-0dbd-3cb0-fb133fe60c02", "resource": { "resourceType": "Procedure", "id": "b4c05bc6-9c19-0dbd-3cb0-fb133fe60c02", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-12T02:58:07+02:00", "end": "2015-05-12T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:6aa95a03-0da9-71c1-8150-23643e312ad2", "resource": { "resourceType": "Procedure", "id": "6aa95a03-0da9-71c1-8150-23643e312ad2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-13T02:58:07+02:00", "end": "2015-05-13T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:e54d30cd-b46a-33b0-9627-597a1aeed653", "resource": { "resourceType": "Procedure", "id": "e54d30cd-b46a-33b0-9627-597a1aeed653", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-13T02:58:07+02:00", "end": "2015-05-13T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:4446d092-9bb0-c515-9671-1ebda78d3594", "resource": { "resourceType": "Procedure", "id": "4446d092-9bb0-c515-9671-1ebda78d3594", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-14T02:58:07+02:00", "end": "2015-05-14T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:7288434a-e2e2-c1c6-d722-7d6adc13d577", "resource": { "resourceType": "Procedure", "id": "7288434a-e2e2-c1c6-d722-7d6adc13d577", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-15T02:58:07+02:00", "end": "2015-05-15T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:f0b1bf1f-54dc-873a-0ba1-0fa93466ea8b", "resource": { "resourceType": "Procedure", "id": "f0b1bf1f-54dc-873a-0ba1-0fa93466ea8b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-16T02:58:07+02:00", "end": "2015-05-16T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b1abdb91-4eba-7266-5e64-53b47c606dcf", "resource": { "resourceType": "Procedure", "id": "b1abdb91-4eba-7266-5e64-53b47c606dcf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-17T02:58:07+02:00", "end": "2015-05-17T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:832ad4d2-d7fd-e1b2-aa14-08733e5ac01f", "resource": { "resourceType": "Procedure", "id": "832ad4d2-d7fd-e1b2-aa14-08733e5ac01f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-17T02:58:07+02:00", "end": "2015-05-17T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:19eb287b-ac0b-ee17-5a4a-658fb20c85dc", "resource": { "resourceType": "Procedure", "id": "19eb287b-ac0b-ee17-5a4a-658fb20c85dc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-18T02:58:07+02:00", "end": "2015-05-18T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:f7adb0b3-f033-26e1-2b33-3efaefc22bb4", "resource": { "resourceType": "Procedure", "id": "f7adb0b3-f033-26e1-2b33-3efaefc22bb4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-19T02:58:07+02:00", "end": "2015-05-19T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1d1b82ba-ada8-4a53-784b-6fab5ae6d452", "resource": { "resourceType": "Procedure", "id": "1d1b82ba-ada8-4a53-784b-6fab5ae6d452", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-20T02:58:07+02:00", "end": "2015-05-20T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:f074b2e4-068f-e0f6-a1b0-49ed9392882b", "resource": { "resourceType": "Procedure", "id": "f074b2e4-068f-e0f6-a1b0-49ed9392882b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-20T02:58:07+02:00", "end": "2015-05-20T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:a7d6f021-4ce7-ba72-7411-9f74654f50ae", "resource": { "resourceType": "Procedure", "id": "a7d6f021-4ce7-ba72-7411-9f74654f50ae", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-21T02:58:07+02:00", "end": "2015-05-21T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:5e4d717c-7f3f-da29-3275-a092f4a6327b", "resource": { "resourceType": "Procedure", "id": "5e4d717c-7f3f-da29-3275-a092f4a6327b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-22T02:58:07+02:00", "end": "2015-05-22T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:4edc46a9-ff78-a98a-40a7-86c36a130f37", "resource": { "resourceType": "Procedure", "id": "4edc46a9-ff78-a98a-40a7-86c36a130f37", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-23T02:58:07+02:00", "end": "2015-05-23T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:297a075a-b060-3011-e9bc-652e9bc25b82", "resource": { "resourceType": "Procedure", "id": "297a075a-b060-3011-e9bc-652e9bc25b82", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-23T02:58:07+02:00", "end": "2015-05-23T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:7fa47b21-b956-4e0e-3d8b-056efa0f7f3d", "resource": { "resourceType": "Procedure", "id": "7fa47b21-b956-4e0e-3d8b-056efa0f7f3d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-24T02:58:07+02:00", "end": "2015-05-24T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:738e722c-558a-c68e-4893-f07c9b00eefc", "resource": { "resourceType": "Procedure", "id": "738e722c-558a-c68e-4893-f07c9b00eefc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-25T02:58:07+02:00", "end": "2015-05-25T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1e1a6135-31a3-5549-97c3-ddb8a8c1addb", "resource": { "resourceType": "Procedure", "id": "1e1a6135-31a3-5549-97c3-ddb8a8c1addb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-25T02:58:07+02:00", "end": "2015-05-25T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:ee972ce1-3329-7388-3aee-3ab0cd144e67", "resource": { "resourceType": "Procedure", "id": "ee972ce1-3329-7388-3aee-3ab0cd144e67", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-26T02:58:07+02:00", "end": "2015-05-26T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:db48d794-545d-c34c-6d91-1399ea9dd17d", "resource": { "resourceType": "Procedure", "id": "db48d794-545d-c34c-6d91-1399ea9dd17d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-27T02:58:07+02:00", "end": "2015-05-27T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:13094d44-d3d9-cdfe-15dc-c832db735eeb", "resource": { "resourceType": "Procedure", "id": "13094d44-d3d9-cdfe-15dc-c832db735eeb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-28T02:58:07+02:00", "end": "2015-05-28T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:3334a253-c933-8d9c-e0ba-ab3b85e2cad3", "resource": { "resourceType": "Procedure", "id": "3334a253-c933-8d9c-e0ba-ab3b85e2cad3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-28T02:58:07+02:00", "end": "2015-05-28T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:7e8fee0a-5846-4bcc-999b-5f80a95c9602", "resource": { "resourceType": "Procedure", "id": "7e8fee0a-5846-4bcc-999b-5f80a95c9602", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-29T02:58:07+02:00", "end": "2015-05-29T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:fe6825c4-1a18-daab-a71d-8ebeb8b5e430", "resource": { "resourceType": "Procedure", "id": "fe6825c4-1a18-daab-a71d-8ebeb8b5e430", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-30T02:58:07+02:00", "end": "2015-05-30T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:89759900-7787-4f3d-b0c7-429722261bff", "resource": { "resourceType": "Procedure", "id": "89759900-7787-4f3d-b0c7-429722261bff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-31T02:58:07+02:00", "end": "2015-05-31T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0f02040c-e96e-a7a3-f8fb-0af90a68ccd0", "resource": { "resourceType": "Procedure", "id": "0f02040c-e96e-a7a3-f8fb-0af90a68ccd0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-05-31T02:58:07+02:00", "end": "2015-05-31T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:6c9a6136-e76b-24cc-11f2-8b4d8f578024", "resource": { "resourceType": "Procedure", "id": "6c9a6136-e76b-24cc-11f2-8b4d8f578024", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-06-01T02:58:07+02:00", "end": "2015-06-01T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:6e264b20-0dcd-0620-1554-5c8b2534bf7a", "resource": { "resourceType": "Procedure", "id": "6e264b20-0dcd-0620-1554-5c8b2534bf7a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-06-01T02:58:07+02:00", "end": "2015-06-01T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:a789203b-dc54-1b6a-62de-6089628a78ab", "resource": { "resourceType": "Procedure", "id": "a789203b-dc54-1b6a-62de-6089628a78ab", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-06-02T02:58:07+02:00", "end": "2015-06-02T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:08a19198-3a30-6509-6167-7c0e862952ef", "resource": { "resourceType": "Procedure", "id": "08a19198-3a30-6509-6167-7c0e862952ef", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-06-02T02:58:07+02:00", "end": "2015-06-02T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:7c18d724-ff42-39df-d371-af3ec4ac7ccd", "resource": { "resourceType": "Procedure", "id": "7c18d724-ff42-39df-d371-af3ec4ac7ccd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-06-03T02:58:07+02:00", "end": "2015-06-03T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1285ec3e-b888-a2f4-e696-a6e481ce3c9e", "resource": { "resourceType": "Procedure", "id": "1285ec3e-b888-a2f4-e696-a6e481ce3c9e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-06-04T02:58:07+02:00", "end": "2015-06-04T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c63d4fc9-2c51-845b-e59e-2334fb8b73de", "resource": { "resourceType": "Procedure", "id": "c63d4fc9-2c51-845b-e59e-2334fb8b73de", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-06-04T02:58:07+02:00", "end": "2015-06-04T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:bdf37216-e43f-c9b0-6a32-93278a2553e1", "resource": { "resourceType": "Procedure", "id": "bdf37216-e43f-c9b0-6a32-93278a2553e1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "225386006", "display": "Pre-discharge assessment (procedure)" } ], "text": "Pre-discharge assessment (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-06-05T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0b129d35-1f1f-fdf7-7b32-038592fe06d4", "resource": { "resourceType": "Procedure", "id": "0b129d35-1f1f-fdf7-7b32-038592fe06d4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "449381000124108", "display": "Discharge from skilled nursing facility (procedure)" } ], "text": "Discharge from skilled nursing facility (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "performedPeriod": { "start": "2015-06-05T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:bdcb70bc-3b6c-9a2c-a4b9-93663fabf728", "resource": { "resourceType": "Device", "id": "bdcb70bc-3b6c-9a2c-a4b9-93663fabf728", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ] }, "udiCarrier": [ { "deviceIdentifier": "11267138657713", "carrierHRF": "(01)11267138657713(11)150407(17)400421(10)5703084072949758(21)74765189" } ], "status": "active", "distinctIdentifier": "11267138657713", "manufactureDate": "2015-04-07T02:58:07+02:00", "expirationDate": "2040-04-21T02:58:07+02:00", "lotNumber": "5703084072949758", "serialNumber": "74765189", "deviceName": [ { "name": "Manual wheelchair (physical object)", "type": "user-friendly-name" } ], "type": { "coding": [ { "system": "http://snomed.info/sct", "code": "228869008", "display": "Manual wheelchair (physical object)" } ], "text": "Manual wheelchair (physical object)" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" } }, "request": { "method": "POST", "url": "Device" } }, { "fullUrl": "urn:uuid:1bfc27d3-e016-bc6b-8684-0dabb756c085", "resource": { "resourceType": "DiagnosticReport", "id": "1bfc27d3-e016-bc6b-8684-0dabb756c085", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, "effectiveDateTime": "2015-04-28T02:58:07+02:00", "issued": "2015-04-28T02:58:07.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:d3a01cba-c49d-0a59-d3c0-f00f03cbc813", "resource": { "resourceType": "DocumentReference", "id": "d3a01cba-c49d-0a59-d3c0-f00f03cbc813", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:1bfc27d3-e016-bc6b-8684-0dabb756c085" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2015-04-28T02:58:07.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMTUtMDQtMjgKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMTkgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCBub3QgaW4gbGFib3IgZm9yY2UgKGZpbmRpbmcpLCBwZXJlbm5pYWwgYWxsZXJnaWMgcmhpbml0aXMgd2l0aCBzZWFzb25hbCB2YXJpYXRpb24sIGNoaWxkaG9vZCBhc3RobWEsIHN0cmVzcyAoZmluZGluZykuCgojIFNvY2lhbCBIaXN0b3J5CiBQYXRpZW50IGhhcyBuZXZlciBzbW9rZWQuCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KIFBhdGllbnQgaGFzIGEgaGlnaCBzY2hvb2wgZWR1Y2F0aW9uLgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCmJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uOyBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXTsgaWJ1cHJvZmVuIDQwMCBtZyBvcmFsIHRhYmxldCBbaWJ1XQoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuClBhdGllbnQgaXMgcHJlc2VudGluZyB3aXRoIHBhdGllbnQgdHJhbnNmZXIgdG8gc2tpbGxlZCBudXJzaW5nIGZhY2lsaXR5IChwcm9jZWR1cmUpLiAKCiMjIFBsYW4KClRoZSBmb2xsb3dpbmcgcHJvY2VkdXJlcyB3ZXJlIGNvbmR1Y3RlZDoKLSBoaXN0b3J5IGFuZCBwaHlzaWNhbCBleGFtaW5hdGlvbiAocHJvY2VkdXJlKQotIGluaXRpYWwgcGF0aWVudCBhc3Nlc3NtZW50IChwcm9jZWR1cmUpCi0gZGV2ZWxvcG1lbnQgb2YgaW5kaXZpZHVhbGl6ZWQgcGxhbiBvZiBjYXJlIChwcm9jZWR1cmUpCi0gbnVyc2luZyBjYXJlL3N1cHBsZW1lbnRhcnkgc3VydmVpbGxhbmNlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gbnVyc2luZyBjYXJlL3N1cHBsZW1lbnRhcnkgc3VydmVpbGxhbmNlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gcGh5c2ljYWwgdGhlcmFweSBwcm9jZWR1cmUgKHJlZ2ltZS90aGVyYXB5KQotIHByb2Zlc3Npb25hbCAvIGFuY2lsbGFyeSBzZXJ2aWNlcyBjYXJlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIHByb2Zlc3Npb25hbCAvIGFuY2lsbGFyeSBzZXJ2aWNlcyBjYXJlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIHBoeXNpY2FsIHRoZXJhcHkgcHJvY2VkdXJlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIHByb2Zlc3Npb25hbCAvIGFuY2lsbGFyeSBzZXJ2aWNlcyBjYXJlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gb2NjdXBhdGlvbmFsIHRoZXJhcHkgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gcGh5c2ljYWwgdGhlcmFweSBwcm9jZWR1cmUgKHJlZ2ltZS90aGVyYXB5KQotIG9jY3VwYXRpb25hbCB0aGVyYXB5IChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gc3BlZWNoIGFuZCBsYW5ndWFnZSB0aGVyYXB5IHJlZ2ltZSAocmVnaW1lL3RoZXJhcHkpCi0gbnVyc2luZyBjYXJlL3N1cHBsZW1lbnRhcnkgc3VydmVpbGxhbmNlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIHByb2Zlc3Npb25hbCAvIGFuY2lsbGFyeSBzZXJ2aWNlcyBjYXJlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gbnVyc2luZyBjYXJlL3N1cHBsZW1lbnRhcnkgc3VydmVpbGxhbmNlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIHBoeXNpY2FsIHRoZXJhcHkgcHJvY2VkdXJlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gbnVyc2luZyBjYXJlL3N1cHBsZW1lbnRhcnkgc3VydmVpbGxhbmNlIChyZWdpbWUvdGhlcmFweSkKLSBwcm9mZXNzaW9uYWwgLyBhbmNpbGxhcnkgc2VydmljZXMgY2FyZSAocmVnaW1lL3RoZXJhcHkpCi0gbnVyc2luZyBjYXJlL3N1cHBsZW1lbnRhcnkgc3VydmVpbGxhbmNlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gcHJvZmVzc2lvbmFsIC8gYW5jaWxsYXJ5IHNlcnZpY2VzIGNhcmUgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gbnVyc2luZyBjYXJlL3N1cHBsZW1lbnRhcnkgc3VydmVpbGxhbmNlIChyZWdpbWUvdGhlcmFweSkKLSBvY2N1cGF0aW9uYWwgdGhlcmFweSAocmVnaW1lL3RoZXJhcHkpCi0gbnVyc2luZyBjYXJlL3N1cHBsZW1lbnRhcnkgc3VydmVpbGxhbmNlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gcHJvZmVzc2lvbmFsIC8gYW5jaWxsYXJ5IHNlcnZpY2VzIGNhcmUgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gbnVyc2luZyBjYXJlL3N1cHBsZW1lbnRhcnkgc3VydmVpbGxhbmNlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIG9jY3VwYXRpb25hbCB0aGVyYXB5IChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIHByb2Zlc3Npb25hbCAvIGFuY2lsbGFyeSBzZXJ2aWNlcyBjYXJlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIHByb2Zlc3Npb25hbCAvIGFuY2lsbGFyeSBzZXJ2aWNlcyBjYXJlIChyZWdpbWUvdGhlcmFweSkKLSBudXJzaW5nIGNhcmUvc3VwcGxlbWVudGFyeSBzdXJ2ZWlsbGFuY2UgKHJlZ2ltZS90aGVyYXB5KQotIG51cnNpbmcgY2FyZS9zdXBwbGVtZW50YXJ5IHN1cnZlaWxsYW5jZSAocmVnaW1lL3RoZXJhcHkpCi0gcHJvZmVzc2lvbmFsIC8gYW5jaWxsYXJ5IHNlcnZpY2VzIGNhcmUgKHJlZ2ltZS90aGVyYXB5KQotIHByZS1kaXNjaGFyZ2UgYXNzZXNzbWVudCAocHJvY2VkdXJlKQotIGRpc2NoYXJnZSBmcm9tIHNraWxsZWQgbnVyc2luZyBmYWNpbGl0eSAocHJvY2VkdXJlKQo=" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" } ], "period": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:2025c748-7a43-3538-b475-c0f869c0cda9", "resource": { "resourceType": "Claim", "id": "2025c748-7a43-3538-b475-c0f869c0cda9", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "created": "2015-06-05T03:13:07+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:5e03160f-5468-8f05-df53-028905c040f1" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:836e8548-9480-adf4-eaec-a897a9bbeec4" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:b31417a4-ff4c-4a48-6c2d-55ec2107a133" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:28233694-35f3-831c-258e-d27d9d84716b" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:c61ca3d5-994d-bf55-ccd9-9383d3fba0e4" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:b3d58e45-fcd7-c663-6537-4f3b9bcccea6" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:76f72532-30f8-9e5c-05cb-bea69c6bc885" } }, { "sequence": 7, "procedureReference": { "reference": "urn:uuid:0c7d57b5-c0c3-09a7-de90-430363ed7385" } }, { "sequence": 8, "procedureReference": { "reference": "urn:uuid:089c8fcf-76b9-e79d-44fe-33930de9aff7" } }, { "sequence": 9, "procedureReference": { "reference": "urn:uuid:9ecdea43-5c3e-8b7d-bf41-eb8317113002" } }, { "sequence": 10, "procedureReference": { "reference": "urn:uuid:7416a3a0-4f75-edf1-4ead-acef3b2d3a69" } }, { "sequence": 11, "procedureReference": { "reference": "urn:uuid:b2746a8d-1ae4-73af-e6bf-be4271d495a4" } }, { "sequence": 12, "procedureReference": { "reference": "urn:uuid:2b374d80-b7de-2992-8094-0117322d8058" } }, { "sequence": 13, "procedureReference": { "reference": "urn:uuid:c9ea6d4e-680b-34e7-8809-0463d444b414" } }, { "sequence": 14, "procedureReference": { "reference": "urn:uuid:1a9edf3b-2fc7-508b-84ff-eadb6773623f" } }, { "sequence": 15, "procedureReference": { "reference": "urn:uuid:3d0279f7-a247-cd3a-f2f9-3cab3af2c43b" } }, { "sequence": 16, "procedureReference": { "reference": "urn:uuid:c43dc9bb-3181-e4f3-ef5a-f7ce228ca8be" } }, { "sequence": 17, "procedureReference": { "reference": "urn:uuid:43da8f42-3f7f-a3a3-336a-1c274500ce61" } }, { "sequence": 18, "procedureReference": { "reference": "urn:uuid:cba2cb0f-7578-ce69-e250-5c16cf937c18" } }, { "sequence": 19, "procedureReference": { "reference": "urn:uuid:fe589937-de18-dbd8-7a00-f3ec171f2b14" } }, { "sequence": 20, "procedureReference": { "reference": "urn:uuid:434437b5-9c8f-507d-c676-0a1a2fb180e8" } }, { "sequence": 21, "procedureReference": { "reference": "urn:uuid:4e852944-2175-f0ee-bd9d-5993f1cfcd5b" } }, { "sequence": 22, "procedureReference": { "reference": "urn:uuid:4411164d-e5de-61ee-b299-a9b61f7f67f4" } }, { "sequence": 23, "procedureReference": { "reference": "urn:uuid:2bc36078-0b35-b9ff-a2d1-cde1db7a774e" } }, { "sequence": 24, "procedureReference": { "reference": "urn:uuid:1144a131-0347-9e9c-7d6b-5c04301aa272" } }, { "sequence": 25, "procedureReference": { "reference": "urn:uuid:3b758374-913c-3ef1-be81-bee693f08326" } }, { "sequence": 26, "procedureReference": { "reference": "urn:uuid:cd979b24-3015-efaf-7dc7-3fbf0db3b3c2" } }, { "sequence": 27, "procedureReference": { "reference": "urn:uuid:b4c05bc6-9c19-0dbd-3cb0-fb133fe60c02" } }, { "sequence": 28, "procedureReference": { "reference": "urn:uuid:6aa95a03-0da9-71c1-8150-23643e312ad2" } }, { "sequence": 29, "procedureReference": { "reference": "urn:uuid:e54d30cd-b46a-33b0-9627-597a1aeed653" } }, { "sequence": 30, "procedureReference": { "reference": "urn:uuid:4446d092-9bb0-c515-9671-1ebda78d3594" } }, { "sequence": 31, "procedureReference": { "reference": "urn:uuid:7288434a-e2e2-c1c6-d722-7d6adc13d577" } }, { "sequence": 32, "procedureReference": { "reference": "urn:uuid:f0b1bf1f-54dc-873a-0ba1-0fa93466ea8b" } }, { "sequence": 33, "procedureReference": { "reference": "urn:uuid:b1abdb91-4eba-7266-5e64-53b47c606dcf" } }, { "sequence": 34, "procedureReference": { "reference": "urn:uuid:832ad4d2-d7fd-e1b2-aa14-08733e5ac01f" } }, { "sequence": 35, "procedureReference": { "reference": "urn:uuid:19eb287b-ac0b-ee17-5a4a-658fb20c85dc" } }, { "sequence": 36, "procedureReference": { "reference": "urn:uuid:f7adb0b3-f033-26e1-2b33-3efaefc22bb4" } }, { "sequence": 37, "procedureReference": { "reference": "urn:uuid:1d1b82ba-ada8-4a53-784b-6fab5ae6d452" } }, { "sequence": 38, "procedureReference": { "reference": "urn:uuid:f074b2e4-068f-e0f6-a1b0-49ed9392882b" } }, { "sequence": 39, "procedureReference": { "reference": "urn:uuid:a7d6f021-4ce7-ba72-7411-9f74654f50ae" } }, { "sequence": 40, "procedureReference": { "reference": "urn:uuid:5e4d717c-7f3f-da29-3275-a092f4a6327b" } }, { "sequence": 41, "procedureReference": { "reference": "urn:uuid:4edc46a9-ff78-a98a-40a7-86c36a130f37" } }, { "sequence": 42, "procedureReference": { "reference": "urn:uuid:297a075a-b060-3011-e9bc-652e9bc25b82" } }, { "sequence": 43, "procedureReference": { "reference": "urn:uuid:7fa47b21-b956-4e0e-3d8b-056efa0f7f3d" } }, { "sequence": 44, "procedureReference": { "reference": "urn:uuid:738e722c-558a-c68e-4893-f07c9b00eefc" } }, { "sequence": 45, "procedureReference": { "reference": "urn:uuid:1e1a6135-31a3-5549-97c3-ddb8a8c1addb" } }, { "sequence": 46, "procedureReference": { "reference": "urn:uuid:ee972ce1-3329-7388-3aee-3ab0cd144e67" } }, { "sequence": 47, "procedureReference": { "reference": "urn:uuid:db48d794-545d-c34c-6d91-1399ea9dd17d" } }, { "sequence": 48, "procedureReference": { "reference": "urn:uuid:13094d44-d3d9-cdfe-15dc-c832db735eeb" } }, { "sequence": 49, "procedureReference": { "reference": "urn:uuid:3334a253-c933-8d9c-e0ba-ab3b85e2cad3" } }, { "sequence": 50, "procedureReference": { "reference": "urn:uuid:7e8fee0a-5846-4bcc-999b-5f80a95c9602" } }, { "sequence": 51, "procedureReference": { "reference": "urn:uuid:fe6825c4-1a18-daab-a71d-8ebeb8b5e430" } }, { "sequence": 52, "procedureReference": { "reference": "urn:uuid:89759900-7787-4f3d-b0c7-429722261bff" } }, { "sequence": 53, "procedureReference": { "reference": "urn:uuid:0f02040c-e96e-a7a3-f8fb-0af90a68ccd0" } }, { "sequence": 54, "procedureReference": { "reference": "urn:uuid:6c9a6136-e76b-24cc-11f2-8b4d8f578024" } }, { "sequence": 55, "procedureReference": { "reference": "urn:uuid:6e264b20-0dcd-0620-1554-5c8b2534bf7a" } }, { "sequence": 56, "procedureReference": { "reference": "urn:uuid:a789203b-dc54-1b6a-62de-6089628a78ab" } }, { "sequence": 57, "procedureReference": { "reference": "urn:uuid:08a19198-3a30-6509-6167-7c0e862952ef" } }, { "sequence": 58, "procedureReference": { "reference": "urn:uuid:7c18d724-ff42-39df-d371-af3ec4ac7ccd" } }, { "sequence": 59, "procedureReference": { "reference": "urn:uuid:1285ec3e-b888-a2f4-e696-a6e481ce3c9e" } }, { "sequence": 60, "procedureReference": { "reference": "urn:uuid:c63d4fc9-2c51-845b-e59e-2334fb8b73de" } }, { "sequence": 61, "procedureReference": { "reference": "urn:uuid:bdf37216-e43f-c9b0-6a32-93278a2553e1" } }, { "sequence": 62, "procedureReference": { "reference": "urn:uuid:0b129d35-1f1f-fdf7-7b32-038592fe06d4" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "449411000124106", "display": "Admission to skilled nursing facility (procedure)" } ], "text": "Admission to skilled nursing facility (procedure)" }, "encounter": [ { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "25675004", "display": "Patient transfer to skilled nursing facility (procedure)" } ], "text": "Patient transfer to skilled nursing facility (procedure)" } }, { "sequence": 3, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "63332003", "display": "History AND physical examination (procedure)" } ], "text": "History AND physical examination (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 4, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "315639002", "display": "Initial patient assessment (procedure)" } ], "text": "Initial patient assessment (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "228869008", "display": "Manual wheelchair (physical object)" } ], "text": "Manual wheelchair (physical object)" }, "net": { "value": 0.00, "currency": "USD" } }, { "sequence": 6, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "370789001", "display": "Development of individualized plan of care (procedure)" } ], "text": "Development of individualized plan of care (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "procedureSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 8 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "procedureSequence": [ 9 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 13, "procedureSequence": [ 10 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "net": { "value": 678.24, "currency": "USD" } }, { "sequence": 14, "procedureSequence": [ 11 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 15, "procedureSequence": [ 12 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 16, "procedureSequence": [ 13 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 17, "procedureSequence": [ 14 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 18, "procedureSequence": [ 15 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "net": { "value": 521.29, "currency": "USD" } }, { "sequence": 19, "procedureSequence": [ 16 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 20, "procedureSequence": [ 17 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 21, "procedureSequence": [ 18 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 22, "procedureSequence": [ 19 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 23, "procedureSequence": [ 20 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 24, "procedureSequence": [ 21 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 25, "procedureSequence": [ 22 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "net": { "value": 376.24, "currency": "USD" } }, { "sequence": 26, "procedureSequence": [ 23 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 27, "procedureSequence": [ 24 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 28, "procedureSequence": [ 25 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 29, "procedureSequence": [ 26 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "311555007", "display": "Speech and language therapy regime (regime/therapy)" } ], "text": "Speech and language therapy regime (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 30, "procedureSequence": [ 27 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 31, "procedureSequence": [ 28 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 32, "procedureSequence": [ 29 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 33, "procedureSequence": [ 30 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 34, "procedureSequence": [ 31 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 35, "procedureSequence": [ 32 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 36, "procedureSequence": [ 33 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 37, "procedureSequence": [ 34 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "net": { "value": 538.29, "currency": "USD" } }, { "sequence": 38, "procedureSequence": [ 35 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 39, "procedureSequence": [ 36 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 40, "procedureSequence": [ 37 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 41, "procedureSequence": [ 38 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 42, "procedureSequence": [ 39 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 43, "procedureSequence": [ 40 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 44, "procedureSequence": [ 41 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 45, "procedureSequence": [ 42 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 46, "procedureSequence": [ 43 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 47, "procedureSequence": [ 44 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 48, "procedureSequence": [ 45 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 49, "procedureSequence": [ 46 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 50, "procedureSequence": [ 47 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 51, "procedureSequence": [ 48 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 52, "procedureSequence": [ 49 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 53, "procedureSequence": [ 50 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 54, "procedureSequence": [ 51 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 55, "procedureSequence": [ 52 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 56, "procedureSequence": [ 53 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 57, "procedureSequence": [ 54 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 58, "procedureSequence": [ 55 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 59, "procedureSequence": [ 56 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 60, "procedureSequence": [ 57 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 61, "procedureSequence": [ 58 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 62, "procedureSequence": [ 59 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 63, "procedureSequence": [ 60 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 64, "procedureSequence": [ 61 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "225386006", "display": "Pre-discharge assessment (procedure)" } ], "text": "Pre-discharge assessment (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 65, "procedureSequence": [ 62 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "449381000124108", "display": "Discharge from skilled nursing facility (procedure)" } ], "text": "Discharge from skilled nursing facility (procedure)" }, "net": { "value": 431.40, "currency": "USD" } } ], "total": { "value": 27246.18, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:71995ede-e0fa-85b0-7427-97ecf6ca86c1", "resource": { "resourceType": "ExplanationOfBenefit", "id": "71995ede-e0fa-85b0-7427-97ecf6ca86c1", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "2025c748-7a43-3538-b475-c0f869c0cda9" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2015-06-05T03:13:07+02:00", "end": "2016-06-05T03:13:07+02:00" }, "created": "2015-06-05T03:13:07+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" }, "claim": { "reference": "urn:uuid:2025c748-7a43-3538-b475-c0f869c0cda9" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:5e03160f-5468-8f05-df53-028905c040f1" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "449411000124106", "display": "Admission to skilled nursing facility (procedure)" } ], "text": "Admission to skilled nursing facility (procedure)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "25675004", "display": "Patient transfer to skilled nursing facility (procedure)" } ], "text": "Patient transfer to skilled nursing facility (procedure)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "63332003", "display": "History AND physical examination (procedure)" } ], "text": "History AND physical examination (procedure)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "315639002", "display": "Initial patient assessment (procedure)" } ], "text": "Initial patient assessment (procedure)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "228869008", "display": "Manual wheelchair (physical object)" } ], "text": "Manual wheelchair (physical object)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 0.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 0.0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 0.0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 0.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 0.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "370789001", "display": "Development of individualized plan of care (procedure)" } ], "text": "Development of individualized plan of care (procedure)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 13, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 678.24, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 135.648, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 542.592, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 678.24, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 678.24, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 14, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 15, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 16, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 17, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 18, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 521.29, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 104.258, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 417.032, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 521.29, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 521.29, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 19, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 20, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 21, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 22, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 23, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 24, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 25, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 376.24, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 75.248, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 300.992, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 376.24, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 376.24, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 26, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 27, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 28, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 29, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "311555007", "display": "Speech and language therapy regime (regime/therapy)" } ], "text": "Speech and language therapy regime (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 30, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 31, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 32, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 33, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 34, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 35, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 36, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 37, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "91251008", "display": "Physical therapy procedure (regime/therapy)" } ], "text": "Physical therapy procedure (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 538.29, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 107.658, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 430.632, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 538.29, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 538.29, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 38, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 39, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 40, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 41, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 42, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 43, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 44, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 45, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 46, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 47, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 48, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 49, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 50, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 51, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 52, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 53, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 54, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 55, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 56, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "84478008", "display": "Occupational therapy (regime/therapy)" } ], "text": "Occupational therapy (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 57, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 58, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 59, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 60, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 61, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 62, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "410401003", "display": "Nursing care/supplementary surveillance (regime/therapy)" } ], "text": "Nursing care/supplementary surveillance (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 63, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "409023009", "display": "Professional / ancillary services care (regime/therapy)" } ], "text": "Professional / ancillary services care (regime/therapy)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 64, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "225386006", "display": "Pre-discharge assessment (procedure)" } ], "text": "Pre-discharge assessment (procedure)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 65, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "449381000124108", "display": "Discharge from skilled nursing facility (procedure)" } ], "text": "Discharge from skilled nursing facility (procedure)" }, "servicedPeriod": { "start": "2015-04-28T02:58:07+02:00", "end": "2015-06-05T03:13:07+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 27246.18, "currency": "USD" } } ], "payment": { "amount": { "value": 21708.208, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7", "resource": { "resourceType": "Encounter", "id": "d2454127-558f-54c3-648d-80bd7ef7d2f7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "d2454127-558f-54c3-648d-80bd7ef7d2f7" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:0e695c87-83ea-fbe5-9c48-e44bc0e1780e", "resource": { "resourceType": "Condition", "id": "0e695c87-83ea-fbe5-9c48-e44bc0e1780e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "onsetDateTime": "2016-02-06T02:32:17+01:00", "abatementDateTime": "2016-07-09T03:29:02+02:00", "recordedDate": "2016-02-06T02:32:17+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:9eb2b5f8-5971-f11f-e218-ff8e1cc325b4", "resource": { "resourceType": "Observation", "id": "9eb2b5f8-5971-f11f-e218-ff8e1cc325b4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T01:33:04+01:00", "issued": "2016-02-06T01:33:04.492+01:00", "valueQuantity": { "value": 168.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b92f0b5e-1ca7-181f-71da-89b4bde8c665", "resource": { "resourceType": "Observation", "id": "b92f0b5e-1ca7-181f-71da-89b4bde8c665", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T01:33:04+01:00", "issued": "2016-02-06T01:33:04.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ab68e30f-9efd-de4b-1579-5591f54b7250", "resource": { "resourceType": "Observation", "id": "ab68e30f-9efd-de4b-1579-5591f54b7250", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T01:33:04+01:00", "issued": "2016-02-06T01:33:04.492+01:00", "valueQuantity": { "value": 77.9, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8f9b5798-dd67-108a-bb27-55f29d3646bb", "resource": { "resourceType": "Observation", "id": "8f9b5798-dd67-108a-bb27-55f29d3646bb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T01:33:04+01:00", "issued": "2016-02-06T01:33:04.492+01:00", "valueQuantity": { "value": 27.33, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d14492a2-05dc-c96f-8925-39796361e814", "resource": { "resourceType": "Observation", "id": "d14492a2-05dc-c96f-8925-39796361e814", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T01:33:04+01:00", "issued": "2016-02-06T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 84, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 143, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:051ead10-6b88-8d7a-0676-1365be7fdda1", "resource": { "resourceType": "Observation", "id": "051ead10-6b88-8d7a-0676-1365be7fdda1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T01:33:04+01:00", "issued": "2016-02-06T01:33:04.492+01:00", "valueQuantity": { "value": 64, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:694bbb94-adb4-9833-293b-cc369c90ee54", "resource": { "resourceType": "Observation", "id": "694bbb94-adb4-9833-293b-cc369c90ee54", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T01:33:04+01:00", "issued": "2016-02-06T01:33:04.492+01:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:23c4ca07-5b28-be25-cae5-b271416410ac", "resource": { "resourceType": "Observation", "id": "23c4ca07-5b28-be25-cae5-b271416410ac", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T01:33:04+01:00", "issued": "2016-02-06T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:35610fd6-c024-6fa9-d311-9225ed81797b", "resource": { "resourceType": "Observation", "id": "35610fd6-c024-6fa9-d311-9225ed81797b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T02:32:17+01:00", "issued": "2016-02-06T02:32:17.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30132-7", "display": "5 or more times a week" } ], "text": "5 or more times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30138-4", "display": "Part-time or temporary work" } ], "text": "Part-time or temporary work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9a24a72b-a0d4-14f0-f8a7-05d59291ff23", "resource": { "resourceType": "Observation", "id": "9a24a72b-a0d4-14f0-f8a7-05d59291ff23", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "70274-6", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ], "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T02:56:22+01:00", "issued": "2016-02-06T02:56:22.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2565212b-8943-64fd-e67b-9261ea2a484a", "resource": { "resourceType": "Observation", "id": "2565212b-8943-64fd-e67b-9261ea2a484a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T03:40:54+01:00", "issued": "2016-02-06T03:40:54.492+01:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ec0c9162-b042-a000-e491-cccad3a2bba8", "resource": { "resourceType": "Procedure", "id": "ec0c9162-b042-a000-e491-cccad3a2bba8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "performedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T01:48:04+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:710a586d-fdf6-b8c7-03d9-306d2d1664ef", "resource": { "resourceType": "Procedure", "id": "710a586d-fdf6-b8c7-03d9-306d2d1664ef", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "performedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0769a18c-0cd2-be5a-1a2c-e5361fd7114f", "resource": { "resourceType": "Procedure", "id": "0769a18c-0cd2-be5a-1a2c-e5361fd7114f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "performedPeriod": { "start": "2016-02-06T02:32:17+01:00", "end": "2016-02-06T02:56:22+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:12385a12-406d-26e7-c003-0c6631b46b1d", "resource": { "resourceType": "Procedure", "id": "12385a12-406d-26e7-c003-0c6631b46b1d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "performedPeriod": { "start": "2016-02-06T02:56:22+01:00", "end": "2016-02-06T03:11:13+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:8f725d76-c910-97c7-c3bb-12329e99d9ea", "resource": { "resourceType": "Procedure", "id": "8f725d76-c910-97c7-c3bb-12329e99d9ea", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "performedPeriod": { "start": "2016-02-06T03:11:13+01:00", "end": "2016-02-06T03:40:54+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:df0bd2d1-cd30-6b8b-06b8-b390354b235b", "resource": { "resourceType": "MedicationRequest", "id": "df0bd2d1-cd30-6b8b-06b8-b390354b235b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "authoredOn": "2016-02-06T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:9e6632ad-2c0d-8e31-c698-c715901d7305", "resource": { "resourceType": "Claim", "id": "9e6632ad-2c0d-8e31-c698-c715901d7305", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "created": "2016-02-06T02:32:17+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:df0bd2d1-cd30-6b8b-06b8-b390354b235b" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:424e1686-18a7-9db8-869a-27029dfb11b8", "resource": { "resourceType": "ExplanationOfBenefit", "id": "424e1686-18a7-9db8-869a-27029dfb11b8", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "9e6632ad-2c0d-8e31-c698-c715901d7305" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-02-06T02:32:17+01:00", "end": "2017-02-06T02:32:17+01:00" }, "created": "2016-02-06T02:32:17+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:9e6632ad-2c0d-8e31-c698-c715901d7305" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a6e32f0f-b062-1812-af64-5794192a09d0", "resource": { "resourceType": "MedicationRequest", "id": "a6e32f0f-b062-1812-af64-5794192a09d0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "authoredOn": "2016-02-06T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:e980da57-548b-7793-00d0-0acaab048c82", "resource": { "resourceType": "Claim", "id": "e980da57-548b-7793-00d0-0acaab048c82", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "created": "2016-02-06T02:32:17+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:a6e32f0f-b062-1812-af64-5794192a09d0" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:d80eb612-3add-e07a-1ccf-bdda9015207f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "d80eb612-3add-e07a-1ccf-bdda9015207f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e980da57-548b-7793-00d0-0acaab048c82" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-02-06T02:32:17+01:00", "end": "2017-02-06T02:32:17+01:00" }, "created": "2016-02-06T02:32:17+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:e980da57-548b-7793-00d0-0acaab048c82" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:bca43795-1095-6fc2-4c28-5552d9a81504", "resource": { "resourceType": "MedicationRequest", "id": "bca43795-1095-6fc2-4c28-5552d9a81504", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "authoredOn": "2016-02-06T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:c5c288a4-c5e6-4ede-3f4f-48cf97bab68e", "resource": { "resourceType": "Claim", "id": "c5c288a4-c5e6-4ede-3f4f-48cf97bab68e", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "created": "2016-02-06T02:32:17+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:bca43795-1095-6fc2-4c28-5552d9a81504" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:b9b263f5-5968-9bc3-cac5-68147abdf8c3", "resource": { "resourceType": "ExplanationOfBenefit", "id": "b9b263f5-5968-9bc3-cac5-68147abdf8c3", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c5c288a4-c5e6-4ede-3f4f-48cf97bab68e" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-02-06T02:32:17+01:00", "end": "2017-02-06T02:32:17+01:00" }, "created": "2016-02-06T02:32:17+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:c5c288a4-c5e6-4ede-3f4f-48cf97bab68e" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:8f10ee6c-2427-587a-7495-b8b0c85b445d", "resource": { "resourceType": "Immunization", "id": "8f10ee6c-2427-587a-7495-b8b0c85b445d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "occurrenceDateTime": "2016-02-06T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:2f6c86f8-fcdd-95f7-69f3-f995f6674f74", "resource": { "resourceType": "Immunization", "id": "2f6c86f8-fcdd-95f7-69f3-f995f6674f74", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "43", "display": "Hep B, adult" } ], "text": "Hep B, adult" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "occurrenceDateTime": "2016-02-06T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:c8d44a90-08ef-6e09-c7fa-daefc13276f8", "resource": { "resourceType": "DiagnosticReport", "id": "c8d44a90-08ef-6e09-c7fa-daefc13276f8", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T02:56:22+01:00", "issued": "2016-02-06T02:56:22.492+01:00", "result": [ { "reference": "urn:uuid:9a24a72b-a0d4-14f0-f8a7-05d59291ff23", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:4fe23543-5dec-fc02-e950-fae8efb422b5", "resource": { "resourceType": "DiagnosticReport", "id": "4fe23543-5dec-fc02-e950-fae8efb422b5", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T03:40:54+01:00", "issued": "2016-02-06T03:40:54.492+01:00", "result": [ { "reference": "urn:uuid:2565212b-8943-64fd-e67b-9261ea2a484a", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:d85da058-6462-52d3-b3fd-a26599a645bf", "resource": { "resourceType": "DiagnosticReport", "id": "d85da058-6462-52d3-b3fd-a26599a645bf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, "effectiveDateTime": "2016-02-06T01:33:04+01:00", "issued": "2016-02-06T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:8445d496-2ee0-ed90-a3dd-33f32ef1573a", "resource": { "resourceType": "DocumentReference", "id": "8445d496-2ee0-ed90-a3dd-33f32ef1573a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:d85da058-6462-52d3-b3fd-a26599a645bf" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2016-02-06T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" } ], "period": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:f04e922c-7b23-3054-7891-09e5fd52d0db", "resource": { "resourceType": "Claim", "id": "f04e922c-7b23-3054-7891-09e5fd52d0db", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "created": "2016-02-06T02:32:17+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:8f10ee6c-2427-587a-7495-b8b0c85b445d" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:2f6c86f8-fcdd-95f7-69f3-f995f6674f74" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:0e695c87-83ea-fbe5-9c48-e44bc0e1780e" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:ec0c9162-b042-a000-e491-cccad3a2bba8" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:710a586d-fdf6-b8c7-03d9-306d2d1664ef" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:0769a18c-0cd2-be5a-1a2c-e5361fd7114f" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:12385a12-406d-26e7-c003-0c6631b46b1d" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:8f725d76-c910-97c7-c3bb-12329e99d9ea" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "43", "display": "Hep B, adult" } ], "text": "Hep B, adult" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 4, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 481.70, "currency": "USD" } }, { "sequence": 5, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 6, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" } }, { "sequence": 7, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 9, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1321.90, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:dde5d9ea-98d3-4926-ed76-845918dbd2a8", "resource": { "resourceType": "ExplanationOfBenefit", "id": "dde5d9ea-98d3-4926-ed76-845918dbd2a8", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "f04e922c-7b23-3054-7891-09e5fd52d0db" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-02-06T02:32:17+01:00", "end": "2017-02-06T02:32:17+01:00" }, "created": "2016-02-06T02:32:17+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:f04e922c-7b23-3054-7891-09e5fd52d0db" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:0e695c87-83ea-fbe5-9c48-e44bc0e1780e" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "43", "display": "Hep B, adult" } ], "text": "Hep B, adult" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 481.70, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 96.34, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 385.36, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 481.70, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 481.70, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2016-02-06T01:33:04+01:00", "end": "2016-02-06T02:32:17+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1321.90, "currency": "USD" } } ], "payment": { "amount": { "value": 2102.768, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f", "resource": { "resourceType": "Encounter", "id": "d0a86141-bd9a-97fe-af46-1de935b2d18f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "d0a86141-bd9a-97fe-af46-1de935b2d18f" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up (procedure)" } ], "text": "Encounter for check up (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:483c5997-0da5-b52c-b9d7-ea6eff15b579", "resource": { "resourceType": "Condition", "id": "483c5997-0da5-b52c-b9d7-ea6eff15b579", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "onsetDateTime": "2016-07-09T02:33:04+02:00", "abatementDateTime": "2017-02-11T01:33:04+01:00", "recordedDate": "2016-07-09T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:6a048bbd-6408-511b-00b1-0874cc640ddd", "resource": { "resourceType": "Condition", "id": "6a048bbd-6408-511b-00b1-0874cc640ddd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "onsetDateTime": "2016-07-09T03:29:02+02:00", "abatementDateTime": "2018-02-17T02:28:31+01:00", "recordedDate": "2016-07-09T03:29:02+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:0ca35a38-ff5d-b410-275a-617dce30bf30", "resource": { "resourceType": "Condition", "id": "0ca35a38-ff5d-b410-275a-617dce30bf30", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "onsetDateTime": "2016-07-09T03:29:02+02:00", "abatementDateTime": "2017-02-11T02:28:10+01:00", "recordedDate": "2016-07-09T03:29:02+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:35f5cfb0-dfb0-d3fc-9c1e-82494e8c0932", "resource": { "resourceType": "Observation", "id": "35f5cfb0-dfb0-d3fc-9c1e-82494e8c0932", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T02:33:04+02:00", "issued": "2016-07-09T02:33:04.492+02:00", "valueQuantity": { "value": 168.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:903fcd37-443a-30ad-9dee-68ef16efefc5", "resource": { "resourceType": "Observation", "id": "903fcd37-443a-30ad-9dee-68ef16efefc5", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T02:33:04+02:00", "issued": "2016-07-09T02:33:04.492+02:00", "valueQuantity": { "value": 4, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b5a7259e-0f11-731c-dc12-cb08b28f5efd", "resource": { "resourceType": "Observation", "id": "b5a7259e-0f11-731c-dc12-cb08b28f5efd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T02:33:04+02:00", "issued": "2016-07-09T02:33:04.492+02:00", "valueQuantity": { "value": 77.9, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f606de66-1bd7-40e0-3122-99dc05b980cd", "resource": { "resourceType": "Observation", "id": "f606de66-1bd7-40e0-3122-99dc05b980cd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T02:33:04+02:00", "issued": "2016-07-09T02:33:04.492+02:00", "valueQuantity": { "value": 27.33, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5da76937-08c8-b302-7dee-d362fb8c2b54", "resource": { "resourceType": "Observation", "id": "5da76937-08c8-b302-7dee-d362fb8c2b54", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T02:33:04+02:00", "issued": "2016-07-09T02:33:04.492+02:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 82, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 147, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:67951a85-7063-4389-c79e-3024b381adfa", "resource": { "resourceType": "Observation", "id": "67951a85-7063-4389-c79e-3024b381adfa", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T02:33:04+02:00", "issued": "2016-07-09T02:33:04.492+02:00", "valueQuantity": { "value": 61, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f1d8cbf4-610f-e740-bd91-adc7adb28a62", "resource": { "resourceType": "Observation", "id": "f1d8cbf4-610f-e740-bd91-adc7adb28a62", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T02:33:04+02:00", "issued": "2016-07-09T02:33:04.492+02:00", "valueQuantity": { "value": 12, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:31ba2a02-2fe4-5402-e405-ae9e24e35172", "resource": { "resourceType": "Observation", "id": "31ba2a02-2fe4-5402-e405-ae9e24e35172", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T02:33:04+02:00", "issued": "2016-07-09T02:33:04.492+02:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:67d13ebe-e070-f17b-c341-43806e49078a", "resource": { "resourceType": "Observation", "id": "67d13ebe-e070-f17b-c341-43806e49078a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T03:29:02+02:00", "issued": "2016-07-09T03:29:02.492+02:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13902-4", "display": "Quite a bit" } ], "text": "Quite a bit" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30132-7", "display": "5 or more times a week" } ], "text": "5 or more times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30136-8", "display": "Full-time work" } ], "text": "Full-time work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5b705fff-ba7f-824b-cff1-312b78b57183", "resource": { "resourceType": "Observation", "id": "5b705fff-ba7f-824b-cff1-312b78b57183", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "70274-6", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ], "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T03:46:09+02:00", "issued": "2016-07-09T03:46:09.492+02:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cede15fa-a34f-623b-b585-24ac00e9398f", "resource": { "resourceType": "Procedure", "id": "cede15fa-a34f-623b-b585-24ac00e9398f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "performedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:e0c6ce49-8620-24b5-4c3d-d1cad0eeded2", "resource": { "resourceType": "Procedure", "id": "e0c6ce49-8620-24b5-4c3d-d1cad0eeded2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "performedPeriod": { "start": "2016-07-09T03:29:02+02:00", "end": "2016-07-09T03:46:09+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:10bf1af1-2581-8a04-b10d-63fce5af999f", "resource": { "resourceType": "MedicationRequest", "id": "10bf1af1-2581-8a04-b10d-63fce5af999f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "authoredOn": "2016-07-09T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:2fc8069e-b105-6e42-5e42-9de8c9e9079d", "resource": { "resourceType": "Claim", "id": "2fc8069e-b105-6e42-5e42-9de8c9e9079d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "created": "2016-07-09T03:29:02+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:10bf1af1-2581-8a04-b10d-63fce5af999f" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:715ae7c2-24ee-eefb-8b05-836227118110", "resource": { "resourceType": "ExplanationOfBenefit", "id": "715ae7c2-24ee-eefb-8b05-836227118110", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "2fc8069e-b105-6e42-5e42-9de8c9e9079d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-07-09T03:29:02+02:00", "end": "2017-07-09T03:29:02+02:00" }, "created": "2016-07-09T03:29:02+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:2fc8069e-b105-6e42-5e42-9de8c9e9079d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:316d5ca0-3511-4f0b-0211-40effa192ff1", "resource": { "resourceType": "MedicationRequest", "id": "316d5ca0-3511-4f0b-0211-40effa192ff1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "authoredOn": "2016-07-09T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:86a23887-cdb4-62d7-c254-f9c2a81196ba", "resource": { "resourceType": "Claim", "id": "86a23887-cdb4-62d7-c254-f9c2a81196ba", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "created": "2016-07-09T03:29:02+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:316d5ca0-3511-4f0b-0211-40effa192ff1" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:a6dda992-2a65-3ba3-2c24-14391265c448", "resource": { "resourceType": "ExplanationOfBenefit", "id": "a6dda992-2a65-3ba3-2c24-14391265c448", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "86a23887-cdb4-62d7-c254-f9c2a81196ba" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-07-09T03:29:02+02:00", "end": "2017-07-09T03:29:02+02:00" }, "created": "2016-07-09T03:29:02+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:86a23887-cdb4-62d7-c254-f9c2a81196ba" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:0c6ccacb-3a66-a364-8725-9de676f4a0d2", "resource": { "resourceType": "MedicationRequest", "id": "0c6ccacb-3a66-a364-8725-9de676f4a0d2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "authoredOn": "2016-07-09T02:33:04+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:9970623b-640b-72ed-ce54-3ada103f5e21", "resource": { "resourceType": "Claim", "id": "9970623b-640b-72ed-ce54-3ada103f5e21", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "created": "2016-07-09T03:29:02+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:0c6ccacb-3a66-a364-8725-9de676f4a0d2" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:9c2a54fd-901c-77de-c65d-aa34d020bd02", "resource": { "resourceType": "ExplanationOfBenefit", "id": "9c2a54fd-901c-77de-c65d-aa34d020bd02", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "9970623b-640b-72ed-ce54-3ada103f5e21" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-07-09T03:29:02+02:00", "end": "2017-07-09T03:29:02+02:00" }, "created": "2016-07-09T03:29:02+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:9970623b-640b-72ed-ce54-3ada103f5e21" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:88ea5fb5-a2d3-16c8-be20-0715508e0475", "resource": { "resourceType": "Immunization", "id": "88ea5fb5-a2d3-16c8-be20-0715508e0475", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "occurrenceDateTime": "2016-07-09T02:33:04+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:7194d2d1-6380-801a-e179-458fbb5b3cfe", "resource": { "resourceType": "Immunization", "id": "7194d2d1-6380-801a-e179-458fbb5b3cfe", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "43", "display": "Hep B, adult" } ], "text": "Hep B, adult" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "occurrenceDateTime": "2016-07-09T02:33:04+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:8e2e0910-ca94-9246-1c9e-edaeb965a4f8", "resource": { "resourceType": "DiagnosticReport", "id": "8e2e0910-ca94-9246-1c9e-edaeb965a4f8", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T03:46:09+02:00", "issued": "2016-07-09T03:46:09.492+02:00", "result": [ { "reference": "urn:uuid:5b705fff-ba7f-824b-cff1-312b78b57183", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:2f7c593b-ac97-32b7-9926-78d30bf432c7", "resource": { "resourceType": "DiagnosticReport", "id": "2f7c593b-ac97-32b7-9926-78d30bf432c7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, "effectiveDateTime": "2016-07-09T02:33:04+02:00", "issued": "2016-07-09T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1c822c43-4e57-5712-0482-af909f541209", "resource": { "resourceType": "DocumentReference", "id": "1c822c43-4e57-5712-0482-af909f541209", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:2f7c593b-ac97-32b7-9926-78d30bf432c7" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2016-07-09T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMTYtMDctMDkKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMjAgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIGluanVyeSBvZiBuZWNrIChkaXNvcmRlciksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgd2hpcGxhc2ggaW5qdXJ5IHRvIG5lY2ssIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKSwgbm90IGluIGxhYm9yIGZvcmNlIChmaW5kaW5nKSwgcGVyZW5uaWFsIGFsbGVyZ2ljIHJoaW5pdGlzIHdpdGggc2Vhc29uYWwgdmFyaWF0aW9uLCBjaGlsZGhvb2QgYXN0aG1hLCBzdHJlc3MgKGZpbmRpbmcpLCBwYXRpZW50IHRyYW5zZmVyIHRvIHNraWxsZWQgbnVyc2luZyBmYWNpbGl0eSAocHJvY2VkdXJlKS4KCiMgU29jaWFsIEhpc3RvcnkKIFBhdGllbnQgaGFzIG5ldmVyIHNtb2tlZC4KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuCgpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgogUGF0aWVudCBoYXMgYSBoaWdoIHNjaG9vbCBlZHVjYXRpb24uClBhdGllbnQgY3VycmVudGx5IGhhcyBNZWRpY2FyZS4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKYnVkZXNvbmlkZSAwLjEyNSBtZy9tbCBpbmhhbGF0aW9uIHN1c3BlbnNpb247IG5kYTAyMDk4MyAyMDAgYWN0dWF0IGFsYnV0ZXJvbCAwLjA5IG1nL2FjdHVhdCBtZXRlcmVkIGRvc2UgaW5oYWxlciBbdmVudG9saW5dOyBpYnVwcm9mZW4gNDAwIG1nIG9yYWwgdGFibGV0IFtpYnVdOyBpYnVwcm9mZW4gMjAwIG1nIG9yYWwgdGFibGV0CgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KUGF0aWVudCBpcyBwcmVzZW50aW5nIHdpdGggbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIHN0cmVzcyAoZmluZGluZykuIAoKIyMgUGxhbgpQYXRpZW50IHdhcyBnaXZlbiB0aGUgZm9sbG93aW5nIGltbXVuaXphdGlvbnM6IGluZmx1ZW56YSwgc2Vhc29uYWwsIGluamVjdGFibGUsIHByZXNlcnZhdGl2ZSBmcmVlLCBoZXAgYiwgYWR1bHQuIApUaGUgZm9sbG93aW5nIHByb2NlZHVyZXMgd2VyZSBjb25kdWN0ZWQ6Ci0gYXNzZXNzbWVudCBvZiBoZWFsdGggYW5kIHNvY2lhbCBjYXJlIG5lZWRzIChwcm9jZWR1cmUpCi0gYXNzZXNzbWVudCBvZiBhbnhpZXR5IChwcm9jZWR1cmUpClRoZSBwYXRpZW50IHdhcyBwcmVzY3JpYmVkIHRoZSBmb2xsb3dpbmcgbWVkaWNhdGlvbnM6Ci0gbmRhMDIwOTgzIDIwMCBhY3R1YXQgYWxidXRlcm9sIDAuMDkgbWcvYWN0dWF0IG1ldGVyZWQgZG9zZSBpbmhhbGVyIFt2ZW50b2xpbl0KLSBpYnVwcm9mZW4gNDAwIG1nIG9yYWwgdGFibGV0IFtpYnVdCi0gYnVkZXNvbmlkZSAwLjEyNSBtZy9tbCBpbmhhbGF0aW9uIHN1c3BlbnNpb24K" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" } ], "period": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:735ab991-3cda-96c0-c877-c9431e602539", "resource": { "resourceType": "Claim", "id": "735ab991-3cda-96c0-c877-c9431e602539", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "created": "2016-07-09T03:29:02+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:88ea5fb5-a2d3-16c8-be20-0715508e0475" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:7194d2d1-6380-801a-e179-458fbb5b3cfe" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:483c5997-0da5-b52c-b9d7-ea6eff15b579" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:6a048bbd-6408-511b-00b1-0874cc640ddd" } }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:0ca35a38-ff5d-b410-275a-617dce30bf30" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:cede15fa-a34f-623b-b585-24ac00e9398f" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:e0c6ce49-8620-24b5-4c3d-d1cad0eeded2" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up (procedure)" } ], "text": "Encounter for check up (procedure)" }, "encounter": [ { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "43", "display": "Hep B, adult" } ], "text": "Hep B, adult" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 4, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 5, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 6, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" } }, { "sequence": 7, "diagnosisSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" } }, { "sequence": 8, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 788.95, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:97760831-2c97-44e8-ac06-b0fe81f444f9", "resource": { "resourceType": "ExplanationOfBenefit", "id": "97760831-2c97-44e8-ac06-b0fe81f444f9", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "735ab991-3cda-96c0-c877-c9431e602539" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-07-09T03:29:02+02:00", "end": "2017-07-09T03:29:02+02:00" }, "created": "2016-07-09T03:29:02+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:735ab991-3cda-96c0-c877-c9431e602539" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:483c5997-0da5-b52c-b9d7-ea6eff15b579" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:6a048bbd-6408-511b-00b1-0874cc640ddd" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:0ca35a38-ff5d-b410-275a-617dce30bf30" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up (procedure)" } ], "text": "Encounter for check up (procedure)" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "43", "display": "Hep B, adult" } ], "text": "Hep B, adult" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 7, "diagnosisSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2016-07-09T02:33:04+02:00", "end": "2016-07-09T03:29:02+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 788.95, "currency": "USD" } } ], "payment": { "amount": { "value": 967.504, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b0ba0c5e-196a-1038-bb0c-216b40639787", "resource": { "resourceType": "Encounter", "id": "b0ba0c5e-196a-1038-bb0c-216b40639787", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "b0ba0c5e-196a-1038-bb0c-216b40639787" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2016-07-16T02:33:04+02:00", "end": "2016-07-16T02:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2016-07-16T02:33:04+02:00", "end": "2016-07-16T02:48:04+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "36971009", "display": "Sinusitis (disorder)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:aadfcb68-2be0-0a56-3e88-30dbee86e641", "resource": { "resourceType": "Condition", "id": "aadfcb68-2be0-0a56-3e88-30dbee86e641", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "36971009", "display": "Sinusitis (disorder)" } ], "text": "Sinusitis (disorder)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b0ba0c5e-196a-1038-bb0c-216b40639787" }, "onsetDateTime": "2016-07-16T02:33:04+02:00", "abatementDateTime": "2016-08-07T02:33:04+02:00", "recordedDate": "2016-07-16T02:33:04+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:75ed60e1-bc7a-c3fe-6f63-56b1bd815ea0", "resource": { "resourceType": "DiagnosticReport", "id": "75ed60e1-bc7a-c3fe-6f63-56b1bd815ea0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b0ba0c5e-196a-1038-bb0c-216b40639787" }, "effectiveDateTime": "2016-07-16T02:33:04+02:00", "issued": "2016-07-16T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:a896ac87-05ec-549b-dd6b-bc52b55ad4a3", "resource": { "resourceType": "DocumentReference", "id": "a896ac87-05ec-549b-dd6b-bc52b55ad4a3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:75ed60e1-bc7a-c3fe-6f63-56b1bd815ea0" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2016-07-16T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:b0ba0c5e-196a-1038-bb0c-216b40639787" } ], "period": { "start": "2016-07-16T02:33:04+02:00", "end": "2016-07-16T02:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:f86e068a-b64b-00bd-5a02-0b1e856ead36", "resource": { "resourceType": "Claim", "id": "f86e068a-b64b-00bd-5a02-0b1e856ead36", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2016-07-16T02:33:04+02:00", "end": "2016-07-16T02:48:04+02:00" }, "created": "2016-07-16T02:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:aadfcb68-2be0-0a56-3e88-30dbee86e641" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "encounter": [ { "reference": "urn:uuid:b0ba0c5e-196a-1038-bb0c-216b40639787" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "36971009", "display": "Sinusitis (disorder)" } ], "text": "Sinusitis (disorder)" } } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e1c6672e-876c-b229-61ce-f17fdef45c98", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e1c6672e-876c-b229-61ce-f17fdef45c98", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "f86e068a-b64b-00bd-5a02-0b1e856ead36" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2016-07-16T02:48:04+02:00", "end": "2017-07-16T02:48:04+02:00" }, "created": "2016-07-16T02:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:f86e068a-b64b-00bd-5a02-0b1e856ead36" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:aadfcb68-2be0-0a56-3e88-30dbee86e641" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "servicedPeriod": { "start": "2016-07-16T02:33:04+02:00", "end": "2016-07-16T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b0ba0c5e-196a-1038-bb0c-216b40639787" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "36971009", "display": "Sinusitis (disorder)" } ], "text": "Sinusitis (disorder)" }, "servicedPeriod": { "start": "2016-07-16T02:33:04+02:00", "end": "2016-07-16T02:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 85.55, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:808fa9b1-5a57-fc38-8f22-a8cf97a3bf1c", "resource": { "resourceType": "Encounter", "id": "808fa9b1-5a57-fc38-8f22-a8cf97a3bf1c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "808fa9b1-5a57-fc38-8f22-a8cf97a3bf1c" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2017-01-16T01:33:04+01:00", "end": "2017-01-16T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2017-01-16T01:33:04+01:00", "end": "2017-01-16T01:48:04+01:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "195967001", "display": "Asthma" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:8715959a-c308-9c96-977f-3fba5a67f996", "resource": { "resourceType": "DiagnosticReport", "id": "8715959a-c308-9c96-977f-3fba5a67f996", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:808fa9b1-5a57-fc38-8f22-a8cf97a3bf1c" }, "effectiveDateTime": "2017-01-16T01:33:04+01:00", "issued": "2017-01-16T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:f28b1fe6-1c18-6391-e973-20696969604c", "resource": { "resourceType": "DocumentReference", "id": "f28b1fe6-1c18-6391-e973-20696969604c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:8715959a-c308-9c96-977f-3fba5a67f996" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2017-01-16T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:808fa9b1-5a57-fc38-8f22-a8cf97a3bf1c" } ], "period": { "start": "2017-01-16T01:33:04+01:00", "end": "2017-01-16T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:17d85bc5-65c9-f3ab-d196-32a0fd7a965d", "resource": { "resourceType": "Claim", "id": "17d85bc5-65c9-f3ab-d196-32a0fd7a965d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2017-01-16T01:33:04+01:00", "end": "2017-01-16T01:48:04+01:00" }, "created": "2017-01-16T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" }, "encounter": [ { "reference": "urn:uuid:808fa9b1-5a57-fc38-8f22-a8cf97a3bf1c" } ] } ], "total": { "value": 142.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:749441a9-15eb-b2e0-ffd2-7db8c05a32e8", "resource": { "resourceType": "ExplanationOfBenefit", "id": "749441a9-15eb-b2e0-ffd2-7db8c05a32e8", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "17d85bc5-65c9-f3ab-d196-32a0fd7a965d" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2017-01-16T01:48:04+01:00", "end": "2018-01-16T01:48:04+01:00" }, "created": "2017-01-16T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:17d85bc5-65c9-f3ab-d196-32a0fd7a965d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" }, "servicedPeriod": { "start": "2017-01-16T01:33:04+01:00", "end": "2017-01-16T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:808fa9b1-5a57-fc38-8f22-a8cf97a3bf1c" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 142.58, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86", "resource": { "resourceType": "Encounter", "id": "ce36acc9-beb8-242b-d5e3-7b7bab4adc86", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "ce36acc9-beb8-242b-d5e3-7b7bab4adc86" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:9135e393-a55f-2122-c7c0-17cec78ad937", "resource": { "resourceType": "Condition", "id": "9135e393-a55f-2122-c7c0-17cec78ad937", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "422650009", "display": "Social isolation (finding)" } ], "text": "Social isolation (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "onsetDateTime": "2017-02-11T02:28:10+01:00", "abatementDateTime": "2019-02-23T02:27:39+01:00", "recordedDate": "2017-02-11T02:28:10+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:a968c01e-16e8-41c0-e4cd-e3a39e39a5ee", "resource": { "resourceType": "Condition", "id": "a968c01e-16e8-41c0-e4cd-e3a39e39a5ee", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "80583007", "display": "Severe anxiety (panic) (finding)" } ], "text": "Severe anxiety (panic) (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "onsetDateTime": "2017-02-11T02:45:25+01:00", "abatementDateTime": "2020-02-29T02:43:47+01:00", "recordedDate": "2017-02-11T02:45:25+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:ce46bdec-c236-a801-4d02-31ae19a0222e", "resource": { "resourceType": "Observation", "id": "ce46bdec-c236-a801-4d02-31ae19a0222e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 168.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bbf87a8c-2698-4bc2-6500-67207b7b2020", "resource": { "resourceType": "Observation", "id": "bbf87a8c-2698-4bc2-6500-67207b7b2020", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bee8c200-1c08-a7bf-f5cc-632c1ee7263f", "resource": { "resourceType": "Observation", "id": "bee8c200-1c08-a7bf-f5cc-632c1ee7263f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 78.9, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c4478bab-5dcc-9cd9-6ff4-59cbeba53344", "resource": { "resourceType": "Observation", "id": "c4478bab-5dcc-9cd9-6ff4-59cbeba53344", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 27.7, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a5430653-3601-a640-6079-ce0d2cac27ac", "resource": { "resourceType": "Observation", "id": "a5430653-3601-a640-6079-ce0d2cac27ac", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 86, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 156, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:74d0087f-cf2d-01a2-a2a0-f23c14b559e5", "resource": { "resourceType": "Observation", "id": "74d0087f-cf2d-01a2-a2a0-f23c14b559e5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 64, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ba28da9e-5667-72ca-75f2-a0da297e6162", "resource": { "resourceType": "Observation", "id": "ba28da9e-5667-72ca-75f2-a0da297e6162", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9679871d-b4cd-3f22-1d9b-f3ef2b5c3bf5", "resource": { "resourceType": "Observation", "id": "9679871d-b4cd-3f22-1d9b-f3ef2b5c3bf5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6690-2", "display": "Leukocytes [#/volume] in Blood by Automated count" } ], "text": "Leukocytes [#/volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 8.4647, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ffb5dad5-bd75-7df7-d752-727a53a901e0", "resource": { "resourceType": "Observation", "id": "ffb5dad5-bd75-7df7-d752-727a53a901e0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "789-8", "display": "Erythrocytes [#/volume] in Blood by Automated count" } ], "text": "Erythrocytes [#/volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 5.0603, "unit": "10*6/uL", "system": "http://unitsofmeasure.org", "code": "10*6/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6e3393c6-7840-a503-e472-0d5f5e55f854", "resource": { "resourceType": "Observation", "id": "6e3393c6-7840-a503-e472-0d5f5e55f854", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "718-7", "display": "Hemoglobin [Mass/volume] in Blood" } ], "text": "Hemoglobin [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 14.606, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6b2435d2-e7e1-92ec-828d-5da5adfc3f80", "resource": { "resourceType": "Observation", "id": "6b2435d2-e7e1-92ec-828d-5da5adfc3f80", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4544-3", "display": "Hematocrit [Volume Fraction] of Blood by Automated count" } ], "text": "Hematocrit [Volume Fraction] of Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 46.842, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ec7d8cb6-4e86-7271-bc22-496e17f5b64d", "resource": { "resourceType": "Observation", "id": "ec7d8cb6-4e86-7271-bc22-496e17f5b64d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "787-2", "display": "MCV [Entitic volume] by Automated count" } ], "text": "MCV [Entitic volume] by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 87.586, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:81c59573-76f2-2f3a-1e7f-5061b8b1e327", "resource": { "resourceType": "Observation", "id": "81c59573-76f2-2f3a-1e7f-5061b8b1e327", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "785-6", "display": "MCH [Entitic mass] by Automated count" } ], "text": "MCH [Entitic mass] by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 30.426, "unit": "pg", "system": "http://unitsofmeasure.org", "code": "pg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1e82db29-dbfc-973e-2b7d-cb625045a185", "resource": { "resourceType": "Observation", "id": "1e82db29-dbfc-973e-2b7d-cb625045a185", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "786-4", "display": "MCHC [Mass/volume] by Automated count" } ], "text": "MCHC [Mass/volume] by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 33.118, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6167b45d-3329-2bf4-b086-ce180887162e", "resource": { "resourceType": "Observation", "id": "6167b45d-3329-2bf4-b086-ce180887162e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "21000-5", "display": "Erythrocyte distribution width [Entitic volume] by Automated count" } ], "text": "Erythrocyte distribution width [Entitic volume] by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 43.309, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3a0b2500-2e99-4cd9-5f00-a2b0507e1c66", "resource": { "resourceType": "Observation", "id": "3a0b2500-2e99-4cd9-5f00-a2b0507e1c66", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "777-3", "display": "Platelets [#/volume] in Blood by Automated count" } ], "text": "Platelets [#/volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 389.28, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f65dc6f6-d2e7-d8f0-b2fa-d6f5d59c8c91", "resource": { "resourceType": "Observation", "id": "f65dc6f6-d2e7-d8f0-b2fa-d6f5d59c8c91", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "32207-3", "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" } ], "text": "Platelet distribution width [Entitic volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 326.81, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:63f9cdc7-1e04-3739-a8a8-d778611d78ea", "resource": { "resourceType": "Observation", "id": "63f9cdc7-1e04-3739-a8a8-d778611d78ea", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "32623-1", "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" } ], "text": "Platelet mean volume [Entitic volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueQuantity": { "value": 10.147, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e9d6f08a-5042-575c-83ed-43908321e5ea", "resource": { "resourceType": "Observation", "id": "e9d6f08a-5042-575c-83ed-43908321e5ea", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1842496d-a04a-8bb6-62cc-ad73bc0acf4e", "resource": { "resourceType": "Observation", "id": "1842496d-a04a-8bb6-62cc-ad73bc0acf4e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T02:28:10+01:00", "issued": "2017-02-11T02:28:10.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA27722-0", "display": "Less than once a week" } ], "text": "Less than once a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30136-8", "display": "Full-time work" } ], "text": "Full-time work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3b63a152-f5b6-85db-c6a7-8530afd8d486", "resource": { "resourceType": "Observation", "id": "3b63a152-f5b6-85db-c6a7-8530afd8d486", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "70274-6", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ], "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T02:45:25+01:00", "issued": "2017-02-11T02:45:25.492+01:00", "valueQuantity": { "value": 19, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:dc8ca80f-f78a-4566-2a64-6e065dc6e73b", "resource": { "resourceType": "Observation", "id": "dc8ca80f-f78a-4566-2a64-6e065dc6e73b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T03:17:51+01:00", "issued": "2017-02-11T03:17:51.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:495a564c-41d7-4261-fe0e-f280c7610c40", "resource": { "resourceType": "Observation", "id": "495a564c-41d7-4261-fe0e-f280c7610c40", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "75626-2", "display": "Total score [AUDIT-C]" } ], "text": "Total score [AUDIT-C]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T03:51:08+01:00", "issued": "2017-02-11T03:51:08.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b693530c-b5ac-9c3d-10ba-27426034d14f", "resource": { "resourceType": "Procedure", "id": "b693530c-b5ac-9c3d-10ba-27426034d14f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "performedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T01:48:04+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:a5bc6d24-eec5-7203-8d64-8e3b6f3817a7", "resource": { "resourceType": "Procedure", "id": "a5bc6d24-eec5-7203-8d64-8e3b6f3817a7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "performedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:822f83e9-ce87-3992-d706-6e59ef2c5a5b", "resource": { "resourceType": "Procedure", "id": "822f83e9-ce87-3992-d706-6e59ef2c5a5b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "performedPeriod": { "start": "2017-02-11T02:28:10+01:00", "end": "2017-02-11T02:45:25+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:668cdede-b866-2831-01ae-3cf7c19dfbb0", "resource": { "resourceType": "Procedure", "id": "668cdede-b866-2831-01ae-3cf7c19dfbb0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "performedPeriod": { "start": "2017-02-11T02:45:25+01:00", "end": "2017-02-11T02:55:36+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:12286435-b1d3-cf71-b7de-46062d36696b", "resource": { "resourceType": "Procedure", "id": "12286435-b1d3-cf71-b7de-46062d36696b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "performedPeriod": { "start": "2017-02-11T02:55:36+01:00", "end": "2017-02-11T03:17:51+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:435da852-7b3b-de3b-124e-7c9e8bc2c014", "resource": { "resourceType": "Procedure", "id": "435da852-7b3b-de3b-124e-7c9e8bc2c014", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "performedPeriod": { "start": "2017-02-11T03:17:51+01:00", "end": "2017-02-11T03:30:13+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:6ab370e9-cd39-f0e5-e3dd-5b5325592348", "resource": { "resourceType": "Procedure", "id": "6ab370e9-cd39-f0e5-e3dd-5b5325592348", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "performedPeriod": { "start": "2017-02-11T03:30:13+01:00", "end": "2017-02-11T03:51:08+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:3848f74c-0cf9-1515-96b7-a7fc8fcc3bb6", "resource": { "resourceType": "MedicationRequest", "id": "3848f74c-0cf9-1515-96b7-a7fc8fcc3bb6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "authoredOn": "2017-02-11T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:9f5d0b15-de74-bff9-476f-f0dd1fa56481", "resource": { "resourceType": "Claim", "id": "9f5d0b15-de74-bff9-476f-f0dd1fa56481", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "created": "2017-02-11T02:28:10+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:3848f74c-0cf9-1515-96b7-a7fc8fcc3bb6" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:aedc1b7f-04f3-edd0-b767-7b346a9e5c50", "resource": { "resourceType": "ExplanationOfBenefit", "id": "aedc1b7f-04f3-edd0-b767-7b346a9e5c50", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "9f5d0b15-de74-bff9-476f-f0dd1fa56481" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2017-02-11T02:28:10+01:00", "end": "2018-02-11T02:28:10+01:00" }, "created": "2017-02-11T02:28:10+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:9f5d0b15-de74-bff9-476f-f0dd1fa56481" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:a783aa91-ffcf-cacc-eda1-b8b5cff90e3c", "resource": { "resourceType": "MedicationRequest", "id": "a783aa91-ffcf-cacc-eda1-b8b5cff90e3c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "authoredOn": "2017-02-11T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:07cd0d78-acb7-b0e2-a37c-844ef7b59a6c", "resource": { "resourceType": "Claim", "id": "07cd0d78-acb7-b0e2-a37c-844ef7b59a6c", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "created": "2017-02-11T02:28:10+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:a783aa91-ffcf-cacc-eda1-b8b5cff90e3c" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:98c8aea1-badd-e781-de78-895490152785", "resource": { "resourceType": "ExplanationOfBenefit", "id": "98c8aea1-badd-e781-de78-895490152785", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "07cd0d78-acb7-b0e2-a37c-844ef7b59a6c" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2017-02-11T02:28:10+01:00", "end": "2018-02-11T02:28:10+01:00" }, "created": "2017-02-11T02:28:10+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:07cd0d78-acb7-b0e2-a37c-844ef7b59a6c" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:436deb04-7573-23f1-c55b-45c216988f63", "resource": { "resourceType": "MedicationRequest", "id": "436deb04-7573-23f1-c55b-45c216988f63", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "authoredOn": "2017-02-11T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:a4a826e6-2846-e7f6-5d74-d49645a3b0c1", "resource": { "resourceType": "Claim", "id": "a4a826e6-2846-e7f6-5d74-d49645a3b0c1", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "created": "2017-02-11T02:28:10+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:436deb04-7573-23f1-c55b-45c216988f63" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:3efe612b-9499-4fec-1435-a12fda492a9f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "3efe612b-9499-4fec-1435-a12fda492a9f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a4a826e6-2846-e7f6-5d74-d49645a3b0c1" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2017-02-11T02:28:10+01:00", "end": "2018-02-11T02:28:10+01:00" }, "created": "2017-02-11T02:28:10+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:a4a826e6-2846-e7f6-5d74-d49645a3b0c1" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:0b3964d1-c964-75ca-c054-cea035965ecd", "resource": { "resourceType": "Immunization", "id": "0b3964d1-c964-75ca-c054-cea035965ecd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "113", "display": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" } ], "text": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "occurrenceDateTime": "2017-02-11T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:9a888ed9-80ae-b181-55b0-2c87e6efa6c5", "resource": { "resourceType": "Immunization", "id": "9a888ed9-80ae-b181-55b0-2c87e6efa6c5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "43", "display": "Hep B, adult" } ], "text": "Hep B, adult" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "occurrenceDateTime": "2017-02-11T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:f2619218-1c50-c652-b982-ef878650d81f", "resource": { "resourceType": "Immunization", "id": "f2619218-1c50-c652-b982-ef878650d81f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "114", "display": "meningococcal MCV4P" } ], "text": "meningococcal MCV4P" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "occurrenceDateTime": "2017-02-11T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:6ce570a0-8158-a6d7-0fba-53a3eea5f65d", "resource": { "resourceType": "DiagnosticReport", "id": "6ce570a0-8158-a6d7-0fba-53a3eea5f65d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } ], "result": [ { "reference": "urn:uuid:9679871d-b4cd-3f22-1d9b-f3ef2b5c3bf5", "display": "Leukocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:ffb5dad5-bd75-7df7-d752-727a53a901e0", "display": "Erythrocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:6e3393c6-7840-a503-e472-0d5f5e55f854", "display": "Hemoglobin [Mass/volume] in Blood" }, { "reference": "urn:uuid:6b2435d2-e7e1-92ec-828d-5da5adfc3f80", "display": "Hematocrit [Volume Fraction] of Blood by Automated count" }, { "reference": "urn:uuid:ec7d8cb6-4e86-7271-bc22-496e17f5b64d", "display": "MCV [Entitic volume] by Automated count" }, { "reference": "urn:uuid:81c59573-76f2-2f3a-1e7f-5061b8b1e327", "display": "MCH [Entitic mass] by Automated count" }, { "reference": "urn:uuid:1e82db29-dbfc-973e-2b7d-cb625045a185", "display": "MCHC [Mass/volume] by Automated count" }, { "reference": "urn:uuid:6167b45d-3329-2bf4-b086-ce180887162e", "display": "Erythrocyte distribution width [Entitic volume] by Automated count" }, { "reference": "urn:uuid:3a0b2500-2e99-4cd9-5f00-a2b0507e1c66", "display": "Platelets [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:f65dc6f6-d2e7-d8f0-b2fa-d6f5d59c8c91", "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" }, { "reference": "urn:uuid:63f9cdc7-1e04-3739-a8a8-d778611d78ea", "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:82e3e749-57e5-2976-d93a-7de808d455eb", "resource": { "resourceType": "DiagnosticReport", "id": "82e3e749-57e5-2976-d93a-7de808d455eb", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T02:45:25+01:00", "issued": "2017-02-11T02:45:25.492+01:00", "result": [ { "reference": "urn:uuid:3b63a152-f5b6-85db-c6a7-8530afd8d486", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:48d6d497-b4d9-b70b-f95f-3b87f2585275", "resource": { "resourceType": "DiagnosticReport", "id": "48d6d497-b4d9-b70b-f95f-3b87f2585275", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T03:17:51+01:00", "issued": "2017-02-11T03:17:51.492+01:00", "result": [ { "reference": "urn:uuid:dc8ca80f-f78a-4566-2a64-6e065dc6e73b", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:5e8bad28-9514-8ae5-5ef4-7750960ead56", "resource": { "resourceType": "DiagnosticReport", "id": "5e8bad28-9514-8ae5-5ef4-7750960ead56", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T03:51:08+01:00", "issued": "2017-02-11T03:51:08.492+01:00", "result": [ { "reference": "urn:uuid:495a564c-41d7-4261-fe0e-f280c7610c40", "display": "Total score [AUDIT-C]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:93575e4f-9249-b597-7f32-fe519f7ef98a", "resource": { "resourceType": "DiagnosticReport", "id": "93575e4f-9249-b597-7f32-fe519f7ef98a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, "effectiveDateTime": "2017-02-11T01:33:04+01:00", "issued": "2017-02-11T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:3b1e6bd0-2030-0ec0-e53e-032f7d301f29", "resource": { "resourceType": "DocumentReference", "id": "3b1e6bd0-2030-0ec0-e53e-032f7d301f29", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:93575e4f-9249-b597-7f32-fe519f7ef98a" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2017-02-11T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" } ], "period": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:b5b5eae4-4330-376a-92a8-115b61da1301", "resource": { "resourceType": "Claim", "id": "b5b5eae4-4330-376a-92a8-115b61da1301", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "created": "2017-02-11T02:28:10+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:0b3964d1-c964-75ca-c054-cea035965ecd" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:9a888ed9-80ae-b181-55b0-2c87e6efa6c5" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:f2619218-1c50-c652-b982-ef878650d81f" } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 7, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:9135e393-a55f-2122-c7c0-17cec78ad937" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:a968c01e-16e8-41c0-e4cd-e3a39e39a5ee" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:b693530c-b5ac-9c3d-10ba-27426034d14f" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:a5bc6d24-eec5-7203-8d64-8e3b6f3817a7" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:822f83e9-ce87-3992-d706-6e59ef2c5a5b" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:668cdede-b866-2831-01ae-3cf7c19dfbb0" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:12286435-b1d3-cf71-b7de-46062d36696b" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:435da852-7b3b-de3b-124e-7c9e8bc2c014" } }, { "sequence": 7, "procedureReference": { "reference": "urn:uuid:6ab370e9-cd39-f0e5-e3dd-5b5325592348" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "113", "display": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" } ], "text": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "43", "display": "Hep B, adult" } ], "text": "Hep B, adult" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 4, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "114", "display": "meningococcal MCV4P" } ], "text": "meningococcal MCV4P" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 5, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 558.70, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "422650009", "display": "Social isolation (finding)" } ], "text": "Social isolation (finding)" } }, { "sequence": 9, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "80583007", "display": "Severe anxiety (panic) (finding)" } ], "text": "Severe anxiety (panic) (finding)" } }, { "sequence": 11, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 12, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 13, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 14, "informationSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 15, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 16, "procedureSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 17, "informationSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1609.48, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:5c9c5070-7e0b-8958-5cbe-7def53a23312", "resource": { "resourceType": "ExplanationOfBenefit", "id": "5c9c5070-7e0b-8958-5cbe-7def53a23312", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b5b5eae4-4330-376a-92a8-115b61da1301" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2017-02-11T02:28:10+01:00", "end": "2018-02-11T02:28:10+01:00" }, "created": "2017-02-11T02:28:10+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:b5b5eae4-4330-376a-92a8-115b61da1301" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:9135e393-a55f-2122-c7c0-17cec78ad937" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:a968c01e-16e8-41c0-e4cd-e3a39e39a5ee" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "113", "display": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" } ], "text": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "43", "display": "Hep B, adult" } ], "text": "Hep B, adult" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "114", "display": "meningococcal MCV4P" } ], "text": "meningococcal MCV4P" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 558.70, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 111.74000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 446.96000000000004, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 558.70, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 558.70, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "422650009", "display": "Social isolation (finding)" } ], "text": "Social isolation (finding)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "80583007", "display": "Severe anxiety (panic) (finding)" } ], "text": "Severe anxiety (panic) (finding)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 11, "informationSequence": [ 5 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 13, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 14, "informationSequence": [ 6 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 15, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 16, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 17, "informationSequence": [ 7 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "servicedPeriod": { "start": "2017-02-11T01:33:04+01:00", "end": "2017-02-11T02:28:10+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1609.48, "currency": "USD" } } ], "payment": { "amount": { "value": 3082.7360000000003, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:89e0d915-b794-65e9-8480-6f3991fcb3fb", "resource": { "resourceType": "Encounter", "id": "89e0d915-b794-65e9-8480-6f3991fcb3fb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "89e0d915-b794-65e9-8480-6f3991fcb3fb" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "EMER" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "183478001", "display": "Emergency hospital admission for asthma" } ], "text": "Emergency hospital admission for asthma" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2018-01-11T01:33:04+01:00", "end": "2018-01-11T02:33:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } } ], "period": { "start": "2018-01-11T01:33:04+01:00", "end": "2018-01-11T02:33:04+01:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "195967001", "display": "Asthma" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:8e97de38-de43-0959-8eb8-b18d1d71c713", "resource": { "resourceType": "DiagnosticReport", "id": "8e97de38-de43-0959-8eb8-b18d1d71c713", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:89e0d915-b794-65e9-8480-6f3991fcb3fb" }, "effectiveDateTime": "2018-01-11T01:33:04+01:00", "issued": "2018-01-11T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:0ba89056-fa18-9e0d-819e-605800b34006", "resource": { "resourceType": "DocumentReference", "id": "0ba89056-fa18-9e0d-819e-605800b34006", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:8e97de38-de43-0959-8eb8-b18d1d71c713" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2018-01-11T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:89e0d915-b794-65e9-8480-6f3991fcb3fb" } ], "period": { "start": "2018-01-11T01:33:04+01:00", "end": "2018-01-11T02:33:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:808692a9-1ed6-8bce-ec08-e45dd1004146", "resource": { "resourceType": "Claim", "id": "808692a9-1ed6-8bce-ec08-e45dd1004146", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2018-01-11T01:33:04+01:00", "end": "2018-01-11T02:33:04+01:00" }, "created": "2018-01-11T02:33:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "183478001", "display": "Emergency hospital admission for asthma" } ], "text": "Emergency hospital admission for asthma" }, "encounter": [ { "reference": "urn:uuid:89e0d915-b794-65e9-8480-6f3991fcb3fb" } ] } ], "total": { "value": 146.18, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:c092737e-91df-d357-17d2-77c518bc072d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "c092737e-91df-d357-17d2-77c518bc072d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "808692a9-1ed6-8bce-ec08-e45dd1004146" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2018-01-11T02:33:04+01:00", "end": "2019-01-11T02:33:04+01:00" }, "created": "2018-01-11T02:33:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" }, "claim": { "reference": "urn:uuid:808692a9-1ed6-8bce-ec08-e45dd1004146" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "183478001", "display": "Emergency hospital admission for asthma" } ], "text": "Emergency hospital admission for asthma" }, "servicedPeriod": { "start": "2018-01-11T01:33:04+01:00", "end": "2018-01-11T02:33:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:89e0d915-b794-65e9-8480-6f3991fcb3fb" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 146.18, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:fa83aef4-cc01-fb89-0dbc-3549df116cfe", "resource": { "resourceType": "Encounter", "id": "fa83aef4-cc01-fb89-0dbc-3549df116cfe", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "fa83aef4-cc01-fb89-0dbc-3549df116cfe" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2018-01-13T01:33:04+01:00", "end": "2018-01-13T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2018-01-13T01:33:04+01:00", "end": "2018-01-13T01:48:04+01:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "195967001", "display": "Asthma" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:764271e1-4b05-6080-ca81-a09f05058153", "resource": { "resourceType": "DiagnosticReport", "id": "764271e1-4b05-6080-ca81-a09f05058153", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:fa83aef4-cc01-fb89-0dbc-3549df116cfe" }, "effectiveDateTime": "2018-01-13T01:33:04+01:00", "issued": "2018-01-13T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "CjIwMTgtMDEtMTMKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMjIgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIHNldmVyZSBhbnhpZXR5IChwYW5pYykgKGZpbmRpbmcpLCB3aGlwbGFzaCBpbmp1cnkgdG8gbmVjaywgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCBwZXJlbm5pYWwgYWxsZXJnaWMgcmhpbml0aXMgd2l0aCBzZWFzb25hbCB2YXJpYXRpb24sIGNoaWxkaG9vZCBhc3RobWEsIGluanVyeSBvZiBuZWNrIChkaXNvcmRlciksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgbm90IGluIGxhYm9yIGZvcmNlIChmaW5kaW5nKSwgc2ludXNpdGlzIChkaXNvcmRlciksIGZ1bGwtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgc3RyZXNzIChmaW5kaW5nKSwgcGF0aWVudCB0cmFuc2ZlciB0byBza2lsbGVkIG51cnNpbmcgZmFjaWxpdHkgKHByb2NlZHVyZSksIHNvY2lhbCBpc29sYXRpb24gKGZpbmRpbmcpLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgogUGF0aWVudCBpZGVudGlmaWVzIGFzIGhldGVyb3NleHVhbC4KClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCiBQYXRpZW50IGhhcyBhIGhpZ2ggc2Nob29sIGVkdWNhdGlvbi4KUGF0aWVudCBjdXJyZW50bHkgaGFzIE1lZGljYXJlLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwpidWRlc29uaWRlIDAuMTI1IG1nL21sIGluaGFsYXRpb24gc3VzcGVuc2lvbjsgbmRhMDIwOTgzIDIwMCBhY3R1YXQgYWxidXRlcm9sIDAuMDkgbWcvYWN0dWF0IG1ldGVyZWQgZG9zZSBpbmhhbGVyIFt2ZW50b2xpbl07IGlidXByb2ZlbiA0MDAgbWcgb3JhbCB0YWJsZXQgW2lidV07IGlidXByb2ZlbiAyMDAgbWcgb3JhbCB0YWJsZXQKCiMgQXNzZXNzbWVudCBhbmQgUGxhbgoKCiMjIFBsYW4KCg==" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:f82e9289-2e82-60b7-f935-2d2b27f85687", "resource": { "resourceType": "DocumentReference", "id": "f82e9289-2e82-60b7-f935-2d2b27f85687", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:764271e1-4b05-6080-ca81-a09f05058153" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2018-01-13T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMTgtMDEtMTMKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMjIgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIHNldmVyZSBhbnhpZXR5IChwYW5pYykgKGZpbmRpbmcpLCB3aGlwbGFzaCBpbmp1cnkgdG8gbmVjaywgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCBwZXJlbm5pYWwgYWxsZXJnaWMgcmhpbml0aXMgd2l0aCBzZWFzb25hbCB2YXJpYXRpb24sIGNoaWxkaG9vZCBhc3RobWEsIGluanVyeSBvZiBuZWNrIChkaXNvcmRlciksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgbm90IGluIGxhYm9yIGZvcmNlIChmaW5kaW5nKSwgc2ludXNpdGlzIChkaXNvcmRlciksIGZ1bGwtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgc3RyZXNzIChmaW5kaW5nKSwgcGF0aWVudCB0cmFuc2ZlciB0byBza2lsbGVkIG51cnNpbmcgZmFjaWxpdHkgKHByb2NlZHVyZSksIHNvY2lhbCBpc29sYXRpb24gKGZpbmRpbmcpLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgogUGF0aWVudCBpZGVudGlmaWVzIGFzIGhldGVyb3NleHVhbC4KClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCiBQYXRpZW50IGhhcyBhIGhpZ2ggc2Nob29sIGVkdWNhdGlvbi4KUGF0aWVudCBjdXJyZW50bHkgaGFzIE1lZGljYXJlLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwpidWRlc29uaWRlIDAuMTI1IG1nL21sIGluaGFsYXRpb24gc3VzcGVuc2lvbjsgbmRhMDIwOTgzIDIwMCBhY3R1YXQgYWxidXRlcm9sIDAuMDkgbWcvYWN0dWF0IG1ldGVyZWQgZG9zZSBpbmhhbGVyIFt2ZW50b2xpbl07IGlidXByb2ZlbiA0MDAgbWcgb3JhbCB0YWJsZXQgW2lidV07IGlidXByb2ZlbiAyMDAgbWcgb3JhbCB0YWJsZXQKCiMgQXNzZXNzbWVudCBhbmQgUGxhbgoKCiMjIFBsYW4KCg==" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:fa83aef4-cc01-fb89-0dbc-3549df116cfe" } ], "period": { "start": "2018-01-13T01:33:04+01:00", "end": "2018-01-13T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:70d39f06-16dd-df78-2a26-a1d6e15e660b", "resource": { "resourceType": "Claim", "id": "70d39f06-16dd-df78-2a26-a1d6e15e660b", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2018-01-13T01:33:04+01:00", "end": "2018-01-13T01:48:04+01:00" }, "created": "2018-01-13T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" }, "encounter": [ { "reference": "urn:uuid:fa83aef4-cc01-fb89-0dbc-3549df116cfe" } ] } ], "total": { "value": 142.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:dc201992-2ab3-07fb-e0d9-743912b390cc", "resource": { "resourceType": "ExplanationOfBenefit", "id": "dc201992-2ab3-07fb-e0d9-743912b390cc", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "70d39f06-16dd-df78-2a26-a1d6e15e660b" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2018-01-13T01:48:04+01:00", "end": "2019-01-13T01:48:04+01:00" }, "created": "2018-01-13T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:70d39f06-16dd-df78-2a26-a1d6e15e660b" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" }, "servicedPeriod": { "start": "2018-01-13T01:33:04+01:00", "end": "2018-01-13T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:fa83aef4-cc01-fb89-0dbc-3549df116cfe" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 142.58, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060", "resource": { "resourceType": "Encounter", "id": "f69405f2-0672-5339-1a2b-192f8ff5a060", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "f69405f2-0672-5339-1a2b-192f8ff5a060" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:d3313d41-25ed-3f0b-2eb8-6fc6cc3f08ef", "resource": { "resourceType": "Condition", "id": "d3313d41-25ed-3f0b-2eb8-6fc6cc3f08ef", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "onsetDateTime": "2018-02-17T01:33:04+01:00", "abatementDateTime": "2018-02-17T01:33:04+01:00", "recordedDate": "2018-02-17T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:1b58895b-9702-edec-6039-675e066baa1a", "resource": { "resourceType": "Condition", "id": "1b58895b-9702-edec-6039-675e066baa1a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "onsetDateTime": "2018-02-17T02:28:31+01:00", "abatementDateTime": "2019-02-23T02:27:39+01:00", "recordedDate": "2018-02-17T02:28:31+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:d55941ee-3c9b-72b9-0b08-c912b8bff744", "resource": { "resourceType": "Condition", "id": "d55941ee-3c9b-72b9-0b08-c912b8bff744", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "706893006", "display": "Victim of intimate partner abuse (finding)" } ], "text": "Victim of intimate partner abuse (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "onsetDateTime": "2018-02-17T02:28:31+01:00", "abatementDateTime": "2019-02-23T02:27:39+01:00", "recordedDate": "2018-02-17T02:28:31+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:3d3835cd-812e-7404-7a91-c158ac69b523", "resource": { "resourceType": "Observation", "id": "3d3835cd-812e-7404-7a91-c158ac69b523", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T01:33:04+01:00", "issued": "2018-02-17T01:33:04.492+01:00", "valueQuantity": { "value": 168.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ce170a7a-efa3-e674-b82e-9160cd150fc4", "resource": { "resourceType": "Observation", "id": "ce170a7a-efa3-e674-b82e-9160cd150fc4", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T01:33:04+01:00", "issued": "2018-02-17T01:33:04.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c19e0b58-d797-a956-cd10-a103b25f06ee", "resource": { "resourceType": "Observation", "id": "c19e0b58-d797-a956-cd10-a103b25f06ee", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T01:33:04+01:00", "issued": "2018-02-17T01:33:04.492+01:00", "valueQuantity": { "value": 80, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b94ae366-319a-fc26-ea48-bc95e92be0cc", "resource": { "resourceType": "Observation", "id": "b94ae366-319a-fc26-ea48-bc95e92be0cc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T01:33:04+01:00", "issued": "2018-02-17T01:33:04.492+01:00", "valueQuantity": { "value": 28.08, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9ba60613-0885-8798-9f66-81c5d5fd7a44", "resource": { "resourceType": "Observation", "id": "9ba60613-0885-8798-9f66-81c5d5fd7a44", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T01:33:04+01:00", "issued": "2018-02-17T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 84, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 144, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:029026ba-c177-4fb8-0656-594d8fb2f05d", "resource": { "resourceType": "Observation", "id": "029026ba-c177-4fb8-0656-594d8fb2f05d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T01:33:04+01:00", "issued": "2018-02-17T01:33:04.492+01:00", "valueQuantity": { "value": 65, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ef9c0ae7-cae6-d13a-4fff-5c64de5542f0", "resource": { "resourceType": "Observation", "id": "ef9c0ae7-cae6-d13a-4fff-5c64de5542f0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T01:33:04+01:00", "issued": "2018-02-17T01:33:04.492+01:00", "valueQuantity": { "value": 15, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:57c437eb-1228-73a9-3dcf-b7a8fdc22b11", "resource": { "resourceType": "Observation", "id": "57c437eb-1228-73a9-3dcf-b7a8fdc22b11", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T01:33:04+01:00", "issued": "2018-02-17T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f798ae95-6b75-7b56-e37f-2e99d529d0be", "resource": { "resourceType": "Observation", "id": "f798ae95-6b75-7b56-e37f-2e99d529d0be", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T02:28:31+01:00", "issued": "2018-02-17T02:28:31.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA27722-0", "display": "Less than once a week" } ], "text": "Less than once a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30138-4", "display": "Part-time or temporary work" } ], "text": "Part-time or temporary work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9954d173-baf6-1ab9-d259-1b3bd921a7ee", "resource": { "resourceType": "Observation", "id": "9954d173-baf6-1ab9-d259-1b3bd921a7ee", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T03:07:26+01:00", "issued": "2018-02-17T03:07:26.492+01:00", "valueQuantity": { "value": 5, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2ad3ed62-d021-991c-eff3-7d8eb6df99af", "resource": { "resourceType": "Observation", "id": "2ad3ed62-d021-991c-eff3-7d8eb6df99af", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "44261-6", "display": "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]" } ], "text": "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T03:34:06+01:00", "issued": "2018-02-17T03:34:06.492+01:00", "valueQuantity": { "value": 7, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:15c19839-522a-7073-678a-15da533a4a89", "resource": { "resourceType": "Observation", "id": "15c19839-522a-7073-678a-15da533a4a89", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82667-7", "display": "Total score [DAST-10]" } ], "text": "Total score [DAST-10]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T04:11:54+01:00", "issued": "2018-02-17T04:11:54.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ce23f3b2-c892-ebe8-21d9-f7352e45fc00", "resource": { "resourceType": "Procedure", "id": "ce23f3b2-c892-ebe8-21d9-f7352e45fc00", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "performedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T01:48:04+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b3322350-4e1e-f8c0-86ef-f74a126833e6", "resource": { "resourceType": "Procedure", "id": "b3322350-4e1e-f8c0-86ef-f74a126833e6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "performedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0f15e587-9518-abe4-b7fb-db0b5f217c11", "resource": { "resourceType": "Procedure", "id": "0f15e587-9518-abe4-b7fb-db0b5f217c11", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "performedPeriod": { "start": "2018-02-17T02:28:31+01:00", "end": "2018-02-17T02:41:15+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:166f6278-c4c7-ea92-fe98-2afff9a74832", "resource": { "resourceType": "Procedure", "id": "166f6278-c4c7-ea92-fe98-2afff9a74832", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "performedPeriod": { "start": "2018-02-17T02:41:15+01:00", "end": "2018-02-17T03:07:26+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c2a3f6c4-885b-5f02-bf3e-7a69fe7a43be", "resource": { "resourceType": "Procedure", "id": "c2a3f6c4-885b-5f02-bf3e-7a69fe7a43be", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "715252007", "display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "performedPeriod": { "start": "2018-02-17T03:07:26+01:00", "end": "2018-02-17T03:34:06+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:6d7c740d-a8a3-84a1-6968-e64fbed6962e", "resource": { "resourceType": "Procedure", "id": "6d7c740d-a8a3-84a1-6968-e64fbed6962e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "performedPeriod": { "start": "2018-02-17T03:34:06+01:00", "end": "2018-02-17T03:47:04+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:32d94eb5-9bab-291c-d53d-9d8905d9ed3e", "resource": { "resourceType": "Procedure", "id": "32d94eb5-9bab-291c-d53d-9d8905d9ed3e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "performedPeriod": { "start": "2018-02-17T03:47:04+01:00", "end": "2018-02-17T04:11:54+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:511eb593-a4fb-0fa7-fdf6-7aa8f659dc20", "resource": { "resourceType": "MedicationRequest", "id": "511eb593-a4fb-0fa7-fdf6-7aa8f659dc20", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "authoredOn": "2018-02-17T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:3b7458f9-c56f-4545-58c0-a40660eb8ca5", "resource": { "resourceType": "Claim", "id": "3b7458f9-c56f-4545-58c0-a40660eb8ca5", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "created": "2018-02-17T02:28:31+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:511eb593-a4fb-0fa7-fdf6-7aa8f659dc20" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:6ab2c845-f339-dee2-6ef9-66f3908f1622", "resource": { "resourceType": "ExplanationOfBenefit", "id": "6ab2c845-f339-dee2-6ef9-66f3908f1622", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "3b7458f9-c56f-4545-58c0-a40660eb8ca5" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2018-02-17T02:28:31+01:00", "end": "2019-02-17T02:28:31+01:00" }, "created": "2018-02-17T02:28:31+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:3b7458f9-c56f-4545-58c0-a40660eb8ca5" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:8a49cf8e-bc6a-a10d-00df-83e191ec5af4", "resource": { "resourceType": "MedicationRequest", "id": "8a49cf8e-bc6a-a10d-00df-83e191ec5af4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "authoredOn": "2018-02-17T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:b2c50990-a93d-acf3-9680-7f914d1df29b", "resource": { "resourceType": "Claim", "id": "b2c50990-a93d-acf3-9680-7f914d1df29b", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "created": "2018-02-17T02:28:31+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:8a49cf8e-bc6a-a10d-00df-83e191ec5af4" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:91a69dd7-ef99-5ea1-cf01-d8825e19672e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "91a69dd7-ef99-5ea1-cf01-d8825e19672e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b2c50990-a93d-acf3-9680-7f914d1df29b" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2018-02-17T02:28:31+01:00", "end": "2019-02-17T02:28:31+01:00" }, "created": "2018-02-17T02:28:31+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:b2c50990-a93d-acf3-9680-7f914d1df29b" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:70e15a10-171c-d260-b56a-c5899d4b1b83", "resource": { "resourceType": "MedicationRequest", "id": "70e15a10-171c-d260-b56a-c5899d4b1b83", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "authoredOn": "2018-02-17T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:538108e0-8eac-b712-6367-b28027fabb78", "resource": { "resourceType": "Claim", "id": "538108e0-8eac-b712-6367-b28027fabb78", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "created": "2018-02-17T02:28:31+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:70e15a10-171c-d260-b56a-c5899d4b1b83" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:068e695a-bd81-8e32-7379-1314bda3c327", "resource": { "resourceType": "ExplanationOfBenefit", "id": "068e695a-bd81-8e32-7379-1314bda3c327", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "538108e0-8eac-b712-6367-b28027fabb78" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2018-02-17T02:28:31+01:00", "end": "2019-02-17T02:28:31+01:00" }, "created": "2018-02-17T02:28:31+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:538108e0-8eac-b712-6367-b28027fabb78" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:114bd90a-a765-8185-b6f8-468e0cde84a6", "resource": { "resourceType": "Immunization", "id": "114bd90a-a765-8185-b6f8-468e0cde84a6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "occurrenceDateTime": "2018-02-17T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:a631da6a-bef1-8bea-63ff-420caca87a13", "resource": { "resourceType": "DiagnosticReport", "id": "a631da6a-bef1-8bea-63ff-420caca87a13", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T03:07:26+01:00", "issued": "2018-02-17T03:07:26.492+01:00", "result": [ { "reference": "urn:uuid:9954d173-baf6-1ab9-d259-1b3bd921a7ee", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:291b3553-c61d-13f9-4dd8-4df629293336", "resource": { "resourceType": "DiagnosticReport", "id": "291b3553-c61d-13f9-4dd8-4df629293336", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "44249-1", "display": "PHQ-9 quick depression assessment panel [Reported.PHQ]" } ], "text": "PHQ-9 quick depression assessment panel [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T03:34:06+01:00", "issued": "2018-02-17T03:34:06.492+01:00", "result": [ { "reference": "urn:uuid:2ad3ed62-d021-991c-eff3-7d8eb6df99af", "display": "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:d828da84-4ae4-9550-14ca-62d375684482", "resource": { "resourceType": "DiagnosticReport", "id": "d828da84-4ae4-9550-14ca-62d375684482", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T04:11:54+01:00", "issued": "2018-02-17T04:11:54.492+01:00", "result": [ { "reference": "urn:uuid:15c19839-522a-7073-678a-15da533a4a89", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:97a23c13-e01e-0d36-022a-21ebb75e1151", "resource": { "resourceType": "DiagnosticReport", "id": "97a23c13-e01e-0d36-022a-21ebb75e1151", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, "effectiveDateTime": "2018-02-17T01:33:04+01:00", "issued": "2018-02-17T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:b60b6497-f53f-0959-b62c-37ec346dc713", "resource": { "resourceType": "DocumentReference", "id": "b60b6497-f53f-0959-b62c-37ec346dc713", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:97a23c13-e01e-0d36-022a-21ebb75e1151" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2018-02-17T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" } ], "period": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:c1cf8ab9-59ea-40b1-3bf2-8278415d5e4f", "resource": { "resourceType": "Claim", "id": "c1cf8ab9-59ea-40b1-3bf2-8278415d5e4f", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "created": "2018-02-17T02:28:31+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:114bd90a-a765-8185-b6f8-468e0cde84a6" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:d3313d41-25ed-3f0b-2eb8-6fc6cc3f08ef" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:1b58895b-9702-edec-6039-675e066baa1a" } }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:d55941ee-3c9b-72b9-0b08-c912b8bff744" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:ce23f3b2-c892-ebe8-21d9-f7352e45fc00" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:b3322350-4e1e-f8c0-86ef-f74a126833e6" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:0f15e587-9518-abe4-b7fb-db0b5f217c11" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:166f6278-c4c7-ea92-fe98-2afff9a74832" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:c2a3f6c4-885b-5f02-bf3e-7a69fe7a43be" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:6d7c740d-a8a3-84a1-6968-e64fbed6962e" } }, { "sequence": 7, "procedureReference": { "reference": "urn:uuid:32d94eb5-9bab-291c-d53d-9d8905d9ed3e" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 4, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 416.96, "currency": "USD" } }, { "sequence": 5, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 6, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" } }, { "sequence": 7, "diagnosisSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "706893006", "display": "Victim of intimate partner abuse (finding)" } ], "text": "Victim of intimate partner abuse (finding)" } }, { "sequence": 8, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "715252007", "display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)" }, "net": { "value": 28.61, "currency": "USD" } }, { "sequence": 12, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "44249-1", "display": "PHQ-9 quick depression assessment panel [Reported.PHQ]" } ], "text": "PHQ-9 quick depression assessment panel [Reported.PHQ]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 13, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 14, "procedureSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 15, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1121.16, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:9decab3b-0095-bc61-485b-2b438dd3179c", "resource": { "resourceType": "ExplanationOfBenefit", "id": "9decab3b-0095-bc61-485b-2b438dd3179c", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c1cf8ab9-59ea-40b1-3bf2-8278415d5e4f" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2018-02-17T02:28:31+01:00", "end": "2019-02-17T02:28:31+01:00" }, "created": "2018-02-17T02:28:31+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:c1cf8ab9-59ea-40b1-3bf2-8278415d5e4f" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:d3313d41-25ed-3f0b-2eb8-6fc6cc3f08ef" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:1b58895b-9702-edec-6039-675e066baa1a" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:d55941ee-3c9b-72b9-0b08-c912b8bff744" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 416.96, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 83.392, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 333.568, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 416.96, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 416.96, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 7, "diagnosisSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "706893006", "display": "Victim of intimate partner abuse (finding)" } ], "text": "Victim of intimate partner abuse (finding)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "715252007", "display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 28.61, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 5.722, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 22.888, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 28.61, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 28.61, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "44249-1", "display": "PHQ-9 quick depression assessment panel [Reported.PHQ]" } ], "text": "PHQ-9 quick depression assessment panel [Reported.PHQ]" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 13, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 14, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 15, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "servicedPeriod": { "start": "2018-02-17T01:33:04+01:00", "end": "2018-02-17T02:28:31+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1121.16, "currency": "USD" } } ], "payment": { "amount": { "value": 2369.848, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420", "resource": { "resourceType": "Encounter", "id": "43807411-2087-346e-7d3a-38fdcf888420", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "43807411-2087-346e-7d3a-38fdcf888420" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:e0cf41fb-2d73-ea62-b5fb-844b70763048", "resource": { "resourceType": "Condition", "id": "e0cf41fb-2d73-ea62-b5fb-844b70763048", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "onsetDateTime": "2019-02-23T01:33:04+01:00", "abatementDateTime": "2020-02-29T01:33:04+01:00", "recordedDate": "2019-02-23T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:1cad6564-b1d1-3fb4-5202-ab9537eb6561", "resource": { "resourceType": "Condition", "id": "1cad6564-b1d1-3fb4-5202-ab9537eb6561", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "onsetDateTime": "2019-02-23T02:27:39+01:00", "abatementDateTime": "2020-12-26T02:17:11+01:00", "recordedDate": "2019-02-23T02:27:39+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:2b1edb1d-29f8-f04d-3e12-3ed47aa27ab6", "resource": { "resourceType": "Observation", "id": "2b1edb1d-29f8-f04d-3e12-3ed47aa27ab6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T01:33:04+01:00", "issued": "2019-02-23T01:33:04.492+01:00", "valueQuantity": { "value": 168.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a1035900-86d2-eff8-329b-d3ea8cb7b921", "resource": { "resourceType": "Observation", "id": "a1035900-86d2-eff8-329b-d3ea8cb7b921", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T01:33:04+01:00", "issued": "2019-02-23T01:33:04.492+01:00", "valueQuantity": { "value": 4, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b9606cd7-81cc-99a8-6f02-14cfcea779d7", "resource": { "resourceType": "Observation", "id": "b9606cd7-81cc-99a8-6f02-14cfcea779d7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T01:33:04+01:00", "issued": "2019-02-23T01:33:04.492+01:00", "valueQuantity": { "value": 81.3, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cafd7081-3cba-13ff-6085-c4235ccb4c9c", "resource": { "resourceType": "Observation", "id": "cafd7081-3cba-13ff-6085-c4235ccb4c9c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T01:33:04+01:00", "issued": "2019-02-23T01:33:04.492+01:00", "valueQuantity": { "value": 28.54, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4ca7ee1f-a109-79b9-8057-32537f45d4dc", "resource": { "resourceType": "Observation", "id": "4ca7ee1f-a109-79b9-8057-32537f45d4dc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T01:33:04+01:00", "issued": "2019-02-23T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 81, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 146, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0dfa59f8-8c89-1bc9-2692-d7855cb80db0", "resource": { "resourceType": "Observation", "id": "0dfa59f8-8c89-1bc9-2692-d7855cb80db0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T01:33:04+01:00", "issued": "2019-02-23T01:33:04.492+01:00", "valueQuantity": { "value": 90, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:75af2697-ca06-e2af-4598-5c317622c53e", "resource": { "resourceType": "Observation", "id": "75af2697-ca06-e2af-4598-5c317622c53e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T01:33:04+01:00", "issued": "2019-02-23T01:33:04.492+01:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:eaa338dd-b5f4-756f-18e6-0eb1de717bf9", "resource": { "resourceType": "Observation", "id": "eaa338dd-b5f4-756f-18e6-0eb1de717bf9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T01:33:04+01:00", "issued": "2019-02-23T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d970f470-8e87-0cd0-86e2-34a9f8d2c8bb", "resource": { "resourceType": "Observation", "id": "d970f470-8e87-0cd0-86e2-34a9f8d2c8bb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T02:27:39+01:00", "issued": "2019-02-23T02:27:39.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30131-9", "display": "3 to 5 times a week" } ], "text": "3 to 5 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30136-8", "display": "Full-time work" } ], "text": "Full-time work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a9cb4024-19c7-7f19-0bf0-dbb8b6ccb620", "resource": { "resourceType": "Observation", "id": "a9cb4024-19c7-7f19-0bf0-dbb8b6ccb620", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T03:06:40+01:00", "issued": "2019-02-23T03:06:40.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2686cfd9-e379-0cb8-52ae-aab4f9506813", "resource": { "resourceType": "Observation", "id": "2686cfd9-e379-0cb8-52ae-aab4f9506813", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "75626-2", "display": "Total score [AUDIT-C]" } ], "text": "Total score [AUDIT-C]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T03:49:25+01:00", "issued": "2019-02-23T03:49:25.492+01:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:55b4aba5-7fa0-c3b9-ae57-344bda37805f", "resource": { "resourceType": "Procedure", "id": "55b4aba5-7fa0-c3b9-ae57-344bda37805f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "performedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1dffc610-e0df-9b27-216b-d626493ec53f", "resource": { "resourceType": "Procedure", "id": "1dffc610-e0df-9b27-216b-d626493ec53f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "performedPeriod": { "start": "2019-02-23T02:27:39+01:00", "end": "2019-02-23T02:38:11+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:029a3f1f-258c-2327-f54f-6e3156579bdc", "resource": { "resourceType": "Procedure", "id": "029a3f1f-258c-2327-f54f-6e3156579bdc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "performedPeriod": { "start": "2019-02-23T02:38:11+01:00", "end": "2019-02-23T03:06:40+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:2a56a713-1317-e93f-9a59-d63b01ce8bda", "resource": { "resourceType": "Procedure", "id": "2a56a713-1317-e93f-9a59-d63b01ce8bda", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "performedPeriod": { "start": "2019-02-23T03:06:40+01:00", "end": "2019-02-23T03:21:25+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:741e35ee-8c69-ac6b-ce76-08351bc097ea", "resource": { "resourceType": "Procedure", "id": "741e35ee-8c69-ac6b-ce76-08351bc097ea", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "performedPeriod": { "start": "2019-02-23T03:21:25+01:00", "end": "2019-02-23T03:49:25+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:7dead142-1b5c-aeed-4bea-f3b20e30b06d", "resource": { "resourceType": "MedicationRequest", "id": "7dead142-1b5c-aeed-4bea-f3b20e30b06d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "authoredOn": "2019-02-23T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:a6404f23-47ef-cf17-5124-64152e8a21ae", "resource": { "resourceType": "Claim", "id": "a6404f23-47ef-cf17-5124-64152e8a21ae", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "created": "2019-02-23T02:27:39+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:7dead142-1b5c-aeed-4bea-f3b20e30b06d" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:fa63ba25-cef1-232e-a41d-ba480b5d276d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "fa63ba25-cef1-232e-a41d-ba480b5d276d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a6404f23-47ef-cf17-5124-64152e8a21ae" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2019-02-23T02:27:39+01:00", "end": "2020-02-23T02:27:39+01:00" }, "created": "2019-02-23T02:27:39+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:a6404f23-47ef-cf17-5124-64152e8a21ae" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:79b0dda2-fe08-d890-8b8c-6ea635941ac3", "resource": { "resourceType": "MedicationRequest", "id": "79b0dda2-fe08-d890-8b8c-6ea635941ac3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "authoredOn": "2019-02-23T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:2690d4bd-7a69-5d3e-f87c-81ec5719ebec", "resource": { "resourceType": "Claim", "id": "2690d4bd-7a69-5d3e-f87c-81ec5719ebec", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "created": "2019-02-23T02:27:39+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:79b0dda2-fe08-d890-8b8c-6ea635941ac3" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:77afb1f9-4e30-60c9-78c1-95597025b699", "resource": { "resourceType": "ExplanationOfBenefit", "id": "77afb1f9-4e30-60c9-78c1-95597025b699", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "2690d4bd-7a69-5d3e-f87c-81ec5719ebec" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2019-02-23T02:27:39+01:00", "end": "2020-02-23T02:27:39+01:00" }, "created": "2019-02-23T02:27:39+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:2690d4bd-7a69-5d3e-f87c-81ec5719ebec" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:fe4d41aa-b137-3b30-451c-bca111bba9ff", "resource": { "resourceType": "MedicationRequest", "id": "fe4d41aa-b137-3b30-451c-bca111bba9ff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "authoredOn": "2019-02-23T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:ba539663-1202-efcb-bfc6-12dd984656c4", "resource": { "resourceType": "Claim", "id": "ba539663-1202-efcb-bfc6-12dd984656c4", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "created": "2019-02-23T02:27:39+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:fe4d41aa-b137-3b30-451c-bca111bba9ff" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:942da01b-dffe-829b-21ae-27f1173e86e3", "resource": { "resourceType": "ExplanationOfBenefit", "id": "942da01b-dffe-829b-21ae-27f1173e86e3", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "ba539663-1202-efcb-bfc6-12dd984656c4" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2019-02-23T02:27:39+01:00", "end": "2020-02-23T02:27:39+01:00" }, "created": "2019-02-23T02:27:39+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:ba539663-1202-efcb-bfc6-12dd984656c4" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:6eb102e5-2f72-f40c-1315-264853a5d117", "resource": { "resourceType": "Immunization", "id": "6eb102e5-2f72-f40c-1315-264853a5d117", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "occurrenceDateTime": "2019-02-23T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:d6cb484a-dd93-f753-da54-c019324c4f65", "resource": { "resourceType": "DiagnosticReport", "id": "d6cb484a-dd93-f753-da54-c019324c4f65", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T03:06:40+01:00", "issued": "2019-02-23T03:06:40.492+01:00", "result": [ { "reference": "urn:uuid:a9cb4024-19c7-7f19-0bf0-dbb8b6ccb620", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1ed2849d-e033-472a-7c3b-a4691f38e5ad", "resource": { "resourceType": "DiagnosticReport", "id": "1ed2849d-e033-472a-7c3b-a4691f38e5ad", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T03:49:25+01:00", "issued": "2019-02-23T03:49:25.492+01:00", "result": [ { "reference": "urn:uuid:2686cfd9-e379-0cb8-52ae-aab4f9506813", "display": "Total score [AUDIT-C]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:d4623ef4-81fd-0a59-d483-1248c12bc813", "resource": { "resourceType": "DiagnosticReport", "id": "d4623ef4-81fd-0a59-d483-1248c12bc813", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, "effectiveDateTime": "2019-02-23T01:33:04+01:00", "issued": "2019-02-23T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:dba89288-2786-7b2a-519e-62892e211d24", "resource": { "resourceType": "DocumentReference", "id": "dba89288-2786-7b2a-519e-62892e211d24", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:d4623ef4-81fd-0a59-d483-1248c12bc813" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2019-02-23T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" } ], "period": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:08f2a4bd-d0f5-d9ed-7d18-8375749879a0", "resource": { "resourceType": "Claim", "id": "08f2a4bd-d0f5-d9ed-7d18-8375749879a0", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "created": "2019-02-23T02:27:39+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:6eb102e5-2f72-f40c-1315-264853a5d117" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:e0cf41fb-2d73-ea62-b5fb-844b70763048" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:1cad6564-b1d1-3fb4-5202-ab9537eb6561" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:55b4aba5-7fa0-c3b9-ae57-344bda37805f" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:1dffc610-e0df-9b27-216b-d626493ec53f" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:029a3f1f-258c-2327-f54f-6e3156579bdc" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:2a56a713-1317-e93f-9a59-d63b01ce8bda" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:741e35ee-8c69-ac6b-ce76-08351bc097ea" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 4, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 5, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" } }, { "sequence": 6, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 9, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 704.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:a5e8be21-4d37-c38c-11ec-fccb0737e5c9", "resource": { "resourceType": "ExplanationOfBenefit", "id": "a5e8be21-4d37-c38c-11ec-fccb0737e5c9", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "08f2a4bd-d0f5-d9ed-7d18-8375749879a0" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2019-02-23T02:27:39+01:00", "end": "2020-02-23T02:27:39+01:00" }, "created": "2019-02-23T02:27:39+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:08f2a4bd-d0f5-d9ed-7d18-8375749879a0" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:e0cf41fb-2d73-ea62-b5fb-844b70763048" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:1cad6564-b1d1-3fb4-5202-ab9537eb6561" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "servicedPeriod": { "start": "2019-02-23T01:33:04+01:00", "end": "2019-02-23T02:27:39+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 704.20, "currency": "USD" } } ], "payment": { "amount": { "value": 1953.7279999999998, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340", "resource": { "resourceType": "Encounter", "id": "bcd9fc13-2673-d661-90e9-0f66d5db5340", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "bcd9fc13-2673-d661-90e9-0f66d5db5340" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:8efd99eb-115e-591e-fdf9-2760b717f705", "resource": { "resourceType": "Observation", "id": "8efd99eb-115e-591e-fdf9-2760b717f705", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T01:33:04+01:00", "issued": "2020-02-29T01:33:04.492+01:00", "valueQuantity": { "value": 168.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:85bfcc60-0931-41fe-5595-83f7bfa5558a", "resource": { "resourceType": "Observation", "id": "85bfcc60-0931-41fe-5595-83f7bfa5558a", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T01:33:04+01:00", "issued": "2020-02-29T01:33:04.492+01:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f440dd39-d9d7-1c54-f79d-d382323c1fbc", "resource": { "resourceType": "Observation", "id": "f440dd39-d9d7-1c54-f79d-d382323c1fbc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T01:33:04+01:00", "issued": "2020-02-29T01:33:04.492+01:00", "valueQuantity": { "value": 82.7, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7d8c3217-2ddf-d779-e3ae-e03281e988db", "resource": { "resourceType": "Observation", "id": "7d8c3217-2ddf-d779-e3ae-e03281e988db", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T01:33:04+01:00", "issued": "2020-02-29T01:33:04.492+01:00", "valueQuantity": { "value": 29.02, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:af7a7cef-2cdd-13b8-7c03-209189fe5ced", "resource": { "resourceType": "Observation", "id": "af7a7cef-2cdd-13b8-7c03-209189fe5ced", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T01:33:04+01:00", "issued": "2020-02-29T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 82, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 142, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:11625bba-7ff6-374e-3f89-eeaf1e336a58", "resource": { "resourceType": "Observation", "id": "11625bba-7ff6-374e-3f89-eeaf1e336a58", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T01:33:04+01:00", "issued": "2020-02-29T01:33:04.492+01:00", "valueQuantity": { "value": 92, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:16b4a9f3-6a39-4c0b-3f6b-5f1f61aa8621", "resource": { "resourceType": "Observation", "id": "16b4a9f3-6a39-4c0b-3f6b-5f1f61aa8621", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T01:33:04+01:00", "issued": "2020-02-29T01:33:04.492+01:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:024eeb3b-ff03-5d73-bfe4-a3e6767f4f14", "resource": { "resourceType": "Observation", "id": "024eeb3b-ff03-5d73-bfe4-a3e6767f4f14", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T01:33:04+01:00", "issued": "2020-02-29T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4ffa3dd0-2c7a-6051-009d-0e978b8fd79e", "resource": { "resourceType": "Observation", "id": "4ffa3dd0-2c7a-6051-009d-0e978b8fd79e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T02:27:02+01:00", "issued": "2020-02-29T02:27:02.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30131-9", "display": "3 to 5 times a week" } ], "text": "3 to 5 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30136-8", "display": "Full-time work" } ], "text": "Full-time work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0210639d-27d0-926e-7bdb-638e74daea77", "resource": { "resourceType": "Observation", "id": "0210639d-27d0-926e-7bdb-638e74daea77", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "70274-6", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ], "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T02:43:47+01:00", "issued": "2020-02-29T02:43:47.492+01:00", "valueQuantity": { "value": 10, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7477ec8b-5357-2138-02dc-1cc6f0fe11de", "resource": { "resourceType": "Observation", "id": "7477ec8b-5357-2138-02dc-1cc6f0fe11de", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T03:21:18+01:00", "issued": "2020-02-29T03:21:18.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:87e77d89-7dfa-4ae8-18df-973190e372f8", "resource": { "resourceType": "Procedure", "id": "87e77d89-7dfa-4ae8-18df-973190e372f8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "performedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T01:48:04+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c0e0f010-8fd7-dc95-bfc7-4b1d4fb0bd0d", "resource": { "resourceType": "Procedure", "id": "c0e0f010-8fd7-dc95-bfc7-4b1d4fb0bd0d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "performedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:aa60a7d0-ce1e-23ea-86fb-e2a9b2ac8e18", "resource": { "resourceType": "Procedure", "id": "aa60a7d0-ce1e-23ea-86fb-e2a9b2ac8e18", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "performedPeriod": { "start": "2020-02-29T02:27:02+01:00", "end": "2020-02-29T02:43:47+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c7e943a6-e738-9f50-1dc2-12630edc32d1", "resource": { "resourceType": "Procedure", "id": "c7e943a6-e738-9f50-1dc2-12630edc32d1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "performedPeriod": { "start": "2020-02-29T02:43:47+01:00", "end": "2020-02-29T02:56:28+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:2259f9da-d4b2-1624-4baa-4bad3b0b5a73", "resource": { "resourceType": "Procedure", "id": "2259f9da-d4b2-1624-4baa-4bad3b0b5a73", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "performedPeriod": { "start": "2020-02-29T02:56:28+01:00", "end": "2020-02-29T03:21:18+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:357b883b-2fe9-e7d5-2744-15001fcd2c70", "resource": { "resourceType": "MedicationRequest", "id": "357b883b-2fe9-e7d5-2744-15001fcd2c70", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "authoredOn": "2020-02-29T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:4a5134e8-70b9-2008-7be5-5b95b35aee3f", "resource": { "resourceType": "Claim", "id": "4a5134e8-70b9-2008-7be5-5b95b35aee3f", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "created": "2020-02-29T02:27:02+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:357b883b-2fe9-e7d5-2744-15001fcd2c70" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:c09a6ded-c5b9-5397-17da-7236420cc5ed", "resource": { "resourceType": "ExplanationOfBenefit", "id": "c09a6ded-c5b9-5397-17da-7236420cc5ed", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "4a5134e8-70b9-2008-7be5-5b95b35aee3f" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-02-29T02:27:02+01:00", "end": "2021-02-28T02:27:02+01:00" }, "created": "2020-02-29T02:27:02+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:4a5134e8-70b9-2008-7be5-5b95b35aee3f" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:99c9fd44-351f-c240-2d8d-4523b9d97d98", "resource": { "resourceType": "MedicationRequest", "id": "99c9fd44-351f-c240-2d8d-4523b9d97d98", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "authoredOn": "2020-02-29T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:a3bd8f3c-6b4d-f93a-0abc-f27ff8bf31f3", "resource": { "resourceType": "Claim", "id": "a3bd8f3c-6b4d-f93a-0abc-f27ff8bf31f3", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "created": "2020-02-29T02:27:02+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:99c9fd44-351f-c240-2d8d-4523b9d97d98" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:ebea61f8-5739-fee2-f032-de4bc98f3622", "resource": { "resourceType": "ExplanationOfBenefit", "id": "ebea61f8-5739-fee2-f032-de4bc98f3622", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a3bd8f3c-6b4d-f93a-0abc-f27ff8bf31f3" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-02-29T02:27:02+01:00", "end": "2021-02-28T02:27:02+01:00" }, "created": "2020-02-29T02:27:02+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:a3bd8f3c-6b4d-f93a-0abc-f27ff8bf31f3" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:fd762946-951d-c9a0-dc10-29480fc828d2", "resource": { "resourceType": "MedicationRequest", "id": "fd762946-951d-c9a0-dc10-29480fc828d2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "authoredOn": "2020-02-29T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:90d391b9-ed9b-d8d2-76be-0d598f537423", "resource": { "resourceType": "Claim", "id": "90d391b9-ed9b-d8d2-76be-0d598f537423", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "created": "2020-02-29T02:27:02+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:fd762946-951d-c9a0-dc10-29480fc828d2" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:12d9ebdc-e102-a8f1-31ee-c87236d2aa03", "resource": { "resourceType": "ExplanationOfBenefit", "id": "12d9ebdc-e102-a8f1-31ee-c87236d2aa03", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "90d391b9-ed9b-d8d2-76be-0d598f537423" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-02-29T02:27:02+01:00", "end": "2021-02-28T02:27:02+01:00" }, "created": "2020-02-29T02:27:02+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:90d391b9-ed9b-d8d2-76be-0d598f537423" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:afeaa37d-6277-c88b-b8d7-bb113c8e99cb", "resource": { "resourceType": "Immunization", "id": "afeaa37d-6277-c88b-b8d7-bb113c8e99cb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "occurrenceDateTime": "2020-02-29T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:9fcbd698-c0b3-020e-c6f5-d1be69a56775", "resource": { "resourceType": "DiagnosticReport", "id": "9fcbd698-c0b3-020e-c6f5-d1be69a56775", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T02:43:47+01:00", "issued": "2020-02-29T02:43:47.492+01:00", "result": [ { "reference": "urn:uuid:0210639d-27d0-926e-7bdb-638e74daea77", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1bfe92c2-5c60-fc43-7782-3443a47891d6", "resource": { "resourceType": "DiagnosticReport", "id": "1bfe92c2-5c60-fc43-7782-3443a47891d6", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T03:21:18+01:00", "issued": "2020-02-29T03:21:18.492+01:00", "result": [ { "reference": "urn:uuid:7477ec8b-5357-2138-02dc-1cc6f0fe11de", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:65d24843-8f53-0385-20c9-304412a05482", "resource": { "resourceType": "DiagnosticReport", "id": "65d24843-8f53-0385-20c9-304412a05482", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, "effectiveDateTime": "2020-02-29T01:33:04+01:00", "issued": "2020-02-29T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:937896fb-dfec-f3e7-fe00-7cd3972cf801", "resource": { "resourceType": "DocumentReference", "id": "937896fb-dfec-f3e7-fe00-7cd3972cf801", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:65d24843-8f53-0385-20c9-304412a05482" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2020-02-29T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" } ], "period": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:69a8452b-7de4-8275-fa28-2d11d9b42cae", "resource": { "resourceType": "Claim", "id": "69a8452b-7de4-8275-fa28-2d11d9b42cae", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "created": "2020-02-29T02:27:02+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:afeaa37d-6277-c88b-b8d7-bb113c8e99cb" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:87e77d89-7dfa-4ae8-18df-973190e372f8" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:c0e0f010-8fd7-dc95-bfc7-4b1d4fb0bd0d" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:aa60a7d0-ce1e-23ea-86fb-e2a9b2ac8e18" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:c7e943a6-e738-9f50-1dc2-12630edc32d1" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:2259f9da-d4b2-1624-4baa-4bad3b0b5a73" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 564.42, "currency": "USD" } }, { "sequence": 4, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 5, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1268.62, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:893e0ba1-4c5c-9de8-6bd9-9e4b065cc02c", "resource": { "resourceType": "ExplanationOfBenefit", "id": "893e0ba1-4c5c-9de8-6bd9-9e4b065cc02c", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "69a8452b-7de4-8275-fa28-2d11d9b42cae" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-02-29T02:27:02+01:00", "end": "2021-02-28T02:27:02+01:00" }, "created": "2020-02-29T02:27:02+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:69a8452b-7de4-8275-fa28-2d11d9b42cae" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 564.42, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 112.884, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 451.536, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 564.42, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 564.42, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2020-02-29T01:33:04+01:00", "end": "2020-02-29T02:27:02+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1268.62, "currency": "USD" } } ], "payment": { "amount": { "value": 2060.1440000000002, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:1369856a-43a2-3ec4-2079-10528f6dc2a9", "resource": { "resourceType": "Encounter", "id": "1369856a-43a2-3ec4-2079-10528f6dc2a9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "1369856a-43a2-3ec4-2079-10528f6dc2a9" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "EMER" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "183478001", "display": "Emergency hospital admission for asthma" } ], "text": "Emergency hospital admission for asthma" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2020-07-01T02:33:04+02:00", "end": "2020-07-01T03:33:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } } ], "period": { "start": "2020-07-01T02:33:04+02:00", "end": "2020-07-01T03:33:04+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "195967001", "display": "Asthma" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:f1d57916-e0fc-52b4-8c77-728cd6cc53bb", "resource": { "resourceType": "DiagnosticReport", "id": "f1d57916-e0fc-52b4-8c77-728cd6cc53bb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:1369856a-43a2-3ec4-2079-10528f6dc2a9" }, "effectiveDateTime": "2020-07-01T02:33:04+02:00", "issued": "2020-07-01T02:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjAtMDctMDEKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMjQgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIHNldmVyZSBhbnhpZXR5IChwYW5pYykgKGZpbmRpbmcpLCB3aGlwbGFzaCBpbmp1cnkgdG8gbmVjaywgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCBwZXJlbm5pYWwgYWxsZXJnaWMgcmhpbml0aXMgd2l0aCBzZWFzb25hbCB2YXJpYXRpb24sIHZpY3RpbSBvZiBpbnRpbWF0ZSBwYXJ0bmVyIGFidXNlIChmaW5kaW5nKSwgY2hpbGRob29kIGFzdGhtYSwgaW5qdXJ5IG9mIG5lY2sgKGRpc29yZGVyKSwgcGFydC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBub3QgaW4gbGFib3IgZm9yY2UgKGZpbmRpbmcpLCBzaW51c2l0aXMgKGRpc29yZGVyKSwgZnVsbC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBzdHJlc3MgKGZpbmRpbmcpLCBwYXRpZW50IHRyYW5zZmVyIHRvIHNraWxsZWQgbnVyc2luZyBmYWNpbGl0eSAocHJvY2VkdXJlKSwgc29jaWFsIGlzb2xhdGlvbiAoZmluZGluZykuCgojIFNvY2lhbCBIaXN0b3J5CiBQYXRpZW50IGhhcyBuZXZlciBzbW9rZWQuCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KIFBhdGllbnQgaGFzIGEgaGlnaCBzY2hvb2wgZWR1Y2F0aW9uLgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCmJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uOyBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXTsgaWJ1cHJvZmVuIDQwMCBtZyBvcmFsIHRhYmxldCBbaWJ1XTsgaWJ1cHJvZmVuIDIwMCBtZyBvcmFsIHRhYmxldAoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgoK" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:835ab0c5-64a0-5229-0362-e59a746c0198", "resource": { "resourceType": "DocumentReference", "id": "835ab0c5-64a0-5229-0362-e59a746c0198", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:f1d57916-e0fc-52b4-8c77-728cd6cc53bb" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2020-07-01T02:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594", "display": "Dr. Jesenia223 Bednar518" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:1369856a-43a2-3ec4-2079-10528f6dc2a9" } ], "period": { "start": "2020-07-01T02:33:04+02:00", "end": "2020-07-01T03:33:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:25daed95-31f6-f22c-806c-4500f2f211c2", "resource": { "resourceType": "Claim", "id": "25daed95-31f6-f22c-806c-4500f2f211c2", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2020-07-01T02:33:04+02:00", "end": "2020-07-01T03:33:04+02:00" }, "created": "2020-07-01T03:33:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|bdaa3017-130e-34e9-b3ac-ca6d992e8b50", "display": "PENACOOK PLACE, INC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "183478001", "display": "Emergency hospital admission for asthma" } ], "text": "Emergency hospital admission for asthma" }, "encounter": [ { "reference": "urn:uuid:1369856a-43a2-3ec4-2079-10528f6dc2a9" } ] } ], "total": { "value": 146.18, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:3973a638-b7bd-a44f-c62b-b9c60b31a493", "resource": { "resourceType": "ExplanationOfBenefit", "id": "3973a638-b7bd-a44f-c62b-b9c60b31a493", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "25daed95-31f6-f22c-806c-4500f2f211c2" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-07-01T03:33:04+02:00", "end": "2021-07-01T03:33:04+02:00" }, "created": "2020-07-01T03:33:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|0c4f23e7-9558-3969-8dfe-1c2d509c47fa", "display": "PENACOOK PLACE, INC" }, "claim": { "reference": "urn:uuid:25daed95-31f6-f22c-806c-4500f2f211c2" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999888594" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "183478001", "display": "Emergency hospital admission for asthma" } ], "text": "Emergency hospital admission for asthma" }, "servicedPeriod": { "start": "2020-07-01T02:33:04+02:00", "end": "2020-07-01T03:33:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:1369856a-43a2-3ec4-2079-10528f6dc2a9" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 146.18, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:6d6e4680-c5d6-0fdf-d32d-ccd5657ef338", "resource": { "resourceType": "Encounter", "id": "6d6e4680-c5d6-0fdf-d32d-ccd5657ef338", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "6d6e4680-c5d6-0fdf-d32d-ccd5657ef338" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2020-07-02T15:33:04+02:00", "end": "2020-07-02T15:48:04+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2020-07-02T15:33:04+02:00", "end": "2020-07-02T15:48:04+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "195967001", "display": "Asthma" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:4e2d7b41-8035-c962-fd9b-fb49b50ad92d", "resource": { "resourceType": "DiagnosticReport", "id": "4e2d7b41-8035-c962-fd9b-fb49b50ad92d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:6d6e4680-c5d6-0fdf-d32d-ccd5657ef338" }, "effectiveDateTime": "2020-07-02T15:33:04+02:00", "issued": "2020-07-02T15:33:04.492+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:6411cf47-98cf-e319-0c90-2cc30cd024c0", "resource": { "resourceType": "DocumentReference", "id": "6411cf47-98cf-e319-0c90-2cc30cd024c0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:4e2d7b41-8035-c962-fd9b-fb49b50ad92d" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2020-07-02T15:33:04.492+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:6d6e4680-c5d6-0fdf-d32d-ccd5657ef338" } ], "period": { "start": "2020-07-02T15:33:04+02:00", "end": "2020-07-02T15:48:04+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:0d19af8e-a09b-bc57-a620-0469359b594b", "resource": { "resourceType": "Claim", "id": "0d19af8e-a09b-bc57-a620-0469359b594b", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2020-07-02T15:33:04+02:00", "end": "2020-07-02T15:48:04+02:00" }, "created": "2020-07-02T15:48:04+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" }, "encounter": [ { "reference": "urn:uuid:6d6e4680-c5d6-0fdf-d32d-ccd5657ef338" } ] } ], "total": { "value": 142.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:fdecd42c-ce96-faf6-c85b-5435602ff986", "resource": { "resourceType": "ExplanationOfBenefit", "id": "fdecd42c-ce96-faf6-c85b-5435602ff986", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0d19af8e-a09b-bc57-a620-0469359b594b" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-07-02T15:48:04+02:00", "end": "2021-07-02T15:48:04+02:00" }, "created": "2020-07-02T15:48:04+02:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:0d19af8e-a09b-bc57-a620-0469359b594b" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" }, "servicedPeriod": { "start": "2020-07-02T15:33:04+02:00", "end": "2020-07-02T15:48:04+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:6d6e4680-c5d6-0fdf-d32d-ccd5657ef338" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 142.58, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f", "resource": { "resourceType": "Encounter", "id": "f908638a-2545-089c-b441-c16d2954778f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "f908638a-2545-089c-b441-c16d2954778f" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up (procedure)" } ], "text": "Encounter for check up (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:962eb106-b5fa-6240-42b0-05a3759a99f3", "resource": { "resourceType": "Condition", "id": "962eb106-b5fa-6240-42b0-05a3759a99f3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "onsetDateTime": "2020-12-26T01:33:04+01:00", "abatementDateTime": "2020-12-26T01:33:04+01:00", "recordedDate": "2020-12-26T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:a97201ad-8302-3640-5cfc-5714070f3cd9", "resource": { "resourceType": "Condition", "id": "a97201ad-8302-3640-5cfc-5714070f3cd9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "onsetDateTime": "2020-12-26T02:17:11+01:00", "abatementDateTime": "2021-03-06T02:10:15+01:00", "recordedDate": "2020-12-26T02:17:11+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:5dfc4a8a-bf83-7777-0689-3e8f7733fa15", "resource": { "resourceType": "Condition", "id": "5dfc4a8a-bf83-7777-0689-3e8f7733fa15", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "onsetDateTime": "2020-12-26T02:17:11+01:00", "abatementDateTime": "2023-03-18T02:25:18+01:00", "recordedDate": "2020-12-26T02:17:11+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:3770d0f9-e3d5-06a9-5146-17f122327ae5", "resource": { "resourceType": "Condition", "id": "3770d0f9-e3d5-06a9-5146-17f122327ae5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "424393004", "display": "Reports of violence in the environment (finding)" } ], "text": "Reports of violence in the environment (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "onsetDateTime": "2020-12-26T02:17:11+01:00", "abatementDateTime": "2021-03-06T02:10:15+01:00", "recordedDate": "2020-12-26T02:17:11+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:1c33236e-5ca6-67d6-ef75-4b539a9eb1ba", "resource": { "resourceType": "Condition", "id": "1c33236e-5ca6-67d6-ef75-4b539a9eb1ba", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "706893006", "display": "Victim of intimate partner abuse (finding)" } ], "text": "Victim of intimate partner abuse (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "onsetDateTime": "2020-12-26T02:17:11+01:00", "abatementDateTime": "2021-03-06T02:10:15+01:00", "recordedDate": "2020-12-26T02:17:11+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:07f97c3e-a182-3d11-5b22-4935ea4ec5cd", "resource": { "resourceType": "Observation", "id": "07f97c3e-a182-3d11-5b22-4935ea4ec5cd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T01:33:04+01:00", "issued": "2020-12-26T01:33:04.492+01:00", "valueQuantity": { "value": 168.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7f3b1031-f4d2-7598-7e03-7c7e0ae2a89a", "resource": { "resourceType": "Observation", "id": "7f3b1031-f4d2-7598-7e03-7c7e0ae2a89a", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T01:33:04+01:00", "issued": "2020-12-26T01:33:04.492+01:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ae0dde5f-33e4-7c7b-9274-b8228534c321", "resource": { "resourceType": "Observation", "id": "ae0dde5f-33e4-7c7b-9274-b8228534c321", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T01:33:04+01:00", "issued": "2020-12-26T01:33:04.492+01:00", "valueQuantity": { "value": 84, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8a1e872d-7ce1-c189-eb43-ff3935dc4702", "resource": { "resourceType": "Observation", "id": "8a1e872d-7ce1-c189-eb43-ff3935dc4702", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T01:33:04+01:00", "issued": "2020-12-26T01:33:04.492+01:00", "valueQuantity": { "value": 29.48, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:28c3085c-ec86-5e64-28e4-76637aaa6967", "resource": { "resourceType": "Observation", "id": "28c3085c-ec86-5e64-28e4-76637aaa6967", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T01:33:04+01:00", "issued": "2020-12-26T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 79, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 149, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d4c09bd9-a444-badd-558e-36eb659e9083", "resource": { "resourceType": "Observation", "id": "d4c09bd9-a444-badd-558e-36eb659e9083", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T01:33:04+01:00", "issued": "2020-12-26T01:33:04.492+01:00", "valueQuantity": { "value": 74, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d95204c3-156e-abd9-a255-63a3f464f1f8", "resource": { "resourceType": "Observation", "id": "d95204c3-156e-abd9-a255-63a3f464f1f8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T01:33:04+01:00", "issued": "2020-12-26T01:33:04.492+01:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b1c6ebc5-6876-2209-436d-e547b6d67ab1", "resource": { "resourceType": "Observation", "id": "b1c6ebc5-6876-2209-436d-e547b6d67ab1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T01:33:04+01:00", "issued": "2020-12-26T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:fef38f45-4037-0e73-440a-d0cf411eaaa5", "resource": { "resourceType": "Observation", "id": "fef38f45-4037-0e73-440a-d0cf411eaaa5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T02:17:11+01:00", "issued": "2020-12-26T02:17:11.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13909-9", "display": "Somewhat" } ], "text": "Somewhat" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30131-9", "display": "3 to 5 times a week" } ], "text": "3 to 5 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30138-4", "display": "Part-time or temporary work" } ], "text": "Part-time or temporary work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1527dd30-2763-91db-ae8c-f8ff9cfcc77c", "resource": { "resourceType": "Observation", "id": "1527dd30-2763-91db-ae8c-f8ff9cfcc77c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "70274-6", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ], "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T02:41:38+01:00", "issued": "2020-12-26T02:41:38.492+01:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5a1d0005-28fc-9bab-2755-3b5a2515174d", "resource": { "resourceType": "Observation", "id": "5a1d0005-28fc-9bab-2755-3b5a2515174d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "76504-0", "display": "Total score [HARK]" } ], "text": "Total score [HARK]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T03:19:51+01:00", "issued": "2020-12-26T03:19:51.492+01:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:50580aa2-c37c-9c40-3bca-accca9981a17", "resource": { "resourceType": "Observation", "id": "50580aa2-c37c-9c40-3bca-accca9981a17", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "75626-2", "display": "Total score [AUDIT-C]" } ], "text": "Total score [AUDIT-C]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T03:58:25+01:00", "issued": "2020-12-26T03:58:25.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b1dfa601-91d8-ee1a-e64e-688adcaad842", "resource": { "resourceType": "Procedure", "id": "b1dfa601-91d8-ee1a-e64e-688adcaad842", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "performedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T01:48:04+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1b80080d-f387-4974-0776-135738953003", "resource": { "resourceType": "Procedure", "id": "1b80080d-f387-4974-0776-135738953003", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "performedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:4e32382e-ea4b-96a4-505e-321ad5dd5eb3", "resource": { "resourceType": "Procedure", "id": "4e32382e-ea4b-96a4-505e-321ad5dd5eb3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "performedPeriod": { "start": "2020-12-26T02:17:11+01:00", "end": "2020-12-26T02:41:38+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:ff001806-4da0-6e04-6fe9-7948cde021fb", "resource": { "resourceType": "Procedure", "id": "ff001806-4da0-6e04-6fe9-7948cde021fb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "performedPeriod": { "start": "2020-12-26T02:41:38+01:00", "end": "2020-12-26T03:19:51+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:8cb1ff76-7f4e-cc51-25a4-3c3d789523a0", "resource": { "resourceType": "Procedure", "id": "8cb1ff76-7f4e-cc51-25a4-3c3d789523a0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "performedPeriod": { "start": "2020-12-26T03:19:51+01:00", "end": "2020-12-26T03:33:57+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:721e320a-91d8-32ab-bd8c-1b2e6a144c5f", "resource": { "resourceType": "Procedure", "id": "721e320a-91d8-32ab-bd8c-1b2e6a144c5f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "performedPeriod": { "start": "2020-12-26T03:33:57+01:00", "end": "2020-12-26T03:58:25+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:8d5af50e-9a29-2b37-6b7e-8746548ca692", "resource": { "resourceType": "MedicationRequest", "id": "8d5af50e-9a29-2b37-6b7e-8746548ca692", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "authoredOn": "2020-12-26T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:ae73450c-ea11-588b-ff3c-e51060c5036c", "resource": { "resourceType": "Claim", "id": "ae73450c-ea11-588b-ff3c-e51060c5036c", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "created": "2020-12-26T02:17:11+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:8d5af50e-9a29-2b37-6b7e-8746548ca692" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:41f1073b-cf34-d764-4415-a6472b1f7304", "resource": { "resourceType": "ExplanationOfBenefit", "id": "41f1073b-cf34-d764-4415-a6472b1f7304", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "ae73450c-ea11-588b-ff3c-e51060c5036c" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-12-26T02:17:11+01:00", "end": "2021-12-26T02:17:11+01:00" }, "created": "2020-12-26T02:17:11+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:ae73450c-ea11-588b-ff3c-e51060c5036c" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d8997fb2-90a3-f86f-199f-eb78e33ff006", "resource": { "resourceType": "MedicationRequest", "id": "d8997fb2-90a3-f86f-199f-eb78e33ff006", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "authoredOn": "2020-12-26T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:900bba31-16ad-ba55-dd67-af43d1d35c24", "resource": { "resourceType": "Claim", "id": "900bba31-16ad-ba55-dd67-af43d1d35c24", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "created": "2020-12-26T02:17:11+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:d8997fb2-90a3-f86f-199f-eb78e33ff006" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:fef6fe26-5a5e-aa9b-48e7-b3e50418aabe", "resource": { "resourceType": "ExplanationOfBenefit", "id": "fef6fe26-5a5e-aa9b-48e7-b3e50418aabe", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "900bba31-16ad-ba55-dd67-af43d1d35c24" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-12-26T02:17:11+01:00", "end": "2021-12-26T02:17:11+01:00" }, "created": "2020-12-26T02:17:11+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:900bba31-16ad-ba55-dd67-af43d1d35c24" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:959381da-cd5f-39c5-d711-e1bbb381e0c7", "resource": { "resourceType": "MedicationRequest", "id": "959381da-cd5f-39c5-d711-e1bbb381e0c7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "authoredOn": "2020-12-26T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:c2751408-9d8e-a270-cfa6-a53fca4fd456", "resource": { "resourceType": "Claim", "id": "c2751408-9d8e-a270-cfa6-a53fca4fd456", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "created": "2020-12-26T02:17:11+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:959381da-cd5f-39c5-d711-e1bbb381e0c7" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e02ed9ea-95f7-4926-0d9e-845915ffdba3", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e02ed9ea-95f7-4926-0d9e-845915ffdba3", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c2751408-9d8e-a270-cfa6-a53fca4fd456" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-12-26T02:17:11+01:00", "end": "2021-12-26T02:17:11+01:00" }, "created": "2020-12-26T02:17:11+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:c2751408-9d8e-a270-cfa6-a53fca4fd456" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:1a8518d8-9bc3-45fc-1bf2-9e9648cb8989", "resource": { "resourceType": "Immunization", "id": "1a8518d8-9bc3-45fc-1bf2-9e9648cb8989", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "occurrenceDateTime": "2020-12-26T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:7870817c-9230-6e84-f33b-a25a5daf0b6d", "resource": { "resourceType": "DiagnosticReport", "id": "7870817c-9230-6e84-f33b-a25a5daf0b6d", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T02:41:38+01:00", "issued": "2020-12-26T02:41:38.492+01:00", "result": [ { "reference": "urn:uuid:1527dd30-2763-91db-ae8c-f8ff9cfcc77c", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:83efc565-62e5-310e-0ee7-4f69c5949623", "resource": { "resourceType": "DiagnosticReport", "id": "83efc565-62e5-310e-0ee7-4f69c5949623", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T03:19:51+01:00", "issued": "2020-12-26T03:19:51.492+01:00", "result": [ { "reference": "urn:uuid:5a1d0005-28fc-9bab-2755-3b5a2515174d", "display": "Total score [HARK]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:737c268b-a91c-b4f4-3229-ccce35aec9d5", "resource": { "resourceType": "DiagnosticReport", "id": "737c268b-a91c-b4f4-3229-ccce35aec9d5", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T03:58:25+01:00", "issued": "2020-12-26T03:58:25.492+01:00", "result": [ { "reference": "urn:uuid:50580aa2-c37c-9c40-3bca-accca9981a17", "display": "Total score [AUDIT-C]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:13b6497f-b568-d78a-15c3-7ec3a854b32a", "resource": { "resourceType": "DiagnosticReport", "id": "13b6497f-b568-d78a-15c3-7ec3a854b32a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, "effectiveDateTime": "2020-12-26T01:33:04+01:00", "issued": "2020-12-26T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:7c19e3cc-0839-6f5a-db76-e3dc71e38ef1", "resource": { "resourceType": "DocumentReference", "id": "7c19e3cc-0839-6f5a-db76-e3dc71e38ef1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:13b6497f-b568-d78a-15c3-7ec3a854b32a" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2020-12-26T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjAtMTItMjYKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMjUgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIHNldmVyZSBhbnhpZXR5IChwYW5pYykgKGZpbmRpbmcpLCB3aGlwbGFzaCBpbmp1cnkgdG8gbmVjaywgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCBwZXJlbm5pYWwgYWxsZXJnaWMgcmhpbml0aXMgd2l0aCBzZWFzb25hbCB2YXJpYXRpb24sIHZpY3RpbSBvZiBpbnRpbWF0ZSBwYXJ0bmVyIGFidXNlIChmaW5kaW5nKSwgY2hpbGRob29kIGFzdGhtYSwgaW5qdXJ5IG9mIG5lY2sgKGRpc29yZGVyKSwgcGFydC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBub3QgaW4gbGFib3IgZm9yY2UgKGZpbmRpbmcpLCBzaW51c2l0aXMgKGRpc29yZGVyKSwgZnVsbC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBzdHJlc3MgKGZpbmRpbmcpLCBwYXRpZW50IHRyYW5zZmVyIHRvIHNraWxsZWQgbnVyc2luZyBmYWNpbGl0eSAocHJvY2VkdXJlKSwgc29jaWFsIGlzb2xhdGlvbiAoZmluZGluZykuCgojIFNvY2lhbCBIaXN0b3J5CiBQYXRpZW50IGhhcyBuZXZlciBzbW9rZWQuCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KIFBhdGllbnQgaGFzIGEgaGlnaCBzY2hvb2wgZWR1Y2F0aW9uLgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCmJ1ZGVzb25pZGUgMC4xMjUgbWcvbWwgaW5oYWxhdGlvbiBzdXNwZW5zaW9uOyBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXTsgaWJ1cHJvZmVuIDQwMCBtZyBvcmFsIHRhYmxldCBbaWJ1XTsgaWJ1cHJvZmVuIDIwMCBtZyBvcmFsIHRhYmxldAoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuClBhdGllbnQgaXMgcHJlc2VudGluZyB3aXRoIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKSwgcGFydC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBzdHJlc3MgKGZpbmRpbmcpLCByZXBvcnRzIG9mIHZpb2xlbmNlIGluIHRoZSBlbnZpcm9ubWVudCAoZmluZGluZyksIHZpY3RpbSBvZiBpbnRpbWF0ZSBwYXJ0bmVyIGFidXNlIChmaW5kaW5nKS4gCgojIyBQbGFuClBhdGllbnQgd2FzIGdpdmVuIHRoZSBmb2xsb3dpbmcgaW1tdW5pemF0aW9uczogaW5mbHVlbnphLCBzZWFzb25hbCwgaW5qZWN0YWJsZSwgcHJlc2VydmF0aXZlIGZyZWUuIApUaGUgZm9sbG93aW5nIHByb2NlZHVyZXMgd2VyZSBjb25kdWN0ZWQ6Ci0gbWVkaWNhdGlvbiByZWNvbmNpbGlhdGlvbiAocHJvY2VkdXJlKQotIGFzc2Vzc21lbnQgb2YgaGVhbHRoIGFuZCBzb2NpYWwgY2FyZSBuZWVkcyAocHJvY2VkdXJlKQotIGFzc2Vzc21lbnQgb2YgYW54aWV0eSAocHJvY2VkdXJlKQotIHNjcmVlbmluZyBmb3IgZG9tZXN0aWMgYWJ1c2UgKHByb2NlZHVyZSkKLSBhc3Nlc3NtZW50IG9mIHN1YnN0YW5jZSB1c2UgKHByb2NlZHVyZSkKLSBhc3Nlc3NtZW50IHVzaW5nIGFsY29ob2wgdXNlIGRpc29yZGVycyBpZGVudGlmaWNhdGlvbiB0ZXN0IC0gY29uc3VtcHRpb24gKHByb2NlZHVyZSkKVGhlIHBhdGllbnQgd2FzIHByZXNjcmliZWQgdGhlIGZvbGxvd2luZyBtZWRpY2F0aW9uczoKLSBuZGEwMjA5ODMgMjAwIGFjdHVhdCBhbGJ1dGVyb2wgMC4wOSBtZy9hY3R1YXQgbWV0ZXJlZCBkb3NlIGluaGFsZXIgW3ZlbnRvbGluXQotIGlidXByb2ZlbiA0MDAgbWcgb3JhbCB0YWJsZXQgW2lidV0KLSBidWRlc29uaWRlIDAuMTI1IG1nL21sIGluaGFsYXRpb24gc3VzcGVuc2lvbgo=" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" } ], "period": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:24ecae3a-eb60-56b0-1efa-a1bd20d86d6a", "resource": { "resourceType": "Claim", "id": "24ecae3a-eb60-56b0-1efa-a1bd20d86d6a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "created": "2020-12-26T02:17:11+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:1a8518d8-9bc3-45fc-1bf2-9e9648cb8989" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:962eb106-b5fa-6240-42b0-05a3759a99f3" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:a97201ad-8302-3640-5cfc-5714070f3cd9" } }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:5dfc4a8a-bf83-7777-0689-3e8f7733fa15" } }, { "sequence": 4, "diagnosisReference": { "reference": "urn:uuid:3770d0f9-e3d5-06a9-5146-17f122327ae5" } }, { "sequence": 5, "diagnosisReference": { "reference": "urn:uuid:1c33236e-5ca6-67d6-ef75-4b539a9eb1ba" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:b1dfa601-91d8-ee1a-e64e-688adcaad842" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:1b80080d-f387-4974-0776-135738953003" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:4e32382e-ea4b-96a4-505e-321ad5dd5eb3" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:ff001806-4da0-6e04-6fe9-7948cde021fb" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:8cb1ff76-7f4e-cc51-25a4-3c3d789523a0" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:721e320a-91d8-32ab-bd8c-1b2e6a144c5f" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up (procedure)" } ], "text": "Encounter for check up (procedure)" }, "encounter": [ { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 4, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 434.53, "currency": "USD" } }, { "sequence": 5, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 6, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" } }, { "sequence": 7, "diagnosisSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" } }, { "sequence": 8, "diagnosisSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "424393004", "display": "Reports of violence in the environment (finding)" } ], "text": "Reports of violence in the environment (finding)" } }, { "sequence": 9, "diagnosisSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "706893006", "display": "Victim of intimate partner abuse (finding)" } ], "text": "Victim of intimate partner abuse (finding)" } }, { "sequence": 10, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 12, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 13, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 14, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 15, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 16, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1087.48, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:16946256-d2df-4d64-21f0-4cf272e17203", "resource": { "resourceType": "ExplanationOfBenefit", "id": "16946256-d2df-4d64-21f0-4cf272e17203", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "24ecae3a-eb60-56b0-1efa-a1bd20d86d6a" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2020-12-26T02:17:11+01:00", "end": "2021-12-26T02:17:11+01:00" }, "created": "2020-12-26T02:17:11+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:24ecae3a-eb60-56b0-1efa-a1bd20d86d6a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:962eb106-b5fa-6240-42b0-05a3759a99f3" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:a97201ad-8302-3640-5cfc-5714070f3cd9" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:5dfc4a8a-bf83-7777-0689-3e8f7733fa15" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 4, "diagnosisReference": { "reference": "urn:uuid:3770d0f9-e3d5-06a9-5146-17f122327ae5" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 5, "diagnosisReference": { "reference": "urn:uuid:1c33236e-5ca6-67d6-ef75-4b539a9eb1ba" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185349003", "display": "Encounter for check up (procedure)" } ], "text": "Encounter for check up (procedure)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 434.53, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.906, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 347.624, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 434.53, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 434.53, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 7, "diagnosisSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 8, "diagnosisSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "424393004", "display": "Reports of violence in the environment (finding)" } ], "text": "Reports of violence in the environment (finding)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 9, "diagnosisSequence": [ 5 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "706893006", "display": "Victim of intimate partner abuse (finding)" } ], "text": "Victim of intimate partner abuse (finding)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 13, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 14, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 15, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 16, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "servicedPeriod": { "start": "2020-12-26T01:33:04+01:00", "end": "2020-12-26T02:17:11+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1087.48, "currency": "USD" } } ], "payment": { "amount": { "value": 2361.0160000000005, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca", "resource": { "resourceType": "Encounter", "id": "61fd76f9-5466-a529-e935-9c585d8453ca", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "61fd76f9-5466-a529-e935-9c585d8453ca" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-01-02T01:33:04+01:00", "end": "2021-01-02T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2021-01-02T01:33:04+01:00", "end": "2021-01-02T01:48:04+01:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "10509002", "display": "Acute bronchitis (disorder)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:749cd557-5b36-60d1-397b-8a10700529cf", "resource": { "resourceType": "Condition", "id": "749cd557-5b36-60d1-397b-8a10700529cf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "10509002", "display": "Acute bronchitis (disorder)" } ], "text": "Acute bronchitis (disorder)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" }, "onsetDateTime": "2021-01-02T01:33:04+01:00", "abatementDateTime": "2021-01-17T01:40:30+01:00", "recordedDate": "2021-01-02T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:332ee232-aa2b-7a5a-33e4-5401fe989c97", "resource": { "resourceType": "Procedure", "id": "332ee232-aa2b-7a5a-33e4-5401fe989c97", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "269911007", "display": "Sputum examination (procedure)" } ], "text": "Sputum examination (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" }, "performedPeriod": { "start": "2021-01-02T01:33:04+01:00", "end": "2021-01-02T01:40:30+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "reasonReference": [ { "reference": "urn:uuid:749cd557-5b36-60d1-397b-8a10700529cf", "display": "Acute bronchitis (disorder)" } ] }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1feb0d76-986c-0762-c786-4c51718c4700", "resource": { "resourceType": "MedicationRequest", "id": "1feb0d76-986c-0762-c786-4c51718c4700", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "313782", "display": "Acetaminophen 325 MG Oral Tablet" } ], "text": "Acetaminophen 325 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" }, "authoredOn": "2021-01-02T01:40:30+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" }, "reasonReference": [ { "reference": "urn:uuid:749cd557-5b36-60d1-397b-8a10700529cf", "display": "Acute bronchitis (disorder)" } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:0bc1d2f6-8bcf-c66d-f1a5-c8700b92a67a", "resource": { "resourceType": "Claim", "id": "0bc1d2f6-8bcf-c66d-f1a5-c8700b92a67a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-01-02T01:33:04+01:00", "end": "2021-01-02T01:48:04+01:00" }, "created": "2021-01-02T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:1feb0d76-986c-0762-c786-4c51718c4700" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "313782", "display": "Acetaminophen 325 MG Oral Tablet" } ], "text": "Acetaminophen 325 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" } ] } ], "total": { "value": 126.40, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:fd2f93f6-cc18-1c62-2239-f87f39751c74", "resource": { "resourceType": "ExplanationOfBenefit", "id": "fd2f93f6-cc18-1c62-2239-f87f39751c74", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0bc1d2f6-8bcf-c66d-f1a5-c8700b92a67a" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-01-02T01:48:04+01:00", "end": "2022-01-02T01:48:04+01:00" }, "created": "2021-01-02T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:0bc1d2f6-8bcf-c66d-f1a5-c8700b92a67a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "313782", "display": "Acetaminophen 325 MG Oral Tablet" } ], "text": "Acetaminophen 325 MG Oral Tablet" }, "servicedPeriod": { "start": "2021-01-02T01:33:04+01:00", "end": "2021-01-02T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 126.40, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:1888d809-5cac-550e-0089-6131afd09875", "resource": { "resourceType": "CareTeam", "id": "1888d809-5cac-550e-0089-6131afd09875", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ] }, "status": "inactive", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" }, "period": { "start": "2021-01-02T01:40:30+01:00", "end": "2021-03-06T01:33:04+01:00" }, "participant": [ { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "116154003", "display": "Patient" } ], "text": "Patient" } ], "member": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "223366009", "display": "Healthcare professional (occupation)" } ], "text": "Healthcare professional (occupation)" } ], "member": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } }, { "role": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "224891009", "display": "Healthcare services (qualifier value)" } ], "text": "Healthcare services (qualifier value)" } ], "member": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } } ], "managingOrganization": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } ] }, "request": { "method": "POST", "url": "CareTeam" } }, { "fullUrl": "urn:uuid:da449352-4a9c-2181-8848-9bbe4ba18c65", "resource": { "resourceType": "CarePlan", "id": "da449352-4a9c-2181-8848-9bbe4ba18c65", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ] }, "text": { "status": "generated", "div": "
Care Plan for Respiratory therapy.
Activities:
" }, "status": "completed", "intent": "order", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category", "code": "assess-plan" } ] }, { "coding": [ { "system": "http://snomed.info/sct", "code": "53950000", "display": "Respiratory therapy" } ], "text": "Respiratory therapy" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" }, "period": { "start": "2021-01-02T01:40:30+01:00", "end": "2021-03-06T01:33:04+01:00" }, "careTeam": [ { "reference": "urn:uuid:1888d809-5cac-550e-0089-6131afd09875" } ], "activity": [ { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "304510005", "display": "Recommendation to avoid exercise" } ], "text": "Recommendation to avoid exercise" }, "status": "completed", "location": { "display": "WP ACQUISITION SUB LLC" } } }, { "detail": { "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "371605008", "display": "Deep breathing and coughing exercises" } ], "text": "Deep breathing and coughing exercises" }, "status": "completed", "location": { "display": "WP ACQUISITION SUB LLC" } } } ] }, "request": { "method": "POST", "url": "CarePlan" } }, { "fullUrl": "urn:uuid:93b454c7-9534-ef49-3c32-b243093530f0", "resource": { "resourceType": "DiagnosticReport", "id": "93b454c7-9534-ef49-3c32-b243093530f0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" }, "effectiveDateTime": "2021-01-02T01:33:04+01:00", "issued": "2021-01-02T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjEtMDEtMDIKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMjUgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIHNldmVyZSBhbnhpZXR5IChwYW5pYykgKGZpbmRpbmcpLCB3aGlwbGFzaCBpbmp1cnkgdG8gbmVjaywgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCBwZXJlbm5pYWwgYWxsZXJnaWMgcmhpbml0aXMgd2l0aCBzZWFzb25hbCB2YXJpYXRpb24sIHZpY3RpbSBvZiBpbnRpbWF0ZSBwYXJ0bmVyIGFidXNlIChmaW5kaW5nKSwgY2hpbGRob29kIGFzdGhtYSwgaW5qdXJ5IG9mIG5lY2sgKGRpc29yZGVyKSwgcGFydC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBub3QgaW4gbGFib3IgZm9yY2UgKGZpbmRpbmcpLCBzaW51c2l0aXMgKGRpc29yZGVyKSwgcmVwb3J0cyBvZiB2aW9sZW5jZSBpbiB0aGUgZW52aXJvbm1lbnQgKGZpbmRpbmcpLCBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIHN0cmVzcyAoZmluZGluZyksIHBhdGllbnQgdHJhbnNmZXIgdG8gc2tpbGxlZCBudXJzaW5nIGZhY2lsaXR5IChwcm9jZWR1cmUpLCBzb2NpYWwgaXNvbGF0aW9uIChmaW5kaW5nKS4KCiMgU29jaWFsIEhpc3RvcnkKIFBhdGllbnQgaGFzIG5ldmVyIHNtb2tlZC4KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuCgpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgogUGF0aWVudCBoYXMgYSBoaWdoIHNjaG9vbCBlZHVjYXRpb24uClBhdGllbnQgY3VycmVudGx5IGhhcyBNZWRpY2FyZS4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKYnVkZXNvbmlkZSAwLjEyNSBtZy9tbCBpbmhhbGF0aW9uIHN1c3BlbnNpb247IG5kYTAyMDk4MyAyMDAgYWN0dWF0IGFsYnV0ZXJvbCAwLjA5IG1nL2FjdHVhdCBtZXRlcmVkIGRvc2UgaW5oYWxlciBbdmVudG9saW5dOyBpYnVwcm9mZW4gNDAwIG1nIG9yYWwgdGFibGV0IFtpYnVdOyBpYnVwcm9mZW4gMjAwIG1nIG9yYWwgdGFibGV0CgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KUGF0aWVudCBpcyBwcmVzZW50aW5nIHdpdGggYWN1dGUgYnJvbmNoaXRpcyAoZGlzb3JkZXIpLiAKCiMjIFBsYW4KClRoZSBmb2xsb3dpbmcgcHJvY2VkdXJlcyB3ZXJlIGNvbmR1Y3RlZDoKLSBzcHV0dW0gZXhhbWluYXRpb24gKHByb2NlZHVyZSkKVGhlIHBhdGllbnQgd2FzIHByZXNjcmliZWQgdGhlIGZvbGxvd2luZyBtZWRpY2F0aW9uczoKLSBhY2V0YW1pbm9waGVuIDMyNSBtZyBvcmFsIHRhYmxldApUaGUgcGF0aWVudCB3YXMgcGxhY2VkIG9uIGEgY2FyZXBsYW46Ci0gcmVzcGlyYXRvcnkgdGhlcmFweQo=" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:d1e4ca4b-d88c-d77e-d3f1-ff8fcb78b31e", "resource": { "resourceType": "DocumentReference", "id": "d1e4ca4b-d88c-d77e-d3f1-ff8fcb78b31e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:93b454c7-9534-ef49-3c32-b243093530f0" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2021-01-02T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjEtMDEtMDIKCiMgQ2hpZWYgQ29tcGxhaW50Ci0gU2hvcnRuZXNzIG9mIEJyZWF0aAoKCiMgSGlzdG9yeSBvZiBQcmVzZW50IElsbG5lc3MKRmxvcmVudGlubzgKIGlzIGEgMjUgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIHNldmVyZSBhbnhpZXR5IChwYW5pYykgKGZpbmRpbmcpLCB3aGlwbGFzaCBpbmp1cnkgdG8gbmVjaywgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCBwZXJlbm5pYWwgYWxsZXJnaWMgcmhpbml0aXMgd2l0aCBzZWFzb25hbCB2YXJpYXRpb24sIHZpY3RpbSBvZiBpbnRpbWF0ZSBwYXJ0bmVyIGFidXNlIChmaW5kaW5nKSwgY2hpbGRob29kIGFzdGhtYSwgaW5qdXJ5IG9mIG5lY2sgKGRpc29yZGVyKSwgcGFydC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBub3QgaW4gbGFib3IgZm9yY2UgKGZpbmRpbmcpLCBzaW51c2l0aXMgKGRpc29yZGVyKSwgcmVwb3J0cyBvZiB2aW9sZW5jZSBpbiB0aGUgZW52aXJvbm1lbnQgKGZpbmRpbmcpLCBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIHN0cmVzcyAoZmluZGluZyksIHBhdGllbnQgdHJhbnNmZXIgdG8gc2tpbGxlZCBudXJzaW5nIGZhY2lsaXR5IChwcm9jZWR1cmUpLCBzb2NpYWwgaXNvbGF0aW9uIChmaW5kaW5nKS4KCiMgU29jaWFsIEhpc3RvcnkKIFBhdGllbnQgaGFzIG5ldmVyIHNtb2tlZC4KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuCgpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgogUGF0aWVudCBoYXMgYSBoaWdoIHNjaG9vbCBlZHVjYXRpb24uClBhdGllbnQgY3VycmVudGx5IGhhcyBNZWRpY2FyZS4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKYnVkZXNvbmlkZSAwLjEyNSBtZy9tbCBpbmhhbGF0aW9uIHN1c3BlbnNpb247IG5kYTAyMDk4MyAyMDAgYWN0dWF0IGFsYnV0ZXJvbCAwLjA5IG1nL2FjdHVhdCBtZXRlcmVkIGRvc2UgaW5oYWxlciBbdmVudG9saW5dOyBpYnVwcm9mZW4gNDAwIG1nIG9yYWwgdGFibGV0IFtpYnVdOyBpYnVwcm9mZW4gMjAwIG1nIG9yYWwgdGFibGV0CgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KUGF0aWVudCBpcyBwcmVzZW50aW5nIHdpdGggYWN1dGUgYnJvbmNoaXRpcyAoZGlzb3JkZXIpLiAKCiMjIFBsYW4KClRoZSBmb2xsb3dpbmcgcHJvY2VkdXJlcyB3ZXJlIGNvbmR1Y3RlZDoKLSBzcHV0dW0gZXhhbWluYXRpb24gKHByb2NlZHVyZSkKVGhlIHBhdGllbnQgd2FzIHByZXNjcmliZWQgdGhlIGZvbGxvd2luZyBtZWRpY2F0aW9uczoKLSBhY2V0YW1pbm9waGVuIDMyNSBtZyBvcmFsIHRhYmxldApUaGUgcGF0aWVudCB3YXMgcGxhY2VkIG9uIGEgY2FyZXBsYW46Ci0gcmVzcGlyYXRvcnkgdGhlcmFweQo=" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" } ], "period": { "start": "2021-01-02T01:33:04+01:00", "end": "2021-01-02T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:e8ab27ef-664b-4f65-392a-5b91e23475f4", "resource": { "resourceType": "Claim", "id": "e8ab27ef-664b-4f65-392a-5b91e23475f4", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2021-01-02T01:33:04+01:00", "end": "2021-01-02T01:48:04+01:00" }, "created": "2021-01-02T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:749cd557-5b36-60d1-397b-8a10700529cf" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:332ee232-aa2b-7a5a-33e4-5401fe989c97" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "encounter": [ { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "10509002", "display": "Acute bronchitis (disorder)" } ], "text": "Acute bronchitis (disorder)" } }, { "sequence": 3, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "269911007", "display": "Sputum examination (procedure)" } ], "text": "Sputum examination (procedure)" }, "net": { "value": 5669.59, "currency": "USD" } } ], "total": { "value": 5755.14, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:c9385af1-c2a8-7734-db89-0103d7fe4735", "resource": { "resourceType": "ExplanationOfBenefit", "id": "c9385af1-c2a8-7734-db89-0103d7fe4735", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e8ab27ef-664b-4f65-392a-5b91e23475f4" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-01-02T01:48:04+01:00", "end": "2022-01-02T01:48:04+01:00" }, "created": "2021-01-02T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:e8ab27ef-664b-4f65-392a-5b91e23475f4" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:749cd557-5b36-60d1-397b-8a10700529cf" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "servicedPeriod": { "start": "2021-01-02T01:33:04+01:00", "end": "2021-01-02T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "10509002", "display": "Acute bronchitis (disorder)" } ], "text": "Acute bronchitis (disorder)" }, "servicedPeriod": { "start": "2021-01-02T01:33:04+01:00", "end": "2021-01-02T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "269911007", "display": "Sputum examination (procedure)" } ], "text": "Sputum examination (procedure)" }, "servicedPeriod": { "start": "2021-01-02T01:33:04+01:00", "end": "2021-01-02T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 5669.59, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 1133.9180000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 4535.6720000000005, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 5669.59, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 5669.59, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 5755.14, "currency": "USD" } } ], "payment": { "amount": { "value": 4535.6720000000005, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:abdaaf5d-7779-2d8e-0661-eb1f35834035", "resource": { "resourceType": "Encounter", "id": "abdaaf5d-7779-2d8e-0661-eb1f35834035", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "abdaaf5d-7779-2d8e-0661-eb1f35834035" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-02-13T01:33:04+01:00", "end": "2021-02-13T01:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2021-02-13T01:33:04+01:00", "end": "2021-02-13T01:48:04+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:5c5adfa1-beea-b8e6-2482-28ed48c3ead2", "resource": { "resourceType": "Immunization", "id": "5c5adfa1-beea-b8e6-2482-28ed48c3ead2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:abdaaf5d-7779-2d8e-0661-eb1f35834035" }, "occurrenceDateTime": "2021-02-13T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:d656853c-2c97-72b8-4000-a4d38bf472c9", "resource": { "resourceType": "DiagnosticReport", "id": "d656853c-2c97-72b8-4000-a4d38bf472c9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:abdaaf5d-7779-2d8e-0661-eb1f35834035" }, "effectiveDateTime": "2021-02-13T01:33:04+01:00", "issued": "2021-02-13T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1e824da2-1fb7-5b0e-0682-d0ef70b41605", "resource": { "resourceType": "DocumentReference", "id": "1e824da2-1fb7-5b0e-0682-d0ef70b41605", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:d656853c-2c97-72b8-4000-a4d38bf472c9" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2021-02-13T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:abdaaf5d-7779-2d8e-0661-eb1f35834035" } ], "period": { "start": "2021-02-13T01:33:04+01:00", "end": "2021-02-13T01:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:af6ba6e1-7c69-37e2-bbf9-7e9dca62a882", "resource": { "resourceType": "Claim", "id": "af6ba6e1-7c69-37e2-bbf9-7e9dca62a882", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2021-02-13T01:33:04+01:00", "end": "2021-02-13T01:48:04+01:00" }, "created": "2021-02-13T01:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:5c5adfa1-beea-b8e6-2482-28ed48c3ead2" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" }, "encounter": [ { "reference": "urn:uuid:abdaaf5d-7779-2d8e-0661-eb1f35834035" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "net": { "value": 136.00, "currency": "USD" } } ], "total": { "value": 278.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:54e5a534-e6c0-efd4-0a39-19352b56c9ef", "resource": { "resourceType": "ExplanationOfBenefit", "id": "54e5a534-e6c0-efd4-0a39-19352b56c9ef", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "af6ba6e1-7c69-37e2-bbf9-7e9dca62a882" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-02-13T01:48:04+01:00", "end": "2022-02-13T01:48:04+01:00" }, "created": "2021-02-13T01:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:af6ba6e1-7c69-37e2-bbf9-7e9dca62a882" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" }, "servicedPeriod": { "start": "2021-02-13T01:33:04+01:00", "end": "2021-02-13T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:abdaaf5d-7779-2d8e-0661-eb1f35834035" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "servicedPeriod": { "start": "2021-02-13T01:33:04+01:00", "end": "2021-02-13T01:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 278.58, "currency": "USD" } } ], "payment": { "amount": { "value": 108.80000000000001, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c", "resource": { "resourceType": "Encounter", "id": "ef1540db-535c-49c8-0182-ed5e0bb91d1c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "ef1540db-535c-49c8-0182-ed5e0bb91d1c" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:ee25c205-0c7c-19c2-5d40-1a5c0eb4e009", "resource": { "resourceType": "Condition", "id": "ee25c205-0c7c-19c2-5d40-1a5c0eb4e009", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "onsetDateTime": "2021-03-06T01:33:04+01:00", "recordedDate": "2021-03-06T01:33:04+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:311c1777-84f1-09c5-3d77-1e7c8a5344b1", "resource": { "resourceType": "Condition", "id": "311c1777-84f1-09c5-3d77-1e7c8a5344b1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "onsetDateTime": "2021-03-06T02:10:15+01:00", "abatementDateTime": "2022-03-12T02:28:35+01:00", "recordedDate": "2021-03-06T02:10:15+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:3a566639-60cf-46ca-52f7-583687d28093", "resource": { "resourceType": "Condition", "id": "3a566639-60cf-46ca-52f7-583687d28093", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "423315002", "display": "Limited social contact (finding)" } ], "text": "Limited social contact (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "onsetDateTime": "2021-03-06T02:10:15+01:00", "abatementDateTime": "2022-03-12T02:28:35+01:00", "recordedDate": "2021-03-06T02:10:15+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:d995ec8a-475b-956d-e71d-fc16a04bee63", "resource": { "resourceType": "Observation", "id": "d995ec8a-475b-956d-e71d-fc16a04bee63", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T01:33:04+01:00", "issued": "2021-03-06T01:33:04.492+01:00", "valueQuantity": { "value": 168.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f4e73c65-448c-f04d-d10b-95368856c89a", "resource": { "resourceType": "Observation", "id": "f4e73c65-448c-f04d-d10b-95368856c89a", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T01:33:04+01:00", "issued": "2021-03-06T01:33:04.492+01:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:36617b71-402c-8cdc-c0ba-3f46c0fe6edd", "resource": { "resourceType": "Observation", "id": "36617b71-402c-8cdc-c0ba-3f46c0fe6edd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T01:33:04+01:00", "issued": "2021-03-06T01:33:04.492+01:00", "valueQuantity": { "value": 84, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f9197a54-65a8-9a12-b100-7012235ae6a9", "resource": { "resourceType": "Observation", "id": "f9197a54-65a8-9a12-b100-7012235ae6a9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T01:33:04+01:00", "issued": "2021-03-06T01:33:04.492+01:00", "valueQuantity": { "value": 29.48, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:33614996-3b2f-0131-ea4e-2b3a1756cdf4", "resource": { "resourceType": "Observation", "id": "33614996-3b2f-0131-ea4e-2b3a1756cdf4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T01:33:04+01:00", "issued": "2021-03-06T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 84, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 149, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:30d45a53-b960-c588-1002-158fcf020a0c", "resource": { "resourceType": "Observation", "id": "30d45a53-b960-c588-1002-158fcf020a0c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T01:33:04+01:00", "issued": "2021-03-06T01:33:04.492+01:00", "valueQuantity": { "value": 88, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1ee2fe11-839e-7257-26ce-6994ccc6ed49", "resource": { "resourceType": "Observation", "id": "1ee2fe11-839e-7257-26ce-6994ccc6ed49", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T01:33:04+01:00", "issued": "2021-03-06T01:33:04.492+01:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5cf53cf7-1b73-ba13-dab1-35990e0c47d5", "resource": { "resourceType": "Observation", "id": "5cf53cf7-1b73-ba13-dab1-35990e0c47d5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T01:33:04+01:00", "issued": "2021-03-06T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2451100e-7708-f465-8e1b-423426b953c5", "resource": { "resourceType": "Observation", "id": "2451100e-7708-f465-8e1b-423426b953c5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T02:10:15+01:00", "issued": "2021-03-06T02:10:15.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13863-8", "display": "A little bit" } ], "text": "A little bit" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30130-1", "display": "1 or 2 times a week" } ], "text": "1 or 2 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30136-8", "display": "Full-time work" } ], "text": "Full-time work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:06c6f32a-605f-3c32-6d95-8e8f6a31c43e", "resource": { "resourceType": "Observation", "id": "06c6f32a-605f-3c32-6d95-8e8f6a31c43e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "70274-6", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ], "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T02:34:01+01:00", "issued": "2021-03-06T02:34:01.492+01:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:207c5758-f7fb-64bb-ad08-5c1b8cad073d", "resource": { "resourceType": "Observation", "id": "207c5758-f7fb-64bb-ad08-5c1b8cad073d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "76504-0", "display": "Total score [HARK]" } ], "text": "Total score [HARK]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T03:18:59+01:00", "issued": "2021-03-06T03:18:59.492+01:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8d0e761a-f096-d521-9c7c-dc85ef1e063c", "resource": { "resourceType": "Observation", "id": "8d0e761a-f096-d521-9c7c-dc85ef1e063c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T04:03:16+01:00", "issued": "2021-03-06T04:03:16.492+01:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f9400a96-018f-b18c-f299-9a390a18a8e5", "resource": { "resourceType": "Observation", "id": "f9400a96-018f-b18c-f299-9a390a18a8e5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82667-7", "display": "Total score [DAST-10]" } ], "text": "Total score [DAST-10]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T04:39:57+01:00", "issued": "2021-03-06T04:39:57.492+01:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:07d66ebc-2372-534f-c1d3-d78a4b432838", "resource": { "resourceType": "Procedure", "id": "07d66ebc-2372-534f-c1d3-d78a4b432838", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "performedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:04819aa0-7acf-f965-fd58-8eb63ea00a85", "resource": { "resourceType": "Procedure", "id": "04819aa0-7acf-f965-fd58-8eb63ea00a85", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "performedPeriod": { "start": "2021-03-06T02:10:15+01:00", "end": "2021-03-06T02:34:01+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b9b5d4a0-564f-d337-743a-dc31ed801cda", "resource": { "resourceType": "Procedure", "id": "b9b5d4a0-564f-d337-743a-dc31ed801cda", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "performedPeriod": { "start": "2021-03-06T02:34:01+01:00", "end": "2021-03-06T03:18:59+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b1c41449-9108-b319-5203-30e8c920b9e5", "resource": { "resourceType": "Procedure", "id": "b1c41449-9108-b319-5203-30e8c920b9e5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "performedPeriod": { "start": "2021-03-06T03:18:59+01:00", "end": "2021-03-06T03:33:56+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:07af9256-dc75-6110-7a6c-69aa7d7430ee", "resource": { "resourceType": "Procedure", "id": "07af9256-dc75-6110-7a6c-69aa7d7430ee", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "performedPeriod": { "start": "2021-03-06T03:33:56+01:00", "end": "2021-03-06T04:03:16+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c093c4a9-7855-a550-45c8-35abc5833799", "resource": { "resourceType": "Procedure", "id": "c093c4a9-7855-a550-45c8-35abc5833799", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "performedPeriod": { "start": "2021-03-06T04:03:16+01:00", "end": "2021-03-06T04:17:14+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:670168b4-41ed-9849-9ba6-629208a944d7", "resource": { "resourceType": "Procedure", "id": "670168b4-41ed-9849-9ba6-629208a944d7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "performedPeriod": { "start": "2021-03-06T04:17:14+01:00", "end": "2021-03-06T04:39:57+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0fe4a769-4465-e94e-563b-2c25ec08cbec", "resource": { "resourceType": "MedicationRequest", "id": "0fe4a769-4465-e94e-563b-2c25ec08cbec", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "authoredOn": "2021-03-06T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:43c97dad-3235-801b-421c-d98a3aba7a27", "resource": { "resourceType": "Claim", "id": "43c97dad-3235-801b-421c-d98a3aba7a27", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "created": "2021-03-06T02:10:15+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:0fe4a769-4465-e94e-563b-2c25ec08cbec" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:385f30d3-1908-0e20-0860-432de29f4376", "resource": { "resourceType": "ExplanationOfBenefit", "id": "385f30d3-1908-0e20-0860-432de29f4376", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "43c97dad-3235-801b-421c-d98a3aba7a27" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-03-06T02:10:15+01:00", "end": "2022-03-06T02:10:15+01:00" }, "created": "2021-03-06T02:10:15+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:43c97dad-3235-801b-421c-d98a3aba7a27" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:7239b113-bf51-395b-dee6-184c8b4a5a32", "resource": { "resourceType": "MedicationRequest", "id": "7239b113-bf51-395b-dee6-184c8b4a5a32", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "authoredOn": "2021-03-06T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:3012010d-d372-d350-3e53-43c97c7798e6", "resource": { "resourceType": "Claim", "id": "3012010d-d372-d350-3e53-43c97c7798e6", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "created": "2021-03-06T02:10:15+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:7239b113-bf51-395b-dee6-184c8b4a5a32" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:7d77c721-4daf-4cb8-d6aa-adcb07af6f03", "resource": { "resourceType": "ExplanationOfBenefit", "id": "7d77c721-4daf-4cb8-d6aa-adcb07af6f03", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "3012010d-d372-d350-3e53-43c97c7798e6" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-03-06T02:10:15+01:00", "end": "2022-03-06T02:10:15+01:00" }, "created": "2021-03-06T02:10:15+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:3012010d-d372-d350-3e53-43c97c7798e6" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3068cc68-0181-ae74-6bf4-b9123ba6f50a", "resource": { "resourceType": "MedicationRequest", "id": "3068cc68-0181-ae74-6bf4-b9123ba6f50a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "authoredOn": "2021-03-06T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:0712a1de-1459-5475-aab3-ebb4751647f7", "resource": { "resourceType": "Claim", "id": "0712a1de-1459-5475-aab3-ebb4751647f7", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "created": "2021-03-06T02:10:15+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:3068cc68-0181-ae74-6bf4-b9123ba6f50a" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:bf3b1bc8-c592-502f-e186-74fbac3c0a2f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "bf3b1bc8-c592-502f-e186-74fbac3c0a2f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0712a1de-1459-5475-aab3-ebb4751647f7" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-03-06T02:10:15+01:00", "end": "2022-03-06T02:10:15+01:00" }, "created": "2021-03-06T02:10:15+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:0712a1de-1459-5475-aab3-ebb4751647f7" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:eb3d9d25-1694-04f7-0c4d-8ba39eadef0d", "resource": { "resourceType": "Immunization", "id": "eb3d9d25-1694-04f7-0c4d-8ba39eadef0d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "occurrenceDateTime": "2021-03-06T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:d74fd47a-79c8-2999-594e-8a157e989ed5", "resource": { "resourceType": "DiagnosticReport", "id": "d74fd47a-79c8-2999-594e-8a157e989ed5", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T02:34:01+01:00", "issued": "2021-03-06T02:34:01.492+01:00", "result": [ { "reference": "urn:uuid:06c6f32a-605f-3c32-6d95-8e8f6a31c43e", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:a2617817-1631-32fb-5671-fbc605fa15fd", "resource": { "resourceType": "DiagnosticReport", "id": "a2617817-1631-32fb-5671-fbc605fa15fd", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T03:18:59+01:00", "issued": "2021-03-06T03:18:59.492+01:00", "result": [ { "reference": "urn:uuid:207c5758-f7fb-64bb-ad08-5c1b8cad073d", "display": "Total score [HARK]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:68d010fc-96a4-e9e0-599c-db612b40a282", "resource": { "resourceType": "DiagnosticReport", "id": "68d010fc-96a4-e9e0-599c-db612b40a282", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T04:03:16+01:00", "issued": "2021-03-06T04:03:16.492+01:00", "result": [ { "reference": "urn:uuid:8d0e761a-f096-d521-9c7c-dc85ef1e063c", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:42389d7f-453b-e192-22b6-290db24f17e4", "resource": { "resourceType": "DiagnosticReport", "id": "42389d7f-453b-e192-22b6-290db24f17e4", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T04:39:57+01:00", "issued": "2021-03-06T04:39:57.492+01:00", "result": [ { "reference": "urn:uuid:f9400a96-018f-b18c-f299-9a390a18a8e5", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:508560e7-e3ab-f1b1-49fb-56b7e4b28c53", "resource": { "resourceType": "DiagnosticReport", "id": "508560e7-e3ab-f1b1-49fb-56b7e4b28c53", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, "effectiveDateTime": "2021-03-06T01:33:04+01:00", "issued": "2021-03-06T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:74c4435b-c62c-6e44-a999-5327759aee4c", "resource": { "resourceType": "DocumentReference", "id": "74c4435b-c62c-6e44-a999-5327759aee4c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:508560e7-e3ab-f1b1-49fb-56b7e4b28c53" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2021-03-06T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" } ], "period": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:4c79f852-0bd4-382a-cc70-70ecaff4c65f", "resource": { "resourceType": "Claim", "id": "4c79f852-0bd4-382a-cc70-70ecaff4c65f", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "created": "2021-03-06T02:10:15+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:eb3d9d25-1694-04f7-0c4d-8ba39eadef0d" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:ee25c205-0c7c-19c2-5d40-1a5c0eb4e009" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:311c1777-84f1-09c5-3d77-1e7c8a5344b1" } }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:3a566639-60cf-46ca-52f7-583687d28093" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:07d66ebc-2372-534f-c1d3-d78a4b432838" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:04819aa0-7acf-f965-fd58-8eb63ea00a85" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:b9b5d4a0-564f-d337-743a-dc31ed801cda" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:b1c41449-9108-b319-5203-30e8c920b9e5" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:07af9256-dc75-6110-7a6c-69aa7d7430ee" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:c093c4a9-7855-a550-45c8-35abc5833799" } }, { "sequence": 7, "procedureReference": { "reference": "urn:uuid:670168b4-41ed-9849-9ba6-629208a944d7" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 4, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 5, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" } }, { "sequence": 6, "diagnosisSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "423315002", "display": "Limited social contact (finding)" } ], "text": "Limited social contact (finding)" } }, { "sequence": 7, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 9, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 13, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 14, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 15, "procedureSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 16, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 704.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:b4a49562-3ca0-8375-c6ff-5ef971f65376", "resource": { "resourceType": "ExplanationOfBenefit", "id": "b4a49562-3ca0-8375-c6ff-5ef971f65376", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "4c79f852-0bd4-382a-cc70-70ecaff4c65f" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2021-03-06T02:10:15+01:00", "end": "2022-03-06T02:10:15+01:00" }, "created": "2021-03-06T02:10:15+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:4c79f852-0bd4-382a-cc70-70ecaff4c65f" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:ee25c205-0c7c-19c2-5d40-1a5c0eb4e009" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:311c1777-84f1-09c5-3d77-1e7c8a5344b1" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:3a566639-60cf-46ca-52f7-583687d28093" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "208", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 6, "diagnosisSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "423315002", "display": "Limited social contact (finding)" } ], "text": "Limited social contact (finding)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 13, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 14, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 15, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 16, "informationSequence": [ 5 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "servicedPeriod": { "start": "2021-03-06T01:33:04+01:00", "end": "2021-03-06T02:10:15+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 704.20, "currency": "USD" } } ], "payment": { "amount": { "value": 2763.2960000000003, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9", "resource": { "resourceType": "Encounter", "id": "21000445-b3b3-ac87-958c-514c5c9592d9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "21000445-b3b3-ac87-958c-514c5c9592d9" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:4a8e1c25-01fd-c809-f376-956dfacd0956", "resource": { "resourceType": "Condition", "id": "4a8e1c25-01fd-c809-f376-956dfacd0956", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "onsetDateTime": "2022-03-12T02:28:35+01:00", "abatementDateTime": "2023-03-18T02:25:18+01:00", "recordedDate": "2022-03-12T02:28:35+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:199dba72-dffe-c3e6-6cd0-3bfe903668a9", "resource": { "resourceType": "Observation", "id": "199dba72-dffe-c3e6-6cd0-3bfe903668a9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 168.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3ae202cd-65bc-9241-8db8-102ce420e596", "resource": { "resourceType": "Observation", "id": "3ae202cd-65bc-9241-8db8-102ce420e596", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:202e1aa8-a641-ad73-520e-534ef50554a2", "resource": { "resourceType": "Observation", "id": "202e1aa8-a641-ad73-520e-534ef50554a2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 84.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7449ce9e-0321-4d18-abf4-e5842f7c0665", "resource": { "resourceType": "Observation", "id": "7449ce9e-0321-4d18-abf4-e5842f7c0665", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 29.53, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9f0c3f74-6f09-afc7-cd85-39a723607ddc", "resource": { "resourceType": "Observation", "id": "9f0c3f74-6f09-afc7-cd85-39a723607ddc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 83, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 154, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3935c3b4-aae1-da8c-afd0-01c6d00e034e", "resource": { "resourceType": "Observation", "id": "3935c3b4-aae1-da8c-afd0-01c6d00e034e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 66, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0cd69b55-77f6-602c-7b5c-7c9d17112b62", "resource": { "resourceType": "Observation", "id": "0cd69b55-77f6-602c-7b5c-7c9d17112b62", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 15, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:fd9aeb4c-3d00-a542-263c-2ecbd26e577e", "resource": { "resourceType": "Observation", "id": "fd9aeb4c-3d00-a542-263c-2ecbd26e577e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6690-2", "display": "Leukocytes [#/volume] in Blood by Automated count" } ], "text": "Leukocytes [#/volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 5.9687, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7e9b0c8b-45ac-f697-baa9-6b3d4fe71e82", "resource": { "resourceType": "Observation", "id": "7e9b0c8b-45ac-f697-baa9-6b3d4fe71e82", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "789-8", "display": "Erythrocytes [#/volume] in Blood by Automated count" } ], "text": "Erythrocytes [#/volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 4.5313, "unit": "10*6/uL", "system": "http://unitsofmeasure.org", "code": "10*6/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0daec45f-82ca-0c47-978a-659a17d52890", "resource": { "resourceType": "Observation", "id": "0daec45f-82ca-0c47-978a-659a17d52890", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "718-7", "display": "Hemoglobin [Mass/volume] in Blood" } ], "text": "Hemoglobin [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 13.441, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:67e27502-b02e-00eb-a570-6a68b1f9f57c", "resource": { "resourceType": "Observation", "id": "67e27502-b02e-00eb-a570-6a68b1f9f57c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4544-3", "display": "Hematocrit [Volume Fraction] of Blood by Automated count" } ], "text": "Hematocrit [Volume Fraction] of Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 36.861, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9bb1dbd5-6902-82c9-4072-46c7e26eb957", "resource": { "resourceType": "Observation", "id": "9bb1dbd5-6902-82c9-4072-46c7e26eb957", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "787-2", "display": "MCV [Entitic volume] by Automated count" } ], "text": "MCV [Entitic volume] by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 87.864, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:89c0b0b6-90f2-529f-5bd2-fd5da5e583a7", "resource": { "resourceType": "Observation", "id": "89c0b0b6-90f2-529f-5bd2-fd5da5e583a7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "785-6", "display": "MCH [Entitic mass] by Automated count" } ], "text": "MCH [Entitic mass] by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 27.058, "unit": "pg", "system": "http://unitsofmeasure.org", "code": "pg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8afb85ae-dd2e-eaf3-224e-0695c207e3e1", "resource": { "resourceType": "Observation", "id": "8afb85ae-dd2e-eaf3-224e-0695c207e3e1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "786-4", "display": "MCHC [Mass/volume] by Automated count" } ], "text": "MCHC [Mass/volume] by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 33.361, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:392d0c5a-bfc4-13f5-c37b-2a3b2ee96905", "resource": { "resourceType": "Observation", "id": "392d0c5a-bfc4-13f5-c37b-2a3b2ee96905", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "21000-5", "display": "Erythrocyte distribution width [Entitic volume] by Automated count" } ], "text": "Erythrocyte distribution width [Entitic volume] by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 40.795, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:de817ade-3f88-c74f-8a78-4f074eff2b6e", "resource": { "resourceType": "Observation", "id": "de817ade-3f88-c74f-8a78-4f074eff2b6e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "777-3", "display": "Platelets [#/volume] in Blood by Automated count" } ], "text": "Platelets [#/volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 436.68, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4bfcbc4c-49cb-6c79-0b7b-78cf1c43d728", "resource": { "resourceType": "Observation", "id": "4bfcbc4c-49cb-6c79-0b7b-78cf1c43d728", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "32207-3", "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" } ], "text": "Platelet distribution width [Entitic volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 150.53, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:395578c4-72e2-f16a-f28e-284ac8b5ba74", "resource": { "resourceType": "Observation", "id": "395578c4-72e2-f16a-f28e-284ac8b5ba74", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "32623-1", "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" } ], "text": "Platelet mean volume [Entitic volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueQuantity": { "value": 11.388, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:45d477a8-6ba3-ff45-3ab7-e68e0cb6e6b0", "resource": { "resourceType": "Observation", "id": "45d477a8-6ba3-ff45-3ab7-e68e0cb6e6b0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:61596278-009c-0263-12c5-6824d8d5b64f", "resource": { "resourceType": "Observation", "id": "61596278-009c-0263-12c5-6824d8d5b64f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T02:28:35+01:00", "issued": "2022-03-12T02:28:35.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13863-8", "display": "A little bit" } ], "text": "A little bit" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30132-7", "display": "5 or more times a week" } ], "text": "5 or more times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30138-4", "display": "Part-time or temporary work" } ], "text": "Part-time or temporary work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:eb78c37e-d423-dff9-9db5-0ad52c491de4", "resource": { "resourceType": "Observation", "id": "eb78c37e-d423-dff9-9db5-0ad52c491de4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T03:06:48+01:00", "issued": "2022-03-12T03:06:48.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:92f01777-c43e-14d2-6516-1e61eb2d6994", "resource": { "resourceType": "Observation", "id": "92f01777-c43e-14d2-6516-1e61eb2d6994", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82667-7", "display": "Total score [DAST-10]" } ], "text": "Total score [DAST-10]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T03:45:13+01:00", "issued": "2022-03-12T03:45:13.492+01:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0ef28b03-cdef-4da9-f184-356ce6acbfd2", "resource": { "resourceType": "Procedure", "id": "0ef28b03-cdef-4da9-f184-356ce6acbfd2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "performedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:4ed0d319-0907-6456-78e9-eec04587fc7d", "resource": { "resourceType": "Procedure", "id": "4ed0d319-0907-6456-78e9-eec04587fc7d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "performedPeriod": { "start": "2022-03-12T02:28:35+01:00", "end": "2022-03-12T02:39:15+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:127502cc-8cba-4d38-b942-717f25427104", "resource": { "resourceType": "Procedure", "id": "127502cc-8cba-4d38-b942-717f25427104", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "performedPeriod": { "start": "2022-03-12T02:39:15+01:00", "end": "2022-03-12T03:06:48+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:aa49407f-0f66-9844-6143-dae7ee9881ca", "resource": { "resourceType": "Procedure", "id": "aa49407f-0f66-9844-6143-dae7ee9881ca", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "performedPeriod": { "start": "2022-03-12T03:06:48+01:00", "end": "2022-03-12T03:19:55+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:24e647a9-fa29-9e3f-c42b-624b8dc2d493", "resource": { "resourceType": "Procedure", "id": "24e647a9-fa29-9e3f-c42b-624b8dc2d493", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "performedPeriod": { "start": "2022-03-12T03:19:55+01:00", "end": "2022-03-12T03:45:13+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:ac190e73-9d0f-7638-29b7-d0a3d0494048", "resource": { "resourceType": "MedicationRequest", "id": "ac190e73-9d0f-7638-29b7-d0a3d0494048", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "authoredOn": "2022-03-12T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:fea70d4e-1332-605f-d5e6-48a69d02c1ac", "resource": { "resourceType": "Claim", "id": "fea70d4e-1332-605f-d5e6-48a69d02c1ac", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "created": "2022-03-12T02:28:35+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:ac190e73-9d0f-7638-29b7-d0a3d0494048" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:9248d8ca-635f-6056-324a-fdf760030af2", "resource": { "resourceType": "ExplanationOfBenefit", "id": "9248d8ca-635f-6056-324a-fdf760030af2", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "fea70d4e-1332-605f-d5e6-48a69d02c1ac" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2022-03-12T02:28:35+01:00", "end": "2023-03-12T02:28:35+01:00" }, "created": "2022-03-12T02:28:35+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:fea70d4e-1332-605f-d5e6-48a69d02c1ac" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:bd0cb3ca-3b92-f1ba-b701-ee201211134c", "resource": { "resourceType": "MedicationRequest", "id": "bd0cb3ca-3b92-f1ba-b701-ee201211134c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "authoredOn": "2022-03-12T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:84af651f-d8e1-3320-3c3a-209483fbb5a4", "resource": { "resourceType": "Claim", "id": "84af651f-d8e1-3320-3c3a-209483fbb5a4", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "created": "2022-03-12T02:28:35+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:bd0cb3ca-3b92-f1ba-b701-ee201211134c" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:bc992670-4e5d-20c1-11f6-268177c505df", "resource": { "resourceType": "ExplanationOfBenefit", "id": "bc992670-4e5d-20c1-11f6-268177c505df", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "84af651f-d8e1-3320-3c3a-209483fbb5a4" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2022-03-12T02:28:35+01:00", "end": "2023-03-12T02:28:35+01:00" }, "created": "2022-03-12T02:28:35+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:84af651f-d8e1-3320-3c3a-209483fbb5a4" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:4ece19bf-dcdd-3fd9-82e8-a61f29d23af7", "resource": { "resourceType": "MedicationRequest", "id": "4ece19bf-dcdd-3fd9-82e8-a61f29d23af7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "stopped", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "authoredOn": "2022-03-12T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:77e59295-cec0-3196-522b-5a4e42ec9662", "resource": { "resourceType": "Claim", "id": "77e59295-cec0-3196-522b-5a4e42ec9662", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "created": "2022-03-12T02:28:35+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:4ece19bf-dcdd-3fd9-82e8-a61f29d23af7" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:233e34c9-30db-120e-0b3e-be147003fcb5", "resource": { "resourceType": "ExplanationOfBenefit", "id": "233e34c9-30db-120e-0b3e-be147003fcb5", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "77e59295-cec0-3196-522b-5a4e42ec9662" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2022-03-12T02:28:35+01:00", "end": "2023-03-12T02:28:35+01:00" }, "created": "2022-03-12T02:28:35+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:77e59295-cec0-3196-522b-5a4e42ec9662" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:e5f9500c-15c6-f332-6c0b-bcdf991c5dd2", "resource": { "resourceType": "Immunization", "id": "e5f9500c-15c6-f332-6c0b-bcdf991c5dd2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "occurrenceDateTime": "2022-03-12T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:f70a1dcf-4ee2-c278-9913-5fb5b09fe4bd", "resource": { "resourceType": "DiagnosticReport", "id": "f70a1dcf-4ee2-c278-9913-5fb5b09fe4bd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } ], "result": [ { "reference": "urn:uuid:fd9aeb4c-3d00-a542-263c-2ecbd26e577e", "display": "Leukocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:7e9b0c8b-45ac-f697-baa9-6b3d4fe71e82", "display": "Erythrocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:0daec45f-82ca-0c47-978a-659a17d52890", "display": "Hemoglobin [Mass/volume] in Blood" }, { "reference": "urn:uuid:67e27502-b02e-00eb-a570-6a68b1f9f57c", "display": "Hematocrit [Volume Fraction] of Blood by Automated count" }, { "reference": "urn:uuid:9bb1dbd5-6902-82c9-4072-46c7e26eb957", "display": "MCV [Entitic volume] by Automated count" }, { "reference": "urn:uuid:89c0b0b6-90f2-529f-5bd2-fd5da5e583a7", "display": "MCH [Entitic mass] by Automated count" }, { "reference": "urn:uuid:8afb85ae-dd2e-eaf3-224e-0695c207e3e1", "display": "MCHC [Mass/volume] by Automated count" }, { "reference": "urn:uuid:392d0c5a-bfc4-13f5-c37b-2a3b2ee96905", "display": "Erythrocyte distribution width [Entitic volume] by Automated count" }, { "reference": "urn:uuid:de817ade-3f88-c74f-8a78-4f074eff2b6e", "display": "Platelets [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:4bfcbc4c-49cb-6c79-0b7b-78cf1c43d728", "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" }, { "reference": "urn:uuid:395578c4-72e2-f16a-f28e-284ac8b5ba74", "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:4aafa301-c73f-5e27-df75-8e8d9ed65bbc", "resource": { "resourceType": "DiagnosticReport", "id": "4aafa301-c73f-5e27-df75-8e8d9ed65bbc", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T03:06:48+01:00", "issued": "2022-03-12T03:06:48.492+01:00", "result": [ { "reference": "urn:uuid:eb78c37e-d423-dff9-9db5-0ad52c491de4", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:09a2b164-ed87-4550-ece6-25d8803db4b5", "resource": { "resourceType": "DiagnosticReport", "id": "09a2b164-ed87-4550-ece6-25d8803db4b5", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T03:45:13+01:00", "issued": "2022-03-12T03:45:13.492+01:00", "result": [ { "reference": "urn:uuid:92f01777-c43e-14d2-6516-1e61eb2d6994", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:3231463a-e0f3-7e2c-ccd3-3fb0d6c37f32", "resource": { "resourceType": "DiagnosticReport", "id": "3231463a-e0f3-7e2c-ccd3-3fb0d6c37f32", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, "effectiveDateTime": "2022-03-12T01:33:04+01:00", "issued": "2022-03-12T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:caac76c8-4309-7229-4ab4-ab9d52d52198", "resource": { "resourceType": "DocumentReference", "id": "caac76c8-4309-7229-4ab4-ab9d52d52198", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:3231463a-e0f3-7e2c-ccd3-3fb0d6c37f32" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2022-03-12T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" } ], "period": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:e3dcf26e-7988-3126-69f6-311b9f251164", "resource": { "resourceType": "Claim", "id": "e3dcf26e-7988-3126-69f6-311b9f251164", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "created": "2022-03-12T02:28:35+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:e5f9500c-15c6-f332-6c0b-bcdf991c5dd2" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:4a8e1c25-01fd-c809-f376-956dfacd0956" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:0ef28b03-cdef-4da9-f184-356ce6acbfd2" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:4ed0d319-0907-6456-78e9-eec04587fc7d" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:127502cc-8cba-4d38-b942-717f25427104" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:aa49407f-0f66-9844-6143-dae7ee9881ca" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:24e647a9-fa29-9e3f-c42b-624b8dc2d493" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 4, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 5, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" } }, { "sequence": 6, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 9, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 778.78, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f095d77d-23cf-eedf-5f15-e011d7c27d8a", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f095d77d-23cf-eedf-5f15-e011d7c27d8a", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e3dcf26e-7988-3126-69f6-311b9f251164" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2022-03-12T02:28:35+01:00", "end": "2023-03-12T02:28:35+01:00" }, "created": "2022-03-12T02:28:35+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:e3dcf26e-7988-3126-69f6-311b9f251164" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:4a8e1c25-01fd-c809-f376-956dfacd0956" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160904001", "display": "Part-time employment (finding)" } ], "text": "Part-time employment (finding)" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "servicedPeriod": { "start": "2022-03-12T01:33:04+01:00", "end": "2022-03-12T02:28:35+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 778.78, "currency": "USD" } } ], "payment": { "amount": { "value": 2013.392, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:0424c435-5a87-8f14-149e-fd7c46a497ea", "resource": { "resourceType": "Encounter", "id": "0424c435-5a87-8f14-149e-fd7c46a497ea", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "0424c435-5a87-8f14-149e-fd7c46a497ea" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2022-12-19T14:33:04+01:00", "end": "2022-12-19T14:48:04+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } } ], "period": { "start": "2022-12-19T14:33:04+01:00", "end": "2022-12-19T14:48:04+01:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "195967001", "display": "Asthma" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:e0ef4c99-1356-38fc-20f3-67039b3c10b4", "resource": { "resourceType": "DiagnosticReport", "id": "e0ef4c99-1356-38fc-20f3-67039b3c10b4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:0424c435-5a87-8f14-149e-fd7c46a497ea" }, "effectiveDateTime": "2022-12-19T14:33:04+01:00", "issued": "2022-12-19T14:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1031557c-9d1c-a37e-3eef-0f7cbdeff7bd", "resource": { "resourceType": "DocumentReference", "id": "1031557c-9d1c-a37e-3eef-0f7cbdeff7bd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:e0ef4c99-1356-38fc-20f3-67039b3c10b4" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2022-12-19T14:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097", "display": "Dr. Leo278 Pacocha935" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:0424c435-5a87-8f14-149e-fd7c46a497ea" } ], "period": { "start": "2022-12-19T14:33:04+01:00", "end": "2022-12-19T14:48:04+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:d9161ea3-41e9-a8bd-1c05-e2c8df382b91", "resource": { "resourceType": "Claim", "id": "d9161ea3-41e9-a8bd-1c05-e2c8df382b91", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2022-12-19T14:33:04+01:00", "end": "2022-12-19T14:48:04+01:00" }, "created": "2022-12-19T14:48:04+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|6170552c-4d27-3e64-8068-64a380f1837d", "display": "WP ACQUISITION SUB LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" }, "encounter": [ { "reference": "urn:uuid:0424c435-5a87-8f14-149e-fd7c46a497ea" } ] } ], "total": { "value": 142.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:68ec2f12-bd22-c99a-d4b6-9d92c5b8e94f", "resource": { "resourceType": "ExplanationOfBenefit", "id": "68ec2f12-bd22-c99a-d4b6-9d92c5b8e94f", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "d9161ea3-41e9-a8bd-1c05-e2c8df382b91" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2022-12-19T14:48:04+01:00", "end": "2023-12-19T14:48:04+01:00" }, "created": "2022-12-19T14:48:04+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|2b33c37f-a97d-37be-bf95-0862b1be4a97", "display": "WP ACQUISITION SUB LLC" }, "claim": { "reference": "urn:uuid:d9161ea3-41e9-a8bd-1c05-e2c8df382b91" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999988097" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "394701000", "display": "Asthma follow-up" } ], "text": "Asthma follow-up" }, "servicedPeriod": { "start": "2022-12-19T14:33:04+01:00", "end": "2022-12-19T14:48:04+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:0424c435-5a87-8f14-149e-fd7c46a497ea" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 142.58, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db", "resource": { "resourceType": "Encounter", "id": "b6da441e-e46a-3cb9-ad45-1184fd2a68db", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "b6da441e-e46a-3cb9-ad45-1184fd2a68db" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Mr. Florentino8 Abshire638" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } } ], "period": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:c6572d4f-6c36-3329-9e0b-4e8fbff0c11f", "resource": { "resourceType": "Condition", "id": "c6572d4f-6c36-3329-9e0b-4e8fbff0c11f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "onsetDateTime": "2023-03-18T02:25:18+01:00", "recordedDate": "2023-03-18T02:25:18+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:652dce63-8bbb-aa8d-1b63-1306614c305f", "resource": { "resourceType": "Observation", "id": "652dce63-8bbb-aa8d-1b63-1306614c305f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8302-2", "display": "Body Height" } ], "text": "Body Height" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T01:33:04+01:00", "issued": "2023-03-18T01:33:04.492+01:00", "valueQuantity": { "value": 168.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:683bd7b1-f4b5-1baa-4b90-954ea720e138", "resource": { "resourceType": "Observation", "id": "683bd7b1-f4b5-1baa-4b90-954ea720e138", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T01:33:04+01:00", "issued": "2023-03-18T01:33:04.492+01:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:44a37c5d-71d4-adbe-2f0e-042b1e260f59", "resource": { "resourceType": "Observation", "id": "44a37c5d-71d4-adbe-2f0e-042b1e260f59", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29463-7", "display": "Body Weight" } ], "text": "Body Weight" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T01:33:04+01:00", "issued": "2023-03-18T01:33:04.492+01:00", "valueQuantity": { "value": 79.6, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ad2d2911-24ec-88e4-54eb-359d6b881ebd", "resource": { "resourceType": "Observation", "id": "ad2d2911-24ec-88e4-54eb-359d6b881ebd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T01:33:04+01:00", "issued": "2023-03-18T01:33:04.492+01:00", "valueQuantity": { "value": 27.92, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2ba136c4-11e3-c22b-ebf4-5a02585ccf7f", "resource": { "resourceType": "Observation", "id": "2ba136c4-11e3-c22b-ebf4-5a02585ccf7f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85354-9", "display": "Blood pressure panel with all children optional" } ], "text": "Blood pressure panel with all children optional" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T01:33:04+01:00", "issued": "2023-03-18T01:33:04.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 86, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 144, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cd9df49e-ba1c-60d7-a27d-bf7cab1971cd", "resource": { "resourceType": "Observation", "id": "cd9df49e-ba1c-60d7-a27d-bf7cab1971cd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T01:33:04+01:00", "issued": "2023-03-18T01:33:04.492+01:00", "valueQuantity": { "value": 93, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b23ae238-b1e5-35ab-c575-9cca26758f9f", "resource": { "resourceType": "Observation", "id": "b23ae238-b1e5-35ab-c575-9cca26758f9f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T01:33:04+01:00", "issued": "2023-03-18T01:33:04.492+01:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a722af60-a0bc-97fa-2d33-4af4c1e52c8c", "resource": { "resourceType": "Observation", "id": "a722af60-a0bc-97fa-2d33-4af4c1e52c8c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T01:33:04+01:00", "issued": "2023-03-18T01:33:04.492+01:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "266919005", "display": "Never smoked tobacco (finding)" } ], "text": "Never smoked tobacco (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:329b7d6e-0b5b-5482-9943-da78162c7950", "resource": { "resourceType": "Observation", "id": "329b7d6e-0b5b-5482-9943-da78162c7950", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T02:25:18+01:00", "issued": "2023-03-18T02:25:18.492+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30132-7", "display": "5 or more times a week" } ], "text": "5 or more times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 78873, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA15652-3", "display": "Medicare" } ], "text": "Medicare" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30136-8", "display": "Full-time work" } ], "text": "Full-time work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "942 Hansen Dam Apt 2" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 4, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:efaf2998-4891-cee4-b3bc-bfc9cf603192", "resource": { "resourceType": "Observation", "id": "efaf2998-4891-cee4-b3bc-bfc9cf603192", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "70274-6", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ], "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T02:49:40+01:00", "issued": "2023-03-18T02:49:40.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8d74b41d-9522-bf87-8ce9-20502abac3d8", "resource": { "resourceType": "Observation", "id": "8d74b41d-9522-bf87-8ce9-20502abac3d8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T03:25:25+01:00", "issued": "2023-03-18T03:25:25.492+01:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5791814f-f1c4-3a70-bf8c-1bb2d2254b26", "resource": { "resourceType": "Observation", "id": "5791814f-f1c4-3a70-bf8c-1bb2d2254b26", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82667-7", "display": "Total score [DAST-10]" } ], "text": "Total score [DAST-10]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T03:59:56+01:00", "issued": "2023-03-18T03:59:56.492+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4cf819f3-e7b9-a074-3192-cbc9a06be4e8", "resource": { "resourceType": "Procedure", "id": "4cf819f3-e7b9-a074-3192-cbc9a06be4e8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "performedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0e297e6b-92d6-d940-1a4e-30681cbf60bf", "resource": { "resourceType": "Procedure", "id": "0e297e6b-92d6-d940-1a4e-30681cbf60bf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "performedPeriod": { "start": "2023-03-18T02:25:18+01:00", "end": "2023-03-18T02:49:40+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:db84a27d-cd17-248b-087e-ef17cdfee0e7", "resource": { "resourceType": "Procedure", "id": "db84a27d-cd17-248b-087e-ef17cdfee0e7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "performedPeriod": { "start": "2023-03-18T02:49:40+01:00", "end": "2023-03-18T03:02:17+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:3da61c44-e6fc-b63f-2d35-95eb7777073c", "resource": { "resourceType": "Procedure", "id": "3da61c44-e6fc-b63f-2d35-95eb7777073c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "performedPeriod": { "start": "2023-03-18T03:02:17+01:00", "end": "2023-03-18T03:25:25+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:5875234c-27dc-18c1-fb1f-6392f6df1c66", "resource": { "resourceType": "Procedure", "id": "5875234c-27dc-18c1-fb1f-6392f6df1c66", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "performedPeriod": { "start": "2023-03-18T03:25:25+01:00", "end": "2023-03-18T03:36:35+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:f4f969df-bb42-9e43-d17d-dd2c4e66fbc5", "resource": { "resourceType": "Procedure", "id": "f4f969df-bb42-9e43-d17d-dd2c4e66fbc5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "performedPeriod": { "start": "2023-03-18T03:36:35+01:00", "end": "2023-03-18T03:59:56+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:bc0c1beb-a424-a6cf-5e97-8c5e0f2b61ff", "resource": { "resourceType": "MedicationRequest", "id": "bc0c1beb-a424-a6cf-5e97-8c5e0f2b61ff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "authoredOn": "2023-03-18T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:b8d7a59c-0e03-7e2d-f148-bed372386b01", "resource": { "resourceType": "Claim", "id": "b8d7a59c-0e03-7e2d-f148-bed372386b01", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "created": "2023-03-18T02:25:18+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:bc0c1beb-a424-a6cf-5e97-8c5e0f2b61ff" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "encounter": [ { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:0eff68db-831e-b807-1b74-beab84318a3a", "resource": { "resourceType": "ExplanationOfBenefit", "id": "0eff68db-831e-b807-1b74-beab84318a3a", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b8d7a59c-0e03-7e2d-f148-bed372386b01" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2023-03-18T02:25:18+01:00", "end": "2024-03-18T02:25:18+01:00" }, "created": "2023-03-18T02:25:18+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:b8d7a59c-0e03-7e2d-f148-bed372386b01" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "859088", "display": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" } ], "text": "NDA020983 200 ACTUAT albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:0e9d5dca-0ddf-b274-0764-94cb21ee5b0b", "resource": { "resourceType": "MedicationRequest", "id": "0e9d5dca-0ddf-b274-0764-94cb21ee5b0b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "authoredOn": "2023-03-18T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:290da7b0-f500-6c82-7c55-7ad1a629287c", "resource": { "resourceType": "Claim", "id": "290da7b0-f500-6c82-7c55-7ad1a629287c", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "created": "2023-03-18T02:25:18+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:0e9d5dca-0ddf-b274-0764-94cb21ee5b0b" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "encounter": [ { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:0d186a55-e7e2-b82d-b17e-83408382ba52", "resource": { "resourceType": "ExplanationOfBenefit", "id": "0d186a55-e7e2-b82d-b17e-83408382ba52", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "290da7b0-f500-6c82-7c55-7ad1a629287c" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2023-03-18T02:25:18+01:00", "end": "2024-03-18T02:25:18+01:00" }, "created": "2023-03-18T02:25:18+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:290da7b0-f500-6c82-7c55-7ad1a629287c" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "206905", "display": "Ibuprofen 400 MG Oral Tablet [Ibu]" } ], "text": "Ibuprofen 400 MG Oral Tablet [Ibu]" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:de59f296-593c-f7ed-0684-48f824f62f5d", "resource": { "resourceType": "MedicationRequest", "id": "de59f296-593c-f7ed-0684-48f824f62f5d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ] }, "status": "active", "intent": "order", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category", "code": "community", "display": "Community" } ], "text": "Community" } ], "medicationCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "authoredOn": "2023-03-18T01:33:04+01:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "reasonReference": [ { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b", "display": "Childhood asthma" } ], "dosageInstruction": [ { "sequence": 1, "text": "Take as needed.", "asNeededBoolean": true } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:7e99064c-c11f-ef36-f3f8-ccf8803b5ab5", "resource": { "resourceType": "Claim", "id": "7e99064c-c11f-ef36-f3f8-ccf8803b5ab5", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "created": "2023-03-18T02:25:18+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:de59f296-593c-f7ed-0684-48f824f62f5d" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "encounter": [ { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" } ] } ], "total": { "value": 129.94, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:ae319c62-bb79-15b1-ae76-50ef7e966925", "resource": { "resourceType": "ExplanationOfBenefit", "id": "ae319c62-bb79-15b1-ae76-50ef7e966925", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "7e99064c-c11f-ef36-f3f8-ccf8803b5ab5" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2023-03-18T02:25:18+01:00", "end": "2024-03-18T02:25:18+01:00" }, "created": "2023-03-18T02:25:18+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:7e99064c-c11f-ef36-f3f8-ccf8803b5ab5" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "349094", "display": "budesonide 0.125 MG/ML Inhalation Suspension" } ], "text": "budesonide 0.125 MG/ML Inhalation Suspension" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 129.94, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:74204b40-5c21-8218-b3d8-2480f6182260", "resource": { "resourceType": "Immunization", "id": "74204b40-5c21-8218-b3d8-2480f6182260", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "occurrenceDateTime": "2023-03-18T01:33:04+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:1d2bdc4f-fb6b-2257-c3e2-480993da3860", "resource": { "resourceType": "DiagnosticReport", "id": "1d2bdc4f-fb6b-2257-c3e2-480993da3860", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T02:49:40+01:00", "issued": "2023-03-18T02:49:40.492+01:00", "result": [ { "reference": "urn:uuid:efaf2998-4891-cee4-b3bc-bfc9cf603192", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:5a01eb39-939c-0897-605b-c18292f3c3db", "resource": { "resourceType": "DiagnosticReport", "id": "5a01eb39-939c-0897-605b-c18292f3c3db", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T03:25:25+01:00", "issued": "2023-03-18T03:25:25.492+01:00", "result": [ { "reference": "urn:uuid:8d74b41d-9522-bf87-8ce9-20502abac3d8", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:e20d8539-7e21-1226-6bf3-e2a94d8e53f6", "resource": { "resourceType": "DiagnosticReport", "id": "e20d8539-7e21-1226-6bf3-e2a94d8e53f6", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T03:59:56+01:00", "issued": "2023-03-18T03:59:56.492+01:00", "result": [ { "reference": "urn:uuid:5791814f-f1c4-3a70-bf8c-1bb2d2254b26", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:d5a8a492-3365-7538-4b9e-74933a001732", "resource": { "resourceType": "DiagnosticReport", "id": "d5a8a492-3365-7538-4b9e-74933a001732", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "encounter": { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, "effectiveDateTime": "2023-03-18T01:33:04+01:00", "issued": "2023-03-18T01:33:04.492+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:22629e47-f079-5cba-f772-69f75ef964ee", "resource": { "resourceType": "DocumentReference", "id": "22629e47-f079-5cba-f772-69f75ef964ee", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:d5a8a492-3365-7538-4b9e-74933a001732" } ], "status": "current", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "date": "2023-03-18T01:33:04.492+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" } ], "period": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:0fae6a12-0bd4-7223-e6b6-5d7eb068cc5b", "resource": { "resourceType": "Claim", "id": "0fae6a12-0bd4-7223-e6b6-5d7eb068cc5b", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5", "display": "Florentino8 Abshire638" }, "billablePeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "created": "2023-03-18T02:25:18+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:74204b40-5c21-8218-b3d8-2480f6182260" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:c6572d4f-6c36-3329-9e0b-4e8fbff0c11f" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:4cf819f3-e7b9-a074-3192-cbc9a06be4e8" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:0e297e6b-92d6-d940-1a4e-30681cbf60bf" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:db84a27d-cd17-248b-087e-ef17cdfee0e7" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:3da61c44-e6fc-b63f-2d35-95eb7777073c" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:5875234c-27dc-18c1-fb1f-6392f6df1c66" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:f4f969df-bb42-9e43-d17d-dd2c4e66fbc5" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Medicare" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 4, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" } }, { "sequence": 5, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 10, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 704.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:076e3247-9bc4-9e2e-9431-4f9b0fc4e2e2", "resource": { "resourceType": "ExplanationOfBenefit", "id": "076e3247-9bc4-9e2e-9431-4f9b0fc4e2e2", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Medicare" }, "beneficiary": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "payor": [ { "display": "Medicare" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0fae6a12-0bd4-7223-e6b6-5d7eb068cc5b" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, "billablePeriod": { "start": "2023-03-18T02:25:18+01:00", "end": "2024-03-18T02:25:18+01:00" }, "created": "2023-03-18T02:25:18+01:00", "insurer": { "display": "Medicare" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|bee0c1f0-ab71-3dd4-8431-e5d8a345aeea", "display": "ACHIEVE WELLNESS, LLC" }, "claim": { "reference": "urn:uuid:0fae6a12-0bd4-7223-e6b6-5d7eb068cc5b" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:c6572d4f-6c36-3329-9e0b-4e8fbff0c11f" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Medicare" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "servicedPeriod": { "start": "2023-03-18T01:33:04+01:00", "end": "2023-03-18T02:25:18+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 704.20, "currency": "USD" } } ], "payment": { "amount": { "value": 2358.512, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:90f744d6-5109-5f07-04f7-87f9d28ffc5b", "resource": { "resourceType": "Provenance", "id": "90f744d6-5109-5f07-04f7-87f9d28ffc5b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance" ] }, "target": [ { "reference": "urn:uuid:462cc215-c055-3e77-8e4c-9d3bf7f886f5" }, { "reference": "urn:uuid:34feb0bb-3b2f-ff44-ec65-d949793b7a43" }, { "reference": "urn:uuid:8e9e23b5-41e9-cfdf-17f3-ca95d33d88a5" }, { "reference": "urn:uuid:f1539cd8-1dfa-910f-5fd3-a50cf30a5cbf" }, { "reference": "urn:uuid:9b4555b9-1620-24a5-19a2-d12d1661cb4e" }, { "reference": "urn:uuid:9d88deba-6a50-91b4-7ebd-da5cd6374bb0" }, { "reference": "urn:uuid:cb0e8a66-b5a4-4956-cb30-1c2778f2f310" }, { "reference": "urn:uuid:d78816ce-4b4f-6cfa-3452-0456e8703083" }, { "reference": "urn:uuid:a6ab4683-648b-ab59-02f0-5880c37a9606" }, { "reference": "urn:uuid:48e0a620-93eb-97ae-4922-4cc912491322" }, { "reference": "urn:uuid:43675411-628e-b2d5-2f42-f4136fc3f6c8" }, { "reference": "urn:uuid:b87a763e-3d44-cf86-6491-758aa23437c8" }, { "reference": "urn:uuid:4ccc91c9-446a-97ac-4d0f-b93c2977eb20" }, { "reference": "urn:uuid:46d97da4-458b-b9d3-35ee-26cf3d5770b3" }, { "reference": "urn:uuid:c5ab9f5d-89ec-5e05-ff48-de6e1b7751c5" }, { "reference": "urn:uuid:74b06d6a-6591-5029-9583-c1a9944f0a29" }, { "reference": "urn:uuid:e11a7883-3242-6e1f-d6ea-7989cce46795" }, { "reference": "urn:uuid:4d8a9386-a59a-de83-4340-8f1de5d774ca" }, { "reference": "urn:uuid:8d9fe386-2a11-b887-01a0-26b025d80ddb" }, { "reference": "urn:uuid:a2e48f33-b303-8bb5-2884-ef6651180550" }, { "reference": "urn:uuid:41476d17-6fe3-6868-8524-30875982d0af" }, { "reference": "urn:uuid:c8b89d01-920f-7d71-820d-fa01a2da9c08" }, { "reference": "urn:uuid:1c874bdb-0b03-ca49-97aa-9253ec59c373" }, { "reference": "urn:uuid:46dea221-304a-c2ab-1e95-e2254ab54a91" }, { "reference": "urn:uuid:30f8b8a1-4ce7-cbce-8537-e75f06e7eca1" }, { "reference": "urn:uuid:7fe22329-ba47-0ed9-a20a-ebb351b8cbaa" }, { "reference": "urn:uuid:e6feb591-7898-9ec0-3c35-f595ab60446f" }, { "reference": "urn:uuid:687a0300-72ac-5ef5-5073-506b896c3012" }, { "reference": "urn:uuid:87dfd607-7862-9f6d-7535-70dcdf29c2c1" }, { "reference": "urn:uuid:4f0a2986-cd6b-97ae-4f4b-d02f4bc91322" }, { "reference": "urn:uuid:43575427-07c9-e4a1-2f32-f42914ff2894" }, { "reference": "urn:uuid:5e0005eb-7ef0-8121-ed05-d1dfba4e0c4e" }, { "reference": "urn:uuid:c06873d8-c8b7-d27f-17a8-780ba3088e55" }, { "reference": "urn:uuid:eb1978ad-7889-286b-997d-1964292d401d" }, { "reference": "urn:uuid:31206b55-aa52-6473-77cc-03a90be31ae4" }, { "reference": "urn:uuid:ac1b6ac1-15eb-b30d-e0f0-7a8cc55a3315" }, { "reference": "urn:uuid:8f1324cc-911c-c585-0313-6673399b2301" }, { "reference": "urn:uuid:95cccb53-b867-da94-b69c-9f08d3e58bd4" }, { "reference": "urn:uuid:2e2d3ff1-33bc-5a34-d89b-bff99a5b4d05" }, { "reference": "urn:uuid:967d1fd3-222e-0837-dcbf-728cbed5a831" }, { "reference": "urn:uuid:d3253dad-be14-1020-e067-eccfd55a9aef" }, { "reference": "urn:uuid:699325c7-f5e8-1bac-79fc-cfe78d4778ac" }, { "reference": "urn:uuid:f29478b2-2c99-cd28-e97c-793579eac9e3" }, { "reference": "urn:uuid:f481e11b-db5b-3cc1-5ce2-2ff65ff83e67" }, { "reference": "urn:uuid:5c27fd8e-29d1-c812-9ddf-e83511d24e83" }, { "reference": "urn:uuid:31dba6c7-d407-9552-ba7b-16c5ed04f71c" }, { "reference": "urn:uuid:49067cf2-f25b-ba76-75ca-d510e979f79f" }, { "reference": "urn:uuid:1e2cbd94-79c2-43d0-cd9b-3d9cae97539b" }, { "reference": "urn:uuid:c7e53dc7-9766-d691-7063-9b430b671838" }, { "reference": "urn:uuid:c058933d-6279-c372-6983-834f52e2fe46" }, { "reference": "urn:uuid:111d2399-b4e3-ee10-1986-0c57e78e5c90" }, { "reference": "urn:uuid:c789cf1f-67e1-5544-89d8-f8dffbe2f906" }, { "reference": "urn:uuid:89303d6f-5c22-07f0-241b-8b6499884bb4" }, { "reference": "urn:uuid:c04dec9f-0fec-58ef-978d-f0b97a743ec7" }, { "reference": "urn:uuid:4625e95b-2a80-a25a-8554-a7152aa175ae" }, { "reference": "urn:uuid:6ecde416-96c8-7f29-a4c8-530a17f3888e" }, { "reference": "urn:uuid:323045ba-e0f3-3e0c-89dc-629036c33f19" }, { "reference": "urn:uuid:66c68d08-c01d-0100-2363-d77febb1b85d" }, { "reference": "urn:uuid:a24f9d19-8796-1fe5-656d-9c88539e886b" }, { "reference": "urn:uuid:ccc3d555-3ba4-c06e-625b-b89b58456c90" }, { "reference": "urn:uuid:512d43d1-961d-5532-1214-1c759259c781" }, { "reference": "urn:uuid:dc0f60d8-69f0-e519-fca4-b6a86afe5444" }, { "reference": "urn:uuid:91f386ca-2f61-d51b-46ba-5a06e4a9d44a" }, { "reference": "urn:uuid:12f4c950-755b-90f4-6c70-cc60a8862998" }, { "reference": "urn:uuid:8efe58a3-fbdf-186e-e435-98a8319bc4f0" }, { "reference": "urn:uuid:c05111ad-c5c6-bc4f-1791-15e382733ea5" }, { "reference": "urn:uuid:ba6b4965-1518-55f1-a9d2-b8997eb66236" }, { "reference": "urn:uuid:f7c4d979-fdee-f80e-7338-d9bba497766c" }, { "reference": "urn:uuid:25f65e66-b295-890d-69e9-4a4252979642" }, { "reference": "urn:uuid:a3aba56f-d564-32db-f3b0-949b334fde15" }, { "reference": "urn:uuid:2767a884-93e9-7e2e-4cbb-1c84d74548f6" }, { "reference": "urn:uuid:3723e3b4-b299-b089-27a6-8e28337beb99" }, { "reference": "urn:uuid:93b64e54-7e59-9f4a-9628-08aa97a41f12" }, { "reference": "urn:uuid:3c4e187d-0a23-b1cb-4e62-307edaad10fe" }, { "reference": "urn:uuid:f5c58eb2-2c86-bf68-4939-8ef589c4516e" }, { "reference": "urn:uuid:e7e864a4-36b0-9399-d30a-981fa2d9a0be" }, { "reference": "urn:uuid:e9f09cad-f68c-ce5b-6c8a-0c79d0d04f2f" }, { "reference": "urn:uuid:b4aa295d-1bae-c075-7dac-d3171bd06f14" }, { "reference": "urn:uuid:8f19fa69-1873-0585-031a-3c0fc0f16301" }, { "reference": "urn:uuid:ce12d7df-01a0-a671-c0fe-b37f03addbb5" }, { "reference": "urn:uuid:62efa857-9c2e-1ed6-445e-dd0fc478c7ba" }, { "reference": "urn:uuid:c8c6e97e-862c-4521-346e-9bbf309ac52a" }, { "reference": "urn:uuid:03b5ddf2-f460-b95c-793c-2e220b272d71" }, { "reference": "urn:uuid:18740303-6893-4a6f-38f0-dd30cf329690" }, { "reference": "urn:uuid:212148eb-824d-a647-00b8-be91883ef112" }, { "reference": "urn:uuid:c9ee7f35-d7e4-4c3f-2b44-84a073844e5b" }, { "reference": "urn:uuid:d23a3dff-f91c-86ac-c4a3-c5e9e953e5fb" }, { "reference": "urn:uuid:0b87c7de-3be6-3deb-9181-d799b973b5c9" }, { "reference": "urn:uuid:f0e73cda-99fa-62bf-5f67-45481f52786a" }, { "reference": "urn:uuid:6bec9650-a06c-fbb0-160c-2daffd6d0c1a" }, { "reference": "urn:uuid:76fa32ca-f22c-3266-777d-801beee7294e" }, { "reference": "urn:uuid:58909f2d-3046-12f6-730a-0aab146338e6" }, { "reference": "urn:uuid:63d24f8a-e3f2-dd70-be79-378b6acb32f1" }, { "reference": "urn:uuid:9ade51f0-c1ed-a1d7-2200-ebbdb5ba0188" }, { "reference": "urn:uuid:8fa4cf61-b62b-4ca6-326a-555a13434c11" }, { "reference": "urn:uuid:9a26871a-2b2b-5787-0e07-5039b9300599" }, { "reference": "urn:uuid:7d11ed0c-f5e6-96d7-39e2-82cc94bfb23e" }, { "reference": "urn:uuid:45f507f1-ba22-7420-15f6-15c9d2d58976" }, { "reference": "urn:uuid:f7ff57ca-326e-8e4c-55d8-8c57300fec03" }, { "reference": "urn:uuid:a4705689-8f90-f12b-bf1c-e60ae1617191" }, { "reference": "urn:uuid:fac819da-f2de-0c09-3228-7ca748154c0e" }, { "reference": "urn:uuid:b018b971-c6a8-7f34-b6b3-5b6b3c9e4f35" }, { "reference": "urn:uuid:3168ba63-bc84-65d0-9fe8-c2989194317f" }, { "reference": "urn:uuid:d0f59ff0-64a7-fea3-28db-dfb95cc9f4e5" }, { "reference": "urn:uuid:2ece5178-0ca9-ae15-b975-39789395ba6e" }, { "reference": "urn:uuid:264e1c01-b2f5-1c2a-76fa-748fb47aefb4" }, { "reference": "urn:uuid:18adf5c9-1f2e-73c1-e319-252ed4db9c21" }, { "reference": "urn:uuid:25599b16-cc27-da92-e444-04d05aedfc55" }, { "reference": "urn:uuid:033db5f1-091b-5075-515d-0237bcf9f3dc" }, { "reference": "urn:uuid:fa63cba7-08e7-a4a4-a41d-cbc8c5585e8b" }, { "reference": "urn:uuid:3920e9eb-1368-fb2a-48ec-995993712fff" }, { "reference": "urn:uuid:7e91078f-c425-a211-c037-b00e21a11611" }, { "reference": "urn:uuid:faaf08b6-f262-f618-fbe2-7e9fc1fa0da7" }, { "reference": "urn:uuid:e841bf6b-ef5a-909b-83e1-c187b6662f06" }, { "reference": "urn:uuid:31784a9d-90f0-2ea6-c235-fcd69952ed8a" }, { "reference": "urn:uuid:abc15507-401b-e7ba-690c-c9f6003aaebb" }, { "reference": "urn:uuid:e74ebbbb-22fd-b4ef-012e-4b7769049a44" }, { "reference": "urn:uuid:40fd4231-9b3a-101b-2fff-0921d47444cd" }, { "reference": "urn:uuid:12f85cb2-b2ca-1c86-90bc-34b4d0ab9018" }, { "reference": "urn:uuid:b462dbf8-926f-ceab-1b77-b71ca53ef471" }, { "reference": "urn:uuid:f3d91d50-f61d-6088-8e9a-e0b8869fb85d" }, { "reference": "urn:uuid:2e5f1a9e-4bf2-f0aa-4ef3-f8175bd3e144" }, { "reference": "urn:uuid:324b079f-bb86-524b-ada2-98338cc7c380" }, { "reference": "urn:uuid:062bef58-1d8c-e77e-0847-ba52f322831e" }, { "reference": "urn:uuid:a52ad7c8-1728-a668-7ac0-736819447163" }, { "reference": "urn:uuid:034b4457-2110-43d0-4920-3c84a46fbd89" }, { "reference": "urn:uuid:19a34113-e01d-8f36-842b-26ebb75d9350" }, { "reference": "urn:uuid:a91b6ca7-fd67-0959-a93c-3ffc3c95c713" }, { "reference": "urn:uuid:555471b9-f194-69fc-9b6e-1cca01c18f15" }, { "reference": "urn:uuid:5a189ea3-cc1f-7a2f-c9ad-fba3dcfdd1fb" }, { "reference": "urn:uuid:dfe23694-5d6e-947d-3f4f-65dfdfbe9af7" }, { "reference": "urn:uuid:b7248dd9-e8b1-7f02-29e7-3b1296646750" }, { "reference": "urn:uuid:4ae8f427-4835-f569-b753-2b1b9f3ed551" }, { "reference": "urn:uuid:716ed276-789f-dd12-2056-f75b5e7afc87" }, { "reference": "urn:uuid:60af4343-cbb4-3267-6136-3973aa5ed94f" }, { "reference": "urn:uuid:6cdb7345-1bd7-4872-5f68-9edbd5e48d76" }, { "reference": "urn:uuid:41686bf5-eb9c-3eb0-66d5-c2c939216d02" }, { "reference": "urn:uuid:1849a4ca-16e9-4a56-186b-62560e93f410" }, { "reference": "urn:uuid:f705dfac-eb17-93ab-dcdd-96ecef31fe33" }, { "reference": "urn:uuid:60784316-9960-a220-33cc-8245571aa241" }, { "reference": "urn:uuid:ecacf1bc-a8bf-4b77-eb99-6d302bce20c4" }, { "reference": "urn:uuid:728380fa-6e82-db5f-68b3-5fa5156adbe6" }, { "reference": "urn:uuid:da466a64-2755-7239-8496-4668c24a794b" }, { "reference": "urn:uuid:2174178a-cf33-cb7d-508b-67bff9052732" }, { "reference": "urn:uuid:0ef87740-99de-ba77-93cf-7b2dabc0cfc2" }, { "reference": "urn:uuid:57e7e426-fb74-2445-bf9d-2096160393ca" }, { "reference": "urn:uuid:4ddf5959-936b-97ae-4e22-e35eb168eb22" }, { "reference": "urn:uuid:c5710de5-9da5-c71c-e074-9491ca9216dd" }, { "reference": "urn:uuid:d2045137-c939-ddc5-31e0-9d143fedc09d" }, { "reference": "urn:uuid:42eb6ad9-0194-5c28-12ec-7901160c517e" }, { "reference": "urn:uuid:9c1ad13e-b12c-1d0b-fb77-d14f1ad63ca2" }, { "reference": "urn:uuid:cc75d68e-3094-6838-1d72-91851894eb86" }, { "reference": "urn:uuid:06def112-151b-e3e3-5798-75b515b74a8b" }, { "reference": "urn:uuid:c2cc5c33-82e8-7229-42d4-cd7426a81c98" }, { "reference": "urn:uuid:c98100bf-b598-0df9-d251-59f3ab049bea" }, { "reference": "urn:uuid:ea693a0b-2b8c-59b7-84de-0ece5f5ba2e8" }, { "reference": "urn:uuid:1d660c9f-eb80-0294-c601-4b1523432192" }, { "reference": "urn:uuid:1164e257-dd31-8eaf-5148-abf7fbcd53cb" }, { "reference": "urn:uuid:f5c68465-80eb-1627-493a-84a919dd62cd" }, { "reference": "urn:uuid:c69f1162-cf7c-326f-3a35-def3c7d84b00" }, { "reference": "urn:uuid:b8772386-bce8-c9fe-ceac-b7e22e2168f6" }, { "reference": "urn:uuid:6102e266-d3ad-180d-f368-0d0273af34d4" }, { "reference": "urn:uuid:1efe7cfd-80e0-de1d-f6b5-bd019b4b6602" }, { "reference": "urn:uuid:e1d44762-4a6e-a798-3613-7620046ec86c" }, { "reference": "urn:uuid:544f5a28-f501-ed6b-2e0c-943bc280b6c6" }, { "reference": "urn:uuid:d8530964-254a-dde3-73f3-0b80ecdd430e" }, { "reference": "urn:uuid:903e8c98-6b8a-b6e8-275d-110c1b5610a3" }, { "reference": "urn:uuid:c856614d-e193-d3e3-9f3c-8eaa722e3da0" }, { "reference": "urn:uuid:02b19754-d8f2-1363-b265-991b1715c641" }, { "reference": "urn:uuid:06deae69-1c93-2af4-dc15-ee6d571122a8" }, { "reference": "urn:uuid:3af36b65-94e7-85a9-64c3-ce48005378df" }, { "reference": "urn:uuid:171ddc65-854c-656d-6345-322467b41b1a" }, { "reference": "urn:uuid:e1233bf3-8375-d5bd-36f3-3d0222f3c2f3" }, { "reference": "urn:uuid:5aecd128-6898-c947-fce6-471e3899cfe1" }, { "reference": "urn:uuid:f8213190-3e24-2e38-0056-06a009d39cb9" }, { "reference": "urn:uuid:69939375-3e77-d219-2790-19f4fd6037a2" }, { "reference": "urn:uuid:3bfae7c7-72ba-cacf-1665-836774d809cb" }, { "reference": "urn:uuid:b0715590-981e-cbfd-987d-2d48204f3bd3" }, { "reference": "urn:uuid:7d1d9382-7d74-65d7-e3ff-3d8a758fc365" }, { "reference": "urn:uuid:7d2b0830-9286-fe5d-c832-2148748012cb" }, { "reference": "urn:uuid:782557b9-057c-41b6-221a-ab2d05bff883" }, { "reference": "urn:uuid:bf6bb1c7-e489-4ec1-e08d-f05ede245003" }, { "reference": "urn:uuid:465c5569-39ec-f7c0-212e-734a78b44ea4" }, { "reference": "urn:uuid:1e92ad90-11c6-c494-1ea3-9b433c4419f1" }, { "reference": "urn:uuid:4c963acb-dfd4-0dc9-b71e-20a3971411e3" }, { "reference": "urn:uuid:c60af63f-9534-c957-c62b-c993d4638711" }, { "reference": "urn:uuid:bb2660f1-23cf-7296-3b31-c06f5c0d3bbb" }, { "reference": "urn:uuid:fcafae6d-6973-c1bd-509a-555569fb2f57" }, { "reference": "urn:uuid:d238ca71-aa51-e758-bd5f-deb98b744c69" }, { "reference": "urn:uuid:d2ebe8ce-2ef8-2377-d98b-a77e0e984539" }, { "reference": "urn:uuid:ce4420ba-d4ed-4702-3425-5ecfee9cb6fe" }, { "reference": "urn:uuid:7b5a9834-1521-ff3d-7f96-f3d19ef7367d" }, { "reference": "urn:uuid:2cc6f626-c557-5d07-1eaa-f36339c8d44c" }, { "reference": "urn:uuid:309a3b3c-12aa-6105-8022-c31dba8142d9" }, { "reference": "urn:uuid:1c8c34dd-8134-7cc9-ba16-0a14c138b924" }, { "reference": "urn:uuid:f0e32901-91b9-00bf-5f63-313666c8cc6f" }, { "reference": "urn:uuid:8ec2d7b4-127f-3643-0d20-532812c0dcec" }, { "reference": "urn:uuid:e59a7d75-aa7a-588a-1569-f740e43efb60" }, { "reference": "urn:uuid:e55bee88-d332-215d-f906-5d08dbaad898" }, { "reference": "urn:uuid:f883d9af-7a54-b912-a7cf-5223efebdf98" }, { "reference": "urn:uuid:79031ad1-246e-7948-724f-7aa102f595c2" }, { "reference": "urn:uuid:1ad6d316-2501-0a62-e395-ed2fb1785c9b" }, { "reference": "urn:uuid:e915eda7-a5fb-6473-3ee5-eeb6f8978189" }, { "reference": "urn:uuid:4a28e785-6f09-a8b3-6fbd-4afb26e4c77e" }, { "reference": "urn:uuid:ecf7fa07-e2d2-c942-ff48-9f2fc8e09f0d" }, { "reference": "urn:uuid:89882515-ad56-f90e-a82d-5d4fd7f29910" }, { "reference": "urn:uuid:7ec7cfb3-e62c-1fe7-b39c-df7f959a9fef" }, { "reference": "urn:uuid:9274cb3d-f444-5c07-0675-0ce49cc2b983" }, { "reference": "urn:uuid:b2848d01-81b6-69e4-d4be-d84d4db1957d" }, { "reference": "urn:uuid:0772b320-550c-9ed3-a38f-c876250dae25" }, { "reference": "urn:uuid:f2f546b7-fede-1840-91a7-2cf97710b384" }, { "reference": "urn:uuid:f21a3485-8136-ab7e-c444-bbf73a71e3e3" }, { "reference": "urn:uuid:f9f4ef77-ec4e-ee0f-af76-3c742eea1bd3" }, { "reference": "urn:uuid:0b4d95d3-dd11-ff1d-0f8b-cf173be7365d" }, { "reference": "urn:uuid:074b6590-38da-19e9-8004-ec4276a378c7" }, { "reference": "urn:uuid:475e27cc-df8f-fad7-defd-bffcb987f4c4" }, { "reference": "urn:uuid:f7c48473-3974-3626-4b38-84b71d086c14" }, { "reference": "urn:uuid:3da0a375-6a53-21a2-b396-737670edc39b" }, { "reference": "urn:uuid:8fc5e987-f04a-d27d-64d5-b5375ecadab2" }, { "reference": "urn:uuid:f1ea7661-f774-7cb8-6134-e2c9997675d9" }, { "reference": "urn:uuid:ec7e033c-7286-ff73-b3a6-6f17196efffb" }, { "reference": "urn:uuid:c78dc1cb-ab8d-7766-95eb-28c7d489cb8b" }, { "reference": "urn:uuid:89aa883f-f263-95d7-d8b1-e92b17ad48fb" }, { "reference": "urn:uuid:88a71dd4-d656-c75c-b055-da30fcd17258" }, { "reference": "urn:uuid:c717ad7c-6a81-4482-ad01-575f535cba0d" }, { "reference": "urn:uuid:75c80c92-ec7c-2e63-c93c-0cd6defd92f8" }, { "reference": "urn:uuid:3bfa3c3a-f353-39f8-d7f2-11a5d785d85b" }, { "reference": "urn:uuid:858d5757-15a2-4491-bb68-3e0fe757da0f" }, { "reference": "urn:uuid:3a5a34c6-e715-15b1-3a9e-27484baa6925" }, { "reference": "urn:uuid:fc99b5c3-9d8d-eb53-5bf6-b5d407380aeb" }, { "reference": "urn:uuid:dae81992-2ab1-f9fb-2be4-d48912b27d49" }, { "reference": "urn:uuid:c92a83b9-f2bb-f263-1e84-61efcf5ca794" }, { "reference": "urn:uuid:649c2ea0-c61f-2d97-f746-9d20ce9d7dc3" }, { "reference": "urn:uuid:b55fc5dd-3f2a-2c16-d67e-d065b02be1e9" }, { "reference": "urn:uuid:4ae63bd1-ba15-4781-8453-7771b82ae682" }, { "reference": "urn:uuid:800c0f43-821c-9cfd-5079-6a845aef49cb" }, { "reference": "urn:uuid:d0316d28-61d4-0d18-8a7e-627e31d51d1e" }, { "reference": "urn:uuid:396dbd3f-1d9c-7d76-64f4-bf0aa49b0d21" }, { "reference": "urn:uuid:c40e117b-4cec-79d2-697d-a023f9d113db" }, { "reference": "urn:uuid:7f7ad461-4ac0-3cf8-36c4-730b04c05ef9" }, { "reference": "urn:uuid:12703cb1-7028-1b78-22d9-e6d107877878" }, { "reference": "urn:uuid:ee92da01-0951-18fa-e57a-da8456a215b5" }, { "reference": "urn:uuid:95acc6c4-a47d-4ec4-5eb8-0c467b5d8c7d" }, { "reference": "urn:uuid:975653f0-6527-a10d-db57-c283a27b150d" }, { "reference": "urn:uuid:bbd7fdbe-1242-cd18-91b8-e5d342f4d747" }, { "reference": "urn:uuid:0ea15043-529a-c15e-f49d-007f90419a06" }, { "reference": "urn:uuid:037171f5-1c8a-2074-48bd-9240596f18fb" }, { "reference": "urn:uuid:2c1e30ed-676b-a6aa-cc20-98de276ac2fc" }, { "reference": "urn:uuid:d2c404d9-b2a0-7531-e305-73e147f64532" }, { "reference": "urn:uuid:a0ed82d5-d067-e83a-5cec-0a34c1191713" }, { "reference": "urn:uuid:5d134820-525e-d9fd-8a3e-c6b3d9338d54" }, { "reference": "urn:uuid:f84638d0-3454-2d7f-00c8-444870fe9c00" }, { "reference": "urn:uuid:a1b2e7d9-276b-0cda-949e-c3792978421e" }, { "reference": "urn:uuid:365446bc-cc18-0a89-9ffe-66542b750a99" }, { "reference": "urn:uuid:5b52ac3b-9f74-8efe-5420-c3c3e913da19" }, { "reference": "urn:uuid:a3df1496-9ba0-6c70-9458-69f39bb17087" }, { "reference": "urn:uuid:0cb316fa-986e-8408-bd70-41a74538bf76" }, { "reference": "urn:uuid:6d81b2ae-4cb5-4f47-a46e-833d28ba6a6e" }, { "reference": "urn:uuid:1cda2019-0319-6241-121e-5a71429d489d" }, { "reference": "urn:uuid:f963ba98-7e36-5e2e-a31d-baba8ddad675" }, { "reference": "urn:uuid:05958608-47b9-08c9-9c68-cb8c727f56e0" }, { "reference": "urn:uuid:17334b25-b98a-1739-2cf1-0a151f29b4e8" }, { "reference": "urn:uuid:a8c055ba-e34f-3c73-994d-a92ee3935bbc" }, { "reference": "urn:uuid:fc19a867-6928-dbed-5b76-a877d2d2fb85" }, { "reference": "urn:uuid:b26ce98e-2a58-e8b8-0369-a48512596c06" }, { "reference": "urn:uuid:c08a84ff-6242-871d-d119-9d7ca7e09934" }, { "reference": "urn:uuid:f2975ba9-aca2-46f4-997f-5c31eb34280f" }, { "reference": "urn:uuid:c7c040cd-f23e-215c-f056-b8c24a0244ca" }, { "reference": "urn:uuid:dc990ee2-51b1-ee70-41fd-47ef56ebce49" }, { "reference": "urn:uuid:e603ef74-4e55-88d4-621c-596d8b3032a2" }, { "reference": "urn:uuid:b5ac4ae4-b72e-a795-6645-db10a4570256" }, { "reference": "urn:uuid:e11307a3-5343-4abb-36e3-08b3e6eedf71" }, { "reference": "urn:uuid:960824c8-aef3-8c55-d012-9336e370fb0b" }, { "reference": "urn:uuid:860a12dc-4376-1081-b940-b8707845f876" }, { "reference": "urn:uuid:9cd80bc9-d468-5056-3cda-2cf12b91baf2" }, { "reference": "urn:uuid:a95ef813-f452-4ec4-ca32-4c53231008c4" }, { "reference": "urn:uuid:e9240a60-8697-ba95-def4-0b672139b40b" }, { "reference": "urn:uuid:6b3f700e-5844-310d-110b-bb3ac973722a" }, { "reference": "urn:uuid:a3cfab61-4a5b-4f4c-1942-420b045b715f" }, { "reference": "urn:uuid:1ece4b19-047f-b285-ad09-2526ef4c686a" }, { "reference": "urn:uuid:7344d321-7633-9c07-5db8-8235010e80e6" }, { "reference": "urn:uuid:e80bb321-894d-0fe3-cc4e-7ca7d5ed3921" }, { "reference": "urn:uuid:17dd4d95-86d5-e0d6-0d94-e6540e8c1e21" }, { "reference": "urn:uuid:49f5c9d0-7118-8101-03f5-ebe30a979bab" }, { "reference": "urn:uuid:d5aeee24-30da-9760-68bb-caec9f4daf29" }, { "reference": "urn:uuid:5415f38b-927f-8d43-88d2-08030a9dc158" }, { "reference": "urn:uuid:83a097e4-77d2-fdb0-58f6-67e58867c9a9" }, { "reference": "urn:uuid:191afb88-6e84-217a-666b-f843656c21fd" }, { "reference": "urn:uuid:1eccdb64-3448-10fd-5ed0-f5cebc2de8b4" }, { "reference": "urn:uuid:84b23dab-955e-fb4c-44b6-05adc0547b5a" }, { "reference": "urn:uuid:8c169fa1-4c73-8934-2595-ba4b0673ab47" }, { "reference": "urn:uuid:3582656c-571d-ac54-ce70-c6d6a3014f04" }, { "reference": "urn:uuid:3b018fbb-c729-61cc-85ec-9a99d0f3b31a" }, { "reference": "urn:uuid:31e2c466-e35c-c2a4-5cd3-6f75b3176591" }, { "reference": "urn:uuid:e41911e1-b32d-d40c-2038-a12ec41b65f6" }, { "reference": "urn:uuid:17af66e2-4ba9-5703-d53b-058c05a97915" }, { "reference": "urn:uuid:f8f4f305-8de6-2144-f8c4-9f289d35b706" }, { "reference": "urn:uuid:251b6f17-858f-a76a-c861-82067335f233" }, { "reference": "urn:uuid:3d1eca2b-656a-fa3a-a006-7499e5737ee9" }, { "reference": "urn:uuid:3e380b28-5061-fb26-e031-811e206301c0" }, { "reference": "urn:uuid:5da728aa-97f3-eddc-65db-fdba63a35c5c" }, { "reference": "urn:uuid:ddb1e3a9-fe76-0d64-885a-23f225198dce" }, { "reference": "urn:uuid:7ad89e12-00c3-8302-4a2d-fb1211cce1c8" }, { "reference": "urn:uuid:74dcaf44-b692-6c71-ad08-2ac21c0894c0" }, { "reference": "urn:uuid:4b367749-9c5e-7603-7392-ad0f4cfeae84" }, { "reference": "urn:uuid:a45eb327-99c6-1f18-8eb7-683f0c107165" }, { "reference": "urn:uuid:7f8a25a5-8f0c-d77f-81ab-53bf1137731f" }, { "reference": "urn:uuid:fb59fa40-2902-25ca-f388-37194d8891ce" }, { "reference": "urn:uuid:4a80f8b1-b385-78ec-4aa8-72412644c128" }, { "reference": "urn:uuid:cdbc6eff-40e8-9b86-dec5-dfcb523df886" }, { "reference": "urn:uuid:f456ca82-7cb4-d765-f663-ffc66fa0b305" }, { "reference": "urn:uuid:dc1a0d19-0c41-8594-3b77-0d2975eba52c" }, { "reference": "urn:uuid:dfbd5f89-855f-811d-9231-7080ea49613d" }, { "reference": "urn:uuid:007a7495-e1f0-9c6e-cc8b-c9f2e201a5de" }, { "reference": "urn:uuid:a545e785-9ef8-f019-6bd1-92c395244acf" }, { "reference": "urn:uuid:e1119624-03b3-40eb-36e1-97349be06621" }, { "reference": "urn:uuid:f8d50aed-e7a1-42c1-5229-e6b1d55dd85f" }, { "reference": "urn:uuid:14ce573a-a762-0451-cfc5-3f3b2aaf554d" }, { "reference": "urn:uuid:4b7ef473-c009-6967-b606-da4b97496d81" }, { "reference": "urn:uuid:daafa72d-1008-2123-2cab-e4189f310590" }, { "reference": "urn:uuid:ee932b5d-38bf-8092-957b-2be584d6132d" }, { "reference": "urn:uuid:262a30d0-9292-3d96-7b60-fcf4abc226ec" }, { "reference": "urn:uuid:046e0179-0aa0-d8a2-e299-56a4359c88c7" }, { "reference": "urn:uuid:2c5d1ddf-cfdd-4487-d94a-8235b3ac1a15" }, { "reference": "urn:uuid:30faef0e-e991-1dd1-c3bf-595854a7cfd7" }, { "reference": "urn:uuid:65d7390b-20ae-2d5f-96e1-9f2550164dec" }, { "reference": "urn:uuid:13c606d9-5a5b-7e1d-7698-e2cf514b2cbf" }, { "reference": "urn:uuid:bb4f85d4-d3b1-d85e-8a5c-17b0f4e02f25" }, { "reference": "urn:uuid:49015e38-0a60-5acd-eb36-f56256850f9b" }, { "reference": "urn:uuid:8d66ca95-b4b9-f4d0-a07c-9ee6c03d090d" }, { "reference": "urn:uuid:a2ee65b2-692b-6c1f-df6e-75a752be7298" }, { "reference": "urn:uuid:d3e0b8ef-9807-c242-e222-2d4cd5f8c7a6" }, { "reference": "urn:uuid:604eb6fb-f479-6c20-cfcd-de335af44729" }, { "reference": "urn:uuid:434d5505-c320-1768-89ca-b7ceac226c7c" }, { "reference": "urn:uuid:e228ddf3-b5e0-3319-a637-c4390d6e976a" }, { "reference": "urn:uuid:e6ffe6ed-3a80-9646-f9d9-b19c84453793" }, { "reference": "urn:uuid:590c20c4-5316-547a-30d8-943cabee60c7" }, { "reference": "urn:uuid:3f635952-45e9-22d6-9b26-d384fea51e2c" }, { "reference": "urn:uuid:80c3b30a-ada3-fd88-73bf-86b60f98c143" }, { "reference": "urn:uuid:c6ddcc02-2387-5154-654f-5bcdbda252e1" }, { "reference": "urn:uuid:3149d091-8258-2f49-af61-0bfe702b61a1" }, { "reference": "urn:uuid:d19df28d-3679-09e2-f8d7-376bc5ab8135" }, { "reference": "urn:uuid:84f396ab-295d-8145-b317-683c06d9f281" }, { "reference": "urn:uuid:a771a92f-4934-3bf5-f792-73dea3c54fae" }, { "reference": "urn:uuid:8b9de190-2497-6e6b-a9f7-e6b9375a53af" }, { "reference": "urn:uuid:7f65a8ed-e14c-9493-b4b9-1cee257acab2" }, { "reference": "urn:uuid:46f71ac3-bde1-f074-af0b-e9960e944ee1" }, { "reference": "urn:uuid:224f35a3-b2fd-1009-d6c3-a5dd85317159" }, { "reference": "urn:uuid:703cbaa3-2c17-5706-7bca-427081745717" }, { "reference": "urn:uuid:6f678998-6b75-f595-aaa6-b56f2f2974d0" }, { "reference": "urn:uuid:6168dc9e-39dc-6870-d6ea-0b4ddd3d855e" }, { "reference": "urn:uuid:55052f52-3853-0581-fb39-267f446bff4b" }, { "reference": "urn:uuid:daf7a5dc-c880-d796-dd04-db20bb6cb336" }, { "reference": "urn:uuid:3c19546b-2f1c-57f3-9b76-547b98c6778a" }, { "reference": "urn:uuid:34e3fbc7-34b5-3f8f-e8a9-5aafee561706" }, { "reference": "urn:uuid:631ec407-1034-60c5-642f-7cdf8d09b695" }, { "reference": "urn:uuid:407d13d3-8132-5919-7efc-075309d51880" }, { "reference": "urn:uuid:c0a2598a-920f-0347-97e2-5da4fc96e91f" }, { "reference": "urn:uuid:5b78a95c-e539-2a6b-9aa7-6716e559fdbf" }, { "reference": "urn:uuid:a38dd887-d142-4b75-136a-60022187b5a9" }, { "reference": "urn:uuid:cb2aef4b-e5ec-1e87-50fa-b653905a9e90" }, { "reference": "urn:uuid:9fed52ae-9835-3c06-1047-9fd3cf15c6b0" }, { "reference": "urn:uuid:70dc6a81-705b-6d09-d090-2b178dc5f7a5" }, { "reference": "urn:uuid:f1683473-ecaf-0b84-3c38-37812e43e18e" }, { "reference": "urn:uuid:50495af7-5c4b-8296-49bd-e750b0f206ab" }, { "reference": "urn:uuid:07b09a7d-1531-f1b5-e61a-1076ba00c28d" }, { "reference": "urn:uuid:4ef70bef-b3eb-fba2-2c71-d50cf4517267" }, { "reference": "urn:uuid:1d63fed8-6ea8-69b3-9947-7ebcf49be884" }, { "reference": "urn:uuid:2e99261f-9fa8-1b3b-3fa4-cad40afd783b" }, { "reference": "urn:uuid:49110d8c-b235-5a02-0311-2e60067488c0" }, { "reference": "urn:uuid:c5c360d7-3e4d-a468-bf39-56a73f543f0a" }, { "reference": "urn:uuid:e5543a48-945c-90eb-09a4-50454065ca01" }, { "reference": "urn:uuid:09d24a3b-db7b-e6a7-6479-323c63d90c4a" }, { "reference": "urn:uuid:4d4de237-1c9d-ab2d-8689-7167ab12f07b" }, { "reference": "urn:uuid:39a0b7e0-b9cb-4d03-6f3d-243f8fbc92f1" }, { "reference": "urn:uuid:528d5e2c-6f19-b65e-c9e3-db9a8df20041" }, { "reference": "urn:uuid:d6d1261b-d0c7-eea0-1951-0ed54bd56dff" }, { "reference": "urn:uuid:291d5ddb-d7bc-4ab3-ed40-5c138247773b" }, { "reference": "urn:uuid:99b7d2f7-efd7-9602-af80-4d425e579e88" }, { "reference": "urn:uuid:a6828307-ec10-d684-d1c6-3bc415583302" }, { "reference": "urn:uuid:5cec0788-4686-8c1a-4dba-e43426f9d36e" }, { "reference": "urn:uuid:b3725247-352c-ac2b-321c-0c47574b2939" }, { "reference": "urn:uuid:cde8666c-a1d1-6c71-eef1-126b20281379" }, { "reference": "urn:uuid:e759143e-b8f6-543a-9c56-5dca5411ec4f" }, { "reference": "urn:uuid:8f789dd9-2c5f-7aaf-4ecd-fad93d6eb936" }, { "reference": "urn:uuid:088e8dec-1fa2-aac3-70ae-c3be60094bb1" }, { "reference": "urn:uuid:8f7d71d8-8cc0-077a-2fd6-b8ed68091f1d" }, { "reference": "urn:uuid:ddb25430-01f6-ff04-5c5c-0e3024157c12" }, { "reference": "urn:uuid:90e5a5dc-1f54-d39a-6339-19dc638581de" }, { "reference": "urn:uuid:92889598-bde5-706f-802a-42cfe4ff9526" }, { "reference": "urn:uuid:7decc9fd-1d8f-9a39-2d5b-4a055264aa05" }, { "reference": "urn:uuid:329888c7-959d-61c6-db16-e643099da36c" }, { "reference": "urn:uuid:91bcf393-5cbc-e102-4062-109951c5e86d" }, { "reference": "urn:uuid:015fe9c5-9789-acb1-afa3-bc190b89f0e1" }, { "reference": "urn:uuid:d8fd69c3-2fa5-abb9-685a-7a204f2b722f" }, { "reference": "urn:uuid:c205eec1-1c25-55e1-cc23-6e51a3727441" }, { "reference": "urn:uuid:8b83a26a-9d28-a46e-ed2e-e3fea4d82d04" }, { "reference": "urn:uuid:41684e5a-fd4b-103c-bb5c-08713356a1a6" }, { "reference": "urn:uuid:af4dcf9c-6b6c-3dc7-7cbd-c4aa7daba5a1" }, { "reference": "urn:uuid:3d982016-8efc-e91d-b594-de42b779b18e" }, { "reference": "urn:uuid:8148f1c3-4eca-9cd8-f77f-dbb9db29c7b8" }, { "reference": "urn:uuid:2e7a993c-0170-3c8d-b870-f50956e8785f" }, { "reference": "urn:uuid:d45e34ed-5bfe-61b1-8de8-b346cc841461" }, { "reference": "urn:uuid:4389dfcd-297b-4f94-9c24-21786cab00f6" }, { "reference": "urn:uuid:d44ba5d0-86c7-cb11-6983-15aa16ced2ad" }, { "reference": "urn:uuid:2c162f64-97f3-3bf7-e3bf-4bd5a597ece9" }, { "reference": "urn:uuid:6ff61344-2cb8-2c69-8345-19b0bae92082" }, { "reference": "urn:uuid:ae169927-2db8-46f5-56d2-0c2a3650c082" }, { "reference": "urn:uuid:3044c879-566b-47b3-06c8-8dbc93251117" }, { "reference": "urn:uuid:edbaeb82-1ae4-f354-9ae4-0fe0d527a233" }, { "reference": "urn:uuid:f1069fa8-1e79-fed8-5643-9f66aad94132" }, { "reference": "urn:uuid:aca55306-25bc-8d44-01de-06a928aa6789" }, { "reference": "urn:uuid:2c2f258b-8794-4583-4596-811328152055" }, { "reference": "urn:uuid:11f2964d-ba08-bd4e-9d28-2cb3740dc077" }, { "reference": "urn:uuid:e66e3311-ccdf-6d4a-9970-c0fd6570cb16" }, { "reference": "urn:uuid:c8292466-5b40-e62b-d651-a4b2049cc431" }, { "reference": "urn:uuid:cab2a7e8-4967-0cd9-ec9b-c2573402acdb" }, { "reference": "urn:uuid:6e27ae47-cda4-bdd7-23f8-61de3c71e718" }, { "reference": "urn:uuid:d14c8805-aefc-c01c-523e-b06800805389" }, { "reference": "urn:uuid:49f80747-4a2e-7028-19f9-183bd765e57e" }, { "reference": "urn:uuid:76b2a395-1e8c-f57d-7e10-df5139ca2e87" }, { "reference": "urn:uuid:a473e8c4-80aa-105a-3dc0-a503f2a1ce15" }, { "reference": "urn:uuid:b7edff4e-e1ac-9906-95c3-368ee5f06b3b" }, { "reference": "urn:uuid:4ac63cb8-5c4e-8986-a5cb-53ec9417b9ad" }, { "reference": "urn:uuid:0af05330-16c6-6427-e7d9-049f61383c32" }, { "reference": "urn:uuid:15df45bb-d1e8-fc78-678d-668d94b05e0f" }, { "reference": "urn:uuid:8debcb69-e80a-7be7-c32f-be55c3aa7df4" }, { "reference": "urn:uuid:e16d6e5c-d00a-8494-e17d-d806efa1e3f1" }, { "reference": "urn:uuid:76e82552-e845-c39f-2af4-64e39fe6532d" }, { "reference": "urn:uuid:614f7bc9-cd97-9456-0151-9db2e8067ef2" }, { "reference": "urn:uuid:1fdea5a7-e6b1-914f-b018-cb1e3dede828" }, { "reference": "urn:uuid:27b60217-f7af-4b76-0511-bbb9db875915" }, { "reference": "urn:uuid:efb13ab0-b300-a321-374c-4d9028ebca64" }, { "reference": "urn:uuid:6c78417a-547b-423b-de52-697be7312daa" }, { "reference": "urn:uuid:5867af22-7bdb-7d31-6a27-fe52b2690533" }, { "reference": "urn:uuid:f7a31f3e-e8fb-4521-fa31-584cfecb4632" }, { "reference": "urn:uuid:5efe71f6-0595-8998-9735-b1fa499fc27c" }, { "reference": "urn:uuid:6d340042-b394-4f64-eb02-ed7b42fd0132" }, { "reference": "urn:uuid:3deddf4f-0ef6-919b-23c5-968f1310fc23" }, { "reference": "urn:uuid:0a67bd4d-d95f-3e1f-ddbb-fc7c97193e3f" }, { "reference": "urn:uuid:7c7609a4-33e3-5544-7c85-15b5b8f10ca9" }, { "reference": "urn:uuid:a1588d06-598e-af40-fe58-9e1682724021" }, { "reference": "urn:uuid:1e94df21-b37f-785f-82de-1e3094f3be64" }, { "reference": "urn:uuid:5e03160f-5468-8f05-df53-028905c040f1" }, { "reference": "urn:uuid:836e8548-9480-adf4-eaec-a897a9bbeec4" }, { "reference": "urn:uuid:b31417a4-ff4c-4a48-6c2d-55ec2107a133" }, { "reference": "urn:uuid:28233694-35f3-831c-258e-d27d9d84716b" }, { "reference": "urn:uuid:c61ca3d5-994d-bf55-ccd9-9383d3fba0e4" }, { "reference": "urn:uuid:b3d58e45-fcd7-c663-6537-4f3b9bcccea6" }, { "reference": "urn:uuid:76f72532-30f8-9e5c-05cb-bea69c6bc885" }, { "reference": "urn:uuid:0c7d57b5-c0c3-09a7-de90-430363ed7385" }, { "reference": "urn:uuid:089c8fcf-76b9-e79d-44fe-33930de9aff7" }, { "reference": "urn:uuid:9ecdea43-5c3e-8b7d-bf41-eb8317113002" }, { "reference": "urn:uuid:7416a3a0-4f75-edf1-4ead-acef3b2d3a69" }, { "reference": "urn:uuid:b2746a8d-1ae4-73af-e6bf-be4271d495a4" }, { "reference": "urn:uuid:2b374d80-b7de-2992-8094-0117322d8058" }, { "reference": "urn:uuid:c9ea6d4e-680b-34e7-8809-0463d444b414" }, { "reference": "urn:uuid:1a9edf3b-2fc7-508b-84ff-eadb6773623f" }, { "reference": "urn:uuid:3d0279f7-a247-cd3a-f2f9-3cab3af2c43b" }, { "reference": "urn:uuid:c43dc9bb-3181-e4f3-ef5a-f7ce228ca8be" }, { "reference": "urn:uuid:43da8f42-3f7f-a3a3-336a-1c274500ce61" }, { "reference": "urn:uuid:cba2cb0f-7578-ce69-e250-5c16cf937c18" }, { "reference": "urn:uuid:fe589937-de18-dbd8-7a00-f3ec171f2b14" }, { "reference": "urn:uuid:434437b5-9c8f-507d-c676-0a1a2fb180e8" }, { "reference": "urn:uuid:4e852944-2175-f0ee-bd9d-5993f1cfcd5b" }, { "reference": "urn:uuid:4411164d-e5de-61ee-b299-a9b61f7f67f4" }, { "reference": "urn:uuid:2bc36078-0b35-b9ff-a2d1-cde1db7a774e" }, { "reference": "urn:uuid:1144a131-0347-9e9c-7d6b-5c04301aa272" }, { "reference": "urn:uuid:3b758374-913c-3ef1-be81-bee693f08326" }, { "reference": "urn:uuid:cd979b24-3015-efaf-7dc7-3fbf0db3b3c2" }, { "reference": "urn:uuid:b4c05bc6-9c19-0dbd-3cb0-fb133fe60c02" }, { "reference": "urn:uuid:6aa95a03-0da9-71c1-8150-23643e312ad2" }, { "reference": "urn:uuid:e54d30cd-b46a-33b0-9627-597a1aeed653" }, { "reference": "urn:uuid:4446d092-9bb0-c515-9671-1ebda78d3594" }, { "reference": "urn:uuid:7288434a-e2e2-c1c6-d722-7d6adc13d577" }, { "reference": "urn:uuid:f0b1bf1f-54dc-873a-0ba1-0fa93466ea8b" }, { "reference": "urn:uuid:b1abdb91-4eba-7266-5e64-53b47c606dcf" }, { "reference": "urn:uuid:832ad4d2-d7fd-e1b2-aa14-08733e5ac01f" }, { "reference": "urn:uuid:19eb287b-ac0b-ee17-5a4a-658fb20c85dc" }, { "reference": "urn:uuid:f7adb0b3-f033-26e1-2b33-3efaefc22bb4" }, { "reference": "urn:uuid:1d1b82ba-ada8-4a53-784b-6fab5ae6d452" }, { "reference": "urn:uuid:f074b2e4-068f-e0f6-a1b0-49ed9392882b" }, { "reference": "urn:uuid:a7d6f021-4ce7-ba72-7411-9f74654f50ae" }, { "reference": "urn:uuid:5e4d717c-7f3f-da29-3275-a092f4a6327b" }, { "reference": "urn:uuid:4edc46a9-ff78-a98a-40a7-86c36a130f37" }, { "reference": "urn:uuid:297a075a-b060-3011-e9bc-652e9bc25b82" }, { "reference": "urn:uuid:7fa47b21-b956-4e0e-3d8b-056efa0f7f3d" }, { "reference": "urn:uuid:738e722c-558a-c68e-4893-f07c9b00eefc" }, { "reference": "urn:uuid:1e1a6135-31a3-5549-97c3-ddb8a8c1addb" }, { "reference": "urn:uuid:ee972ce1-3329-7388-3aee-3ab0cd144e67" }, { "reference": "urn:uuid:db48d794-545d-c34c-6d91-1399ea9dd17d" }, { "reference": "urn:uuid:13094d44-d3d9-cdfe-15dc-c832db735eeb" }, { "reference": "urn:uuid:3334a253-c933-8d9c-e0ba-ab3b85e2cad3" }, { "reference": "urn:uuid:7e8fee0a-5846-4bcc-999b-5f80a95c9602" }, { "reference": "urn:uuid:fe6825c4-1a18-daab-a71d-8ebeb8b5e430" }, { "reference": "urn:uuid:89759900-7787-4f3d-b0c7-429722261bff" }, { "reference": "urn:uuid:0f02040c-e96e-a7a3-f8fb-0af90a68ccd0" }, { "reference": "urn:uuid:6c9a6136-e76b-24cc-11f2-8b4d8f578024" }, { "reference": "urn:uuid:6e264b20-0dcd-0620-1554-5c8b2534bf7a" }, { "reference": "urn:uuid:a789203b-dc54-1b6a-62de-6089628a78ab" }, { "reference": "urn:uuid:08a19198-3a30-6509-6167-7c0e862952ef" }, { "reference": "urn:uuid:7c18d724-ff42-39df-d371-af3ec4ac7ccd" }, { "reference": "urn:uuid:1285ec3e-b888-a2f4-e696-a6e481ce3c9e" }, { "reference": "urn:uuid:c63d4fc9-2c51-845b-e59e-2334fb8b73de" }, { "reference": "urn:uuid:bdf37216-e43f-c9b0-6a32-93278a2553e1" }, { "reference": "urn:uuid:0b129d35-1f1f-fdf7-7b32-038592fe06d4" }, { "reference": "urn:uuid:bdcb70bc-3b6c-9a2c-a4b9-93663fabf728" }, { "reference": "urn:uuid:1bfc27d3-e016-bc6b-8684-0dabb756c085" }, { "reference": "urn:uuid:d3a01cba-c49d-0a59-d3c0-f00f03cbc813" }, { "reference": "urn:uuid:2025c748-7a43-3538-b475-c0f869c0cda9" }, { "reference": "urn:uuid:71995ede-e0fa-85b0-7427-97ecf6ca86c1" }, { "reference": "urn:uuid:d2454127-558f-54c3-648d-80bd7ef7d2f7" }, { "reference": "urn:uuid:0e695c87-83ea-fbe5-9c48-e44bc0e1780e" }, { "reference": "urn:uuid:9eb2b5f8-5971-f11f-e218-ff8e1cc325b4" }, { "reference": "urn:uuid:b92f0b5e-1ca7-181f-71da-89b4bde8c665" }, { "reference": "urn:uuid:ab68e30f-9efd-de4b-1579-5591f54b7250" }, { "reference": "urn:uuid:8f9b5798-dd67-108a-bb27-55f29d3646bb" }, { "reference": "urn:uuid:d14492a2-05dc-c96f-8925-39796361e814" }, { "reference": "urn:uuid:051ead10-6b88-8d7a-0676-1365be7fdda1" }, { "reference": "urn:uuid:694bbb94-adb4-9833-293b-cc369c90ee54" }, { "reference": "urn:uuid:23c4ca07-5b28-be25-cae5-b271416410ac" }, { "reference": "urn:uuid:35610fd6-c024-6fa9-d311-9225ed81797b" }, { "reference": "urn:uuid:9a24a72b-a0d4-14f0-f8a7-05d59291ff23" }, { "reference": "urn:uuid:2565212b-8943-64fd-e67b-9261ea2a484a" }, { "reference": "urn:uuid:ec0c9162-b042-a000-e491-cccad3a2bba8" }, { "reference": "urn:uuid:710a586d-fdf6-b8c7-03d9-306d2d1664ef" }, { "reference": "urn:uuid:0769a18c-0cd2-be5a-1a2c-e5361fd7114f" }, { "reference": "urn:uuid:12385a12-406d-26e7-c003-0c6631b46b1d" }, { "reference": "urn:uuid:8f725d76-c910-97c7-c3bb-12329e99d9ea" }, { "reference": "urn:uuid:df0bd2d1-cd30-6b8b-06b8-b390354b235b" }, { "reference": "urn:uuid:9e6632ad-2c0d-8e31-c698-c715901d7305" }, { "reference": "urn:uuid:424e1686-18a7-9db8-869a-27029dfb11b8" }, { "reference": "urn:uuid:a6e32f0f-b062-1812-af64-5794192a09d0" }, { "reference": "urn:uuid:e980da57-548b-7793-00d0-0acaab048c82" }, { "reference": "urn:uuid:d80eb612-3add-e07a-1ccf-bdda9015207f" }, { "reference": "urn:uuid:bca43795-1095-6fc2-4c28-5552d9a81504" }, { "reference": "urn:uuid:c5c288a4-c5e6-4ede-3f4f-48cf97bab68e" }, { "reference": "urn:uuid:b9b263f5-5968-9bc3-cac5-68147abdf8c3" }, { "reference": "urn:uuid:8f10ee6c-2427-587a-7495-b8b0c85b445d" }, { "reference": "urn:uuid:2f6c86f8-fcdd-95f7-69f3-f995f6674f74" }, { "reference": "urn:uuid:c8d44a90-08ef-6e09-c7fa-daefc13276f8" }, { "reference": "urn:uuid:4fe23543-5dec-fc02-e950-fae8efb422b5" }, { "reference": "urn:uuid:d85da058-6462-52d3-b3fd-a26599a645bf" }, { "reference": "urn:uuid:8445d496-2ee0-ed90-a3dd-33f32ef1573a" }, { "reference": "urn:uuid:f04e922c-7b23-3054-7891-09e5fd52d0db" }, { "reference": "urn:uuid:dde5d9ea-98d3-4926-ed76-845918dbd2a8" }, { "reference": "urn:uuid:d0a86141-bd9a-97fe-af46-1de935b2d18f" }, { "reference": "urn:uuid:483c5997-0da5-b52c-b9d7-ea6eff15b579" }, { "reference": "urn:uuid:6a048bbd-6408-511b-00b1-0874cc640ddd" }, { "reference": "urn:uuid:0ca35a38-ff5d-b410-275a-617dce30bf30" }, { "reference": "urn:uuid:35f5cfb0-dfb0-d3fc-9c1e-82494e8c0932" }, { "reference": "urn:uuid:903fcd37-443a-30ad-9dee-68ef16efefc5" }, { "reference": "urn:uuid:b5a7259e-0f11-731c-dc12-cb08b28f5efd" }, { "reference": "urn:uuid:f606de66-1bd7-40e0-3122-99dc05b980cd" }, { "reference": "urn:uuid:5da76937-08c8-b302-7dee-d362fb8c2b54" }, { "reference": "urn:uuid:67951a85-7063-4389-c79e-3024b381adfa" }, { "reference": "urn:uuid:f1d8cbf4-610f-e740-bd91-adc7adb28a62" }, { "reference": "urn:uuid:31ba2a02-2fe4-5402-e405-ae9e24e35172" }, { "reference": "urn:uuid:67d13ebe-e070-f17b-c341-43806e49078a" }, { "reference": "urn:uuid:5b705fff-ba7f-824b-cff1-312b78b57183" }, { "reference": "urn:uuid:cede15fa-a34f-623b-b585-24ac00e9398f" }, { "reference": "urn:uuid:e0c6ce49-8620-24b5-4c3d-d1cad0eeded2" }, { "reference": "urn:uuid:10bf1af1-2581-8a04-b10d-63fce5af999f" }, { "reference": "urn:uuid:2fc8069e-b105-6e42-5e42-9de8c9e9079d" }, { "reference": "urn:uuid:715ae7c2-24ee-eefb-8b05-836227118110" }, { "reference": "urn:uuid:316d5ca0-3511-4f0b-0211-40effa192ff1" }, { "reference": "urn:uuid:86a23887-cdb4-62d7-c254-f9c2a81196ba" }, { "reference": "urn:uuid:a6dda992-2a65-3ba3-2c24-14391265c448" }, { "reference": "urn:uuid:0c6ccacb-3a66-a364-8725-9de676f4a0d2" }, { "reference": "urn:uuid:9970623b-640b-72ed-ce54-3ada103f5e21" }, { "reference": "urn:uuid:9c2a54fd-901c-77de-c65d-aa34d020bd02" }, { "reference": "urn:uuid:88ea5fb5-a2d3-16c8-be20-0715508e0475" }, { "reference": "urn:uuid:7194d2d1-6380-801a-e179-458fbb5b3cfe" }, { "reference": "urn:uuid:8e2e0910-ca94-9246-1c9e-edaeb965a4f8" }, { "reference": "urn:uuid:2f7c593b-ac97-32b7-9926-78d30bf432c7" }, { "reference": "urn:uuid:1c822c43-4e57-5712-0482-af909f541209" }, { "reference": "urn:uuid:735ab991-3cda-96c0-c877-c9431e602539" }, { "reference": "urn:uuid:97760831-2c97-44e8-ac06-b0fe81f444f9" }, { "reference": "urn:uuid:b0ba0c5e-196a-1038-bb0c-216b40639787" }, { "reference": "urn:uuid:aadfcb68-2be0-0a56-3e88-30dbee86e641" }, { "reference": "urn:uuid:75ed60e1-bc7a-c3fe-6f63-56b1bd815ea0" }, { "reference": "urn:uuid:a896ac87-05ec-549b-dd6b-bc52b55ad4a3" }, { "reference": "urn:uuid:f86e068a-b64b-00bd-5a02-0b1e856ead36" }, { "reference": "urn:uuid:e1c6672e-876c-b229-61ce-f17fdef45c98" }, { "reference": "urn:uuid:808fa9b1-5a57-fc38-8f22-a8cf97a3bf1c" }, { "reference": "urn:uuid:8715959a-c308-9c96-977f-3fba5a67f996" }, { "reference": "urn:uuid:f28b1fe6-1c18-6391-e973-20696969604c" }, { "reference": "urn:uuid:17d85bc5-65c9-f3ab-d196-32a0fd7a965d" }, { "reference": "urn:uuid:749441a9-15eb-b2e0-ffd2-7db8c05a32e8" }, { "reference": "urn:uuid:ce36acc9-beb8-242b-d5e3-7b7bab4adc86" }, { "reference": "urn:uuid:9135e393-a55f-2122-c7c0-17cec78ad937" }, { "reference": "urn:uuid:a968c01e-16e8-41c0-e4cd-e3a39e39a5ee" }, { "reference": "urn:uuid:ce46bdec-c236-a801-4d02-31ae19a0222e" }, { "reference": "urn:uuid:bbf87a8c-2698-4bc2-6500-67207b7b2020" }, { "reference": "urn:uuid:bee8c200-1c08-a7bf-f5cc-632c1ee7263f" }, { "reference": "urn:uuid:c4478bab-5dcc-9cd9-6ff4-59cbeba53344" }, { "reference": "urn:uuid:a5430653-3601-a640-6079-ce0d2cac27ac" }, { "reference": "urn:uuid:74d0087f-cf2d-01a2-a2a0-f23c14b559e5" }, { "reference": "urn:uuid:ba28da9e-5667-72ca-75f2-a0da297e6162" }, { "reference": "urn:uuid:9679871d-b4cd-3f22-1d9b-f3ef2b5c3bf5" }, { "reference": "urn:uuid:ffb5dad5-bd75-7df7-d752-727a53a901e0" }, { "reference": "urn:uuid:6e3393c6-7840-a503-e472-0d5f5e55f854" }, { "reference": "urn:uuid:6b2435d2-e7e1-92ec-828d-5da5adfc3f80" }, { "reference": "urn:uuid:ec7d8cb6-4e86-7271-bc22-496e17f5b64d" }, { "reference": "urn:uuid:81c59573-76f2-2f3a-1e7f-5061b8b1e327" }, { "reference": "urn:uuid:1e82db29-dbfc-973e-2b7d-cb625045a185" }, { "reference": "urn:uuid:6167b45d-3329-2bf4-b086-ce180887162e" }, { "reference": "urn:uuid:3a0b2500-2e99-4cd9-5f00-a2b0507e1c66" }, { "reference": "urn:uuid:f65dc6f6-d2e7-d8f0-b2fa-d6f5d59c8c91" }, { "reference": "urn:uuid:63f9cdc7-1e04-3739-a8a8-d778611d78ea" }, { "reference": "urn:uuid:e9d6f08a-5042-575c-83ed-43908321e5ea" }, { "reference": "urn:uuid:1842496d-a04a-8bb6-62cc-ad73bc0acf4e" }, { "reference": "urn:uuid:3b63a152-f5b6-85db-c6a7-8530afd8d486" }, { "reference": "urn:uuid:dc8ca80f-f78a-4566-2a64-6e065dc6e73b" }, { "reference": "urn:uuid:495a564c-41d7-4261-fe0e-f280c7610c40" }, { "reference": "urn:uuid:b693530c-b5ac-9c3d-10ba-27426034d14f" }, { "reference": "urn:uuid:a5bc6d24-eec5-7203-8d64-8e3b6f3817a7" }, { "reference": "urn:uuid:822f83e9-ce87-3992-d706-6e59ef2c5a5b" }, { "reference": "urn:uuid:668cdede-b866-2831-01ae-3cf7c19dfbb0" }, { "reference": "urn:uuid:12286435-b1d3-cf71-b7de-46062d36696b" }, { "reference": "urn:uuid:435da852-7b3b-de3b-124e-7c9e8bc2c014" }, { "reference": "urn:uuid:6ab370e9-cd39-f0e5-e3dd-5b5325592348" }, { "reference": "urn:uuid:3848f74c-0cf9-1515-96b7-a7fc8fcc3bb6" }, { "reference": "urn:uuid:9f5d0b15-de74-bff9-476f-f0dd1fa56481" }, { "reference": "urn:uuid:aedc1b7f-04f3-edd0-b767-7b346a9e5c50" }, { "reference": "urn:uuid:a783aa91-ffcf-cacc-eda1-b8b5cff90e3c" }, { "reference": "urn:uuid:07cd0d78-acb7-b0e2-a37c-844ef7b59a6c" }, { "reference": "urn:uuid:98c8aea1-badd-e781-de78-895490152785" }, { "reference": "urn:uuid:436deb04-7573-23f1-c55b-45c216988f63" }, { "reference": "urn:uuid:a4a826e6-2846-e7f6-5d74-d49645a3b0c1" }, { "reference": "urn:uuid:3efe612b-9499-4fec-1435-a12fda492a9f" }, { "reference": "urn:uuid:0b3964d1-c964-75ca-c054-cea035965ecd" }, { "reference": "urn:uuid:9a888ed9-80ae-b181-55b0-2c87e6efa6c5" }, { "reference": "urn:uuid:f2619218-1c50-c652-b982-ef878650d81f" }, { "reference": "urn:uuid:6ce570a0-8158-a6d7-0fba-53a3eea5f65d" }, { "reference": "urn:uuid:82e3e749-57e5-2976-d93a-7de808d455eb" }, { "reference": "urn:uuid:48d6d497-b4d9-b70b-f95f-3b87f2585275" }, { "reference": "urn:uuid:5e8bad28-9514-8ae5-5ef4-7750960ead56" }, { "reference": "urn:uuid:93575e4f-9249-b597-7f32-fe519f7ef98a" }, { "reference": "urn:uuid:3b1e6bd0-2030-0ec0-e53e-032f7d301f29" }, { "reference": "urn:uuid:b5b5eae4-4330-376a-92a8-115b61da1301" }, { "reference": "urn:uuid:5c9c5070-7e0b-8958-5cbe-7def53a23312" }, { "reference": "urn:uuid:89e0d915-b794-65e9-8480-6f3991fcb3fb" }, { "reference": "urn:uuid:8e97de38-de43-0959-8eb8-b18d1d71c713" }, { "reference": "urn:uuid:0ba89056-fa18-9e0d-819e-605800b34006" }, { "reference": "urn:uuid:808692a9-1ed6-8bce-ec08-e45dd1004146" }, { "reference": "urn:uuid:c092737e-91df-d357-17d2-77c518bc072d" }, { "reference": "urn:uuid:fa83aef4-cc01-fb89-0dbc-3549df116cfe" }, { "reference": "urn:uuid:764271e1-4b05-6080-ca81-a09f05058153" }, { "reference": "urn:uuid:f82e9289-2e82-60b7-f935-2d2b27f85687" }, { "reference": "urn:uuid:70d39f06-16dd-df78-2a26-a1d6e15e660b" }, { "reference": "urn:uuid:dc201992-2ab3-07fb-e0d9-743912b390cc" }, { "reference": "urn:uuid:f69405f2-0672-5339-1a2b-192f8ff5a060" }, { "reference": "urn:uuid:d3313d41-25ed-3f0b-2eb8-6fc6cc3f08ef" }, { "reference": "urn:uuid:1b58895b-9702-edec-6039-675e066baa1a" }, { "reference": "urn:uuid:d55941ee-3c9b-72b9-0b08-c912b8bff744" }, { "reference": "urn:uuid:3d3835cd-812e-7404-7a91-c158ac69b523" }, { "reference": "urn:uuid:ce170a7a-efa3-e674-b82e-9160cd150fc4" }, { "reference": "urn:uuid:c19e0b58-d797-a956-cd10-a103b25f06ee" }, { "reference": "urn:uuid:b94ae366-319a-fc26-ea48-bc95e92be0cc" }, { "reference": "urn:uuid:9ba60613-0885-8798-9f66-81c5d5fd7a44" }, { "reference": "urn:uuid:029026ba-c177-4fb8-0656-594d8fb2f05d" }, { "reference": "urn:uuid:ef9c0ae7-cae6-d13a-4fff-5c64de5542f0" }, { "reference": "urn:uuid:57c437eb-1228-73a9-3dcf-b7a8fdc22b11" }, { "reference": "urn:uuid:f798ae95-6b75-7b56-e37f-2e99d529d0be" }, { "reference": "urn:uuid:9954d173-baf6-1ab9-d259-1b3bd921a7ee" }, { "reference": "urn:uuid:2ad3ed62-d021-991c-eff3-7d8eb6df99af" }, { "reference": "urn:uuid:15c19839-522a-7073-678a-15da533a4a89" }, { "reference": "urn:uuid:ce23f3b2-c892-ebe8-21d9-f7352e45fc00" }, { "reference": "urn:uuid:b3322350-4e1e-f8c0-86ef-f74a126833e6" }, { "reference": "urn:uuid:0f15e587-9518-abe4-b7fb-db0b5f217c11" }, { "reference": "urn:uuid:166f6278-c4c7-ea92-fe98-2afff9a74832" }, { "reference": "urn:uuid:c2a3f6c4-885b-5f02-bf3e-7a69fe7a43be" }, { "reference": "urn:uuid:6d7c740d-a8a3-84a1-6968-e64fbed6962e" }, { "reference": "urn:uuid:32d94eb5-9bab-291c-d53d-9d8905d9ed3e" }, { "reference": "urn:uuid:511eb593-a4fb-0fa7-fdf6-7aa8f659dc20" }, { "reference": "urn:uuid:3b7458f9-c56f-4545-58c0-a40660eb8ca5" }, { "reference": "urn:uuid:6ab2c845-f339-dee2-6ef9-66f3908f1622" }, { "reference": "urn:uuid:8a49cf8e-bc6a-a10d-00df-83e191ec5af4" }, { "reference": "urn:uuid:b2c50990-a93d-acf3-9680-7f914d1df29b" }, { "reference": "urn:uuid:91a69dd7-ef99-5ea1-cf01-d8825e19672e" }, { "reference": "urn:uuid:70e15a10-171c-d260-b56a-c5899d4b1b83" }, { "reference": "urn:uuid:538108e0-8eac-b712-6367-b28027fabb78" }, { "reference": "urn:uuid:068e695a-bd81-8e32-7379-1314bda3c327" }, { "reference": "urn:uuid:114bd90a-a765-8185-b6f8-468e0cde84a6" }, { "reference": "urn:uuid:a631da6a-bef1-8bea-63ff-420caca87a13" }, { "reference": "urn:uuid:291b3553-c61d-13f9-4dd8-4df629293336" }, { "reference": "urn:uuid:d828da84-4ae4-9550-14ca-62d375684482" }, { "reference": "urn:uuid:97a23c13-e01e-0d36-022a-21ebb75e1151" }, { "reference": "urn:uuid:b60b6497-f53f-0959-b62c-37ec346dc713" }, { "reference": "urn:uuid:c1cf8ab9-59ea-40b1-3bf2-8278415d5e4f" }, { "reference": "urn:uuid:9decab3b-0095-bc61-485b-2b438dd3179c" }, { "reference": "urn:uuid:43807411-2087-346e-7d3a-38fdcf888420" }, { "reference": "urn:uuid:e0cf41fb-2d73-ea62-b5fb-844b70763048" }, { "reference": "urn:uuid:1cad6564-b1d1-3fb4-5202-ab9537eb6561" }, { "reference": "urn:uuid:2b1edb1d-29f8-f04d-3e12-3ed47aa27ab6" }, { "reference": "urn:uuid:a1035900-86d2-eff8-329b-d3ea8cb7b921" }, { "reference": "urn:uuid:b9606cd7-81cc-99a8-6f02-14cfcea779d7" }, { "reference": "urn:uuid:cafd7081-3cba-13ff-6085-c4235ccb4c9c" }, { "reference": "urn:uuid:4ca7ee1f-a109-79b9-8057-32537f45d4dc" }, { "reference": "urn:uuid:0dfa59f8-8c89-1bc9-2692-d7855cb80db0" }, { "reference": "urn:uuid:75af2697-ca06-e2af-4598-5c317622c53e" }, { "reference": "urn:uuid:eaa338dd-b5f4-756f-18e6-0eb1de717bf9" }, { "reference": "urn:uuid:d970f470-8e87-0cd0-86e2-34a9f8d2c8bb" }, { "reference": "urn:uuid:a9cb4024-19c7-7f19-0bf0-dbb8b6ccb620" }, { "reference": "urn:uuid:2686cfd9-e379-0cb8-52ae-aab4f9506813" }, { "reference": "urn:uuid:55b4aba5-7fa0-c3b9-ae57-344bda37805f" }, { "reference": "urn:uuid:1dffc610-e0df-9b27-216b-d626493ec53f" }, { "reference": "urn:uuid:029a3f1f-258c-2327-f54f-6e3156579bdc" }, { "reference": "urn:uuid:2a56a713-1317-e93f-9a59-d63b01ce8bda" }, { "reference": "urn:uuid:741e35ee-8c69-ac6b-ce76-08351bc097ea" }, { "reference": "urn:uuid:7dead142-1b5c-aeed-4bea-f3b20e30b06d" }, { "reference": "urn:uuid:a6404f23-47ef-cf17-5124-64152e8a21ae" }, { "reference": "urn:uuid:fa63ba25-cef1-232e-a41d-ba480b5d276d" }, { "reference": "urn:uuid:79b0dda2-fe08-d890-8b8c-6ea635941ac3" }, { "reference": "urn:uuid:2690d4bd-7a69-5d3e-f87c-81ec5719ebec" }, { "reference": "urn:uuid:77afb1f9-4e30-60c9-78c1-95597025b699" }, { "reference": "urn:uuid:fe4d41aa-b137-3b30-451c-bca111bba9ff" }, { "reference": "urn:uuid:ba539663-1202-efcb-bfc6-12dd984656c4" }, { "reference": "urn:uuid:942da01b-dffe-829b-21ae-27f1173e86e3" }, { "reference": "urn:uuid:6eb102e5-2f72-f40c-1315-264853a5d117" }, { "reference": "urn:uuid:d6cb484a-dd93-f753-da54-c019324c4f65" }, { "reference": "urn:uuid:1ed2849d-e033-472a-7c3b-a4691f38e5ad" }, { "reference": "urn:uuid:d4623ef4-81fd-0a59-d483-1248c12bc813" }, { "reference": "urn:uuid:dba89288-2786-7b2a-519e-62892e211d24" }, { "reference": "urn:uuid:08f2a4bd-d0f5-d9ed-7d18-8375749879a0" }, { "reference": "urn:uuid:a5e8be21-4d37-c38c-11ec-fccb0737e5c9" }, { "reference": "urn:uuid:bcd9fc13-2673-d661-90e9-0f66d5db5340" }, { "reference": "urn:uuid:8efd99eb-115e-591e-fdf9-2760b717f705" }, { "reference": "urn:uuid:85bfcc60-0931-41fe-5595-83f7bfa5558a" }, { "reference": "urn:uuid:f440dd39-d9d7-1c54-f79d-d382323c1fbc" }, { "reference": "urn:uuid:7d8c3217-2ddf-d779-e3ae-e03281e988db" }, { "reference": "urn:uuid:af7a7cef-2cdd-13b8-7c03-209189fe5ced" }, { "reference": "urn:uuid:11625bba-7ff6-374e-3f89-eeaf1e336a58" }, { "reference": "urn:uuid:16b4a9f3-6a39-4c0b-3f6b-5f1f61aa8621" }, { "reference": "urn:uuid:024eeb3b-ff03-5d73-bfe4-a3e6767f4f14" }, { "reference": "urn:uuid:4ffa3dd0-2c7a-6051-009d-0e978b8fd79e" }, { "reference": "urn:uuid:0210639d-27d0-926e-7bdb-638e74daea77" }, { "reference": "urn:uuid:7477ec8b-5357-2138-02dc-1cc6f0fe11de" }, { "reference": "urn:uuid:87e77d89-7dfa-4ae8-18df-973190e372f8" }, { "reference": "urn:uuid:c0e0f010-8fd7-dc95-bfc7-4b1d4fb0bd0d" }, { "reference": "urn:uuid:aa60a7d0-ce1e-23ea-86fb-e2a9b2ac8e18" }, { "reference": "urn:uuid:c7e943a6-e738-9f50-1dc2-12630edc32d1" }, { "reference": "urn:uuid:2259f9da-d4b2-1624-4baa-4bad3b0b5a73" }, { "reference": "urn:uuid:357b883b-2fe9-e7d5-2744-15001fcd2c70" }, { "reference": "urn:uuid:4a5134e8-70b9-2008-7be5-5b95b35aee3f" }, { "reference": "urn:uuid:c09a6ded-c5b9-5397-17da-7236420cc5ed" }, { "reference": "urn:uuid:99c9fd44-351f-c240-2d8d-4523b9d97d98" }, { "reference": "urn:uuid:a3bd8f3c-6b4d-f93a-0abc-f27ff8bf31f3" }, { "reference": "urn:uuid:ebea61f8-5739-fee2-f032-de4bc98f3622" }, { "reference": "urn:uuid:fd762946-951d-c9a0-dc10-29480fc828d2" }, { "reference": "urn:uuid:90d391b9-ed9b-d8d2-76be-0d598f537423" }, { "reference": "urn:uuid:12d9ebdc-e102-a8f1-31ee-c87236d2aa03" }, { "reference": "urn:uuid:afeaa37d-6277-c88b-b8d7-bb113c8e99cb" }, { "reference": "urn:uuid:9fcbd698-c0b3-020e-c6f5-d1be69a56775" }, { "reference": "urn:uuid:1bfe92c2-5c60-fc43-7782-3443a47891d6" }, { "reference": "urn:uuid:65d24843-8f53-0385-20c9-304412a05482" }, { "reference": "urn:uuid:937896fb-dfec-f3e7-fe00-7cd3972cf801" }, { "reference": "urn:uuid:69a8452b-7de4-8275-fa28-2d11d9b42cae" }, { "reference": "urn:uuid:893e0ba1-4c5c-9de8-6bd9-9e4b065cc02c" }, { "reference": "urn:uuid:1369856a-43a2-3ec4-2079-10528f6dc2a9" }, { "reference": "urn:uuid:f1d57916-e0fc-52b4-8c77-728cd6cc53bb" }, { "reference": "urn:uuid:835ab0c5-64a0-5229-0362-e59a746c0198" }, { "reference": "urn:uuid:25daed95-31f6-f22c-806c-4500f2f211c2" }, { "reference": "urn:uuid:3973a638-b7bd-a44f-c62b-b9c60b31a493" }, { "reference": "urn:uuid:6d6e4680-c5d6-0fdf-d32d-ccd5657ef338" }, { "reference": "urn:uuid:4e2d7b41-8035-c962-fd9b-fb49b50ad92d" }, { "reference": "urn:uuid:6411cf47-98cf-e319-0c90-2cc30cd024c0" }, { "reference": "urn:uuid:0d19af8e-a09b-bc57-a620-0469359b594b" }, { "reference": "urn:uuid:fdecd42c-ce96-faf6-c85b-5435602ff986" }, { "reference": "urn:uuid:f908638a-2545-089c-b441-c16d2954778f" }, { "reference": "urn:uuid:962eb106-b5fa-6240-42b0-05a3759a99f3" }, { "reference": "urn:uuid:a97201ad-8302-3640-5cfc-5714070f3cd9" }, { "reference": "urn:uuid:5dfc4a8a-bf83-7777-0689-3e8f7733fa15" }, { "reference": "urn:uuid:3770d0f9-e3d5-06a9-5146-17f122327ae5" }, { "reference": "urn:uuid:1c33236e-5ca6-67d6-ef75-4b539a9eb1ba" }, { "reference": "urn:uuid:07f97c3e-a182-3d11-5b22-4935ea4ec5cd" }, { "reference": "urn:uuid:7f3b1031-f4d2-7598-7e03-7c7e0ae2a89a" }, { "reference": "urn:uuid:ae0dde5f-33e4-7c7b-9274-b8228534c321" }, { "reference": "urn:uuid:8a1e872d-7ce1-c189-eb43-ff3935dc4702" }, { "reference": "urn:uuid:28c3085c-ec86-5e64-28e4-76637aaa6967" }, { "reference": "urn:uuid:d4c09bd9-a444-badd-558e-36eb659e9083" }, { "reference": "urn:uuid:d95204c3-156e-abd9-a255-63a3f464f1f8" }, { "reference": "urn:uuid:b1c6ebc5-6876-2209-436d-e547b6d67ab1" }, { "reference": "urn:uuid:fef38f45-4037-0e73-440a-d0cf411eaaa5" }, { "reference": "urn:uuid:1527dd30-2763-91db-ae8c-f8ff9cfcc77c" }, { "reference": "urn:uuid:5a1d0005-28fc-9bab-2755-3b5a2515174d" }, { "reference": "urn:uuid:50580aa2-c37c-9c40-3bca-accca9981a17" }, { "reference": "urn:uuid:b1dfa601-91d8-ee1a-e64e-688adcaad842" }, { "reference": "urn:uuid:1b80080d-f387-4974-0776-135738953003" }, { "reference": "urn:uuid:4e32382e-ea4b-96a4-505e-321ad5dd5eb3" }, { "reference": "urn:uuid:ff001806-4da0-6e04-6fe9-7948cde021fb" }, { "reference": "urn:uuid:8cb1ff76-7f4e-cc51-25a4-3c3d789523a0" }, { "reference": "urn:uuid:721e320a-91d8-32ab-bd8c-1b2e6a144c5f" }, { "reference": "urn:uuid:8d5af50e-9a29-2b37-6b7e-8746548ca692" }, { "reference": "urn:uuid:ae73450c-ea11-588b-ff3c-e51060c5036c" }, { "reference": "urn:uuid:41f1073b-cf34-d764-4415-a6472b1f7304" }, { "reference": "urn:uuid:d8997fb2-90a3-f86f-199f-eb78e33ff006" }, { "reference": "urn:uuid:900bba31-16ad-ba55-dd67-af43d1d35c24" }, { "reference": "urn:uuid:fef6fe26-5a5e-aa9b-48e7-b3e50418aabe" }, { "reference": "urn:uuid:959381da-cd5f-39c5-d711-e1bbb381e0c7" }, { "reference": "urn:uuid:c2751408-9d8e-a270-cfa6-a53fca4fd456" }, { "reference": "urn:uuid:e02ed9ea-95f7-4926-0d9e-845915ffdba3" }, { "reference": "urn:uuid:1a8518d8-9bc3-45fc-1bf2-9e9648cb8989" }, { "reference": "urn:uuid:7870817c-9230-6e84-f33b-a25a5daf0b6d" }, { "reference": "urn:uuid:83efc565-62e5-310e-0ee7-4f69c5949623" }, { "reference": "urn:uuid:737c268b-a91c-b4f4-3229-ccce35aec9d5" }, { "reference": "urn:uuid:13b6497f-b568-d78a-15c3-7ec3a854b32a" }, { "reference": "urn:uuid:7c19e3cc-0839-6f5a-db76-e3dc71e38ef1" }, { "reference": "urn:uuid:24ecae3a-eb60-56b0-1efa-a1bd20d86d6a" }, { "reference": "urn:uuid:16946256-d2df-4d64-21f0-4cf272e17203" }, { "reference": "urn:uuid:61fd76f9-5466-a529-e935-9c585d8453ca" }, { "reference": "urn:uuid:749cd557-5b36-60d1-397b-8a10700529cf" }, { "reference": "urn:uuid:332ee232-aa2b-7a5a-33e4-5401fe989c97" }, { "reference": "urn:uuid:1feb0d76-986c-0762-c786-4c51718c4700" }, { "reference": "urn:uuid:0bc1d2f6-8bcf-c66d-f1a5-c8700b92a67a" }, { "reference": "urn:uuid:fd2f93f6-cc18-1c62-2239-f87f39751c74" }, { "reference": "urn:uuid:1888d809-5cac-550e-0089-6131afd09875" }, { "reference": "urn:uuid:da449352-4a9c-2181-8848-9bbe4ba18c65" }, { "reference": "urn:uuid:93b454c7-9534-ef49-3c32-b243093530f0" }, { "reference": "urn:uuid:d1e4ca4b-d88c-d77e-d3f1-ff8fcb78b31e" }, { "reference": "urn:uuid:e8ab27ef-664b-4f65-392a-5b91e23475f4" }, { "reference": "urn:uuid:c9385af1-c2a8-7734-db89-0103d7fe4735" }, { "reference": "urn:uuid:abdaaf5d-7779-2d8e-0661-eb1f35834035" }, { "reference": "urn:uuid:5c5adfa1-beea-b8e6-2482-28ed48c3ead2" }, { "reference": "urn:uuid:d656853c-2c97-72b8-4000-a4d38bf472c9" }, { "reference": "urn:uuid:1e824da2-1fb7-5b0e-0682-d0ef70b41605" }, { "reference": "urn:uuid:af6ba6e1-7c69-37e2-bbf9-7e9dca62a882" }, { "reference": "urn:uuid:54e5a534-e6c0-efd4-0a39-19352b56c9ef" }, { "reference": "urn:uuid:ef1540db-535c-49c8-0182-ed5e0bb91d1c" }, { "reference": "urn:uuid:ee25c205-0c7c-19c2-5d40-1a5c0eb4e009" }, { "reference": "urn:uuid:311c1777-84f1-09c5-3d77-1e7c8a5344b1" }, { "reference": "urn:uuid:3a566639-60cf-46ca-52f7-583687d28093" }, { "reference": "urn:uuid:d995ec8a-475b-956d-e71d-fc16a04bee63" }, { "reference": "urn:uuid:f4e73c65-448c-f04d-d10b-95368856c89a" }, { "reference": "urn:uuid:36617b71-402c-8cdc-c0ba-3f46c0fe6edd" }, { "reference": "urn:uuid:f9197a54-65a8-9a12-b100-7012235ae6a9" }, { "reference": "urn:uuid:33614996-3b2f-0131-ea4e-2b3a1756cdf4" }, { "reference": "urn:uuid:30d45a53-b960-c588-1002-158fcf020a0c" }, { "reference": "urn:uuid:1ee2fe11-839e-7257-26ce-6994ccc6ed49" }, { "reference": "urn:uuid:5cf53cf7-1b73-ba13-dab1-35990e0c47d5" }, { "reference": "urn:uuid:2451100e-7708-f465-8e1b-423426b953c5" }, { "reference": "urn:uuid:06c6f32a-605f-3c32-6d95-8e8f6a31c43e" }, { "reference": "urn:uuid:207c5758-f7fb-64bb-ad08-5c1b8cad073d" }, { "reference": "urn:uuid:8d0e761a-f096-d521-9c7c-dc85ef1e063c" }, { "reference": "urn:uuid:f9400a96-018f-b18c-f299-9a390a18a8e5" }, { "reference": "urn:uuid:07d66ebc-2372-534f-c1d3-d78a4b432838" }, { "reference": "urn:uuid:04819aa0-7acf-f965-fd58-8eb63ea00a85" }, { "reference": "urn:uuid:b9b5d4a0-564f-d337-743a-dc31ed801cda" }, { "reference": "urn:uuid:b1c41449-9108-b319-5203-30e8c920b9e5" }, { "reference": "urn:uuid:07af9256-dc75-6110-7a6c-69aa7d7430ee" }, { "reference": "urn:uuid:c093c4a9-7855-a550-45c8-35abc5833799" }, { "reference": "urn:uuid:670168b4-41ed-9849-9ba6-629208a944d7" }, { "reference": "urn:uuid:0fe4a769-4465-e94e-563b-2c25ec08cbec" }, { "reference": "urn:uuid:43c97dad-3235-801b-421c-d98a3aba7a27" }, { "reference": "urn:uuid:385f30d3-1908-0e20-0860-432de29f4376" }, { "reference": "urn:uuid:7239b113-bf51-395b-dee6-184c8b4a5a32" }, { "reference": "urn:uuid:3012010d-d372-d350-3e53-43c97c7798e6" }, { "reference": "urn:uuid:7d77c721-4daf-4cb8-d6aa-adcb07af6f03" }, { "reference": "urn:uuid:3068cc68-0181-ae74-6bf4-b9123ba6f50a" }, { "reference": "urn:uuid:0712a1de-1459-5475-aab3-ebb4751647f7" }, { "reference": "urn:uuid:bf3b1bc8-c592-502f-e186-74fbac3c0a2f" }, { "reference": "urn:uuid:eb3d9d25-1694-04f7-0c4d-8ba39eadef0d" }, { "reference": "urn:uuid:d74fd47a-79c8-2999-594e-8a157e989ed5" }, { "reference": "urn:uuid:a2617817-1631-32fb-5671-fbc605fa15fd" }, { "reference": "urn:uuid:68d010fc-96a4-e9e0-599c-db612b40a282" }, { "reference": "urn:uuid:42389d7f-453b-e192-22b6-290db24f17e4" }, { "reference": "urn:uuid:508560e7-e3ab-f1b1-49fb-56b7e4b28c53" }, { "reference": "urn:uuid:74c4435b-c62c-6e44-a999-5327759aee4c" }, { "reference": "urn:uuid:4c79f852-0bd4-382a-cc70-70ecaff4c65f" }, { "reference": "urn:uuid:b4a49562-3ca0-8375-c6ff-5ef971f65376" }, { "reference": "urn:uuid:21000445-b3b3-ac87-958c-514c5c9592d9" }, { "reference": "urn:uuid:4a8e1c25-01fd-c809-f376-956dfacd0956" }, { "reference": "urn:uuid:199dba72-dffe-c3e6-6cd0-3bfe903668a9" }, { "reference": "urn:uuid:3ae202cd-65bc-9241-8db8-102ce420e596" }, { "reference": "urn:uuid:202e1aa8-a641-ad73-520e-534ef50554a2" }, { "reference": "urn:uuid:7449ce9e-0321-4d18-abf4-e5842f7c0665" }, { "reference": "urn:uuid:9f0c3f74-6f09-afc7-cd85-39a723607ddc" }, { "reference": "urn:uuid:3935c3b4-aae1-da8c-afd0-01c6d00e034e" }, { "reference": "urn:uuid:0cd69b55-77f6-602c-7b5c-7c9d17112b62" }, { "reference": "urn:uuid:fd9aeb4c-3d00-a542-263c-2ecbd26e577e" }, { "reference": "urn:uuid:7e9b0c8b-45ac-f697-baa9-6b3d4fe71e82" }, { "reference": "urn:uuid:0daec45f-82ca-0c47-978a-659a17d52890" }, { "reference": "urn:uuid:67e27502-b02e-00eb-a570-6a68b1f9f57c" }, { "reference": "urn:uuid:9bb1dbd5-6902-82c9-4072-46c7e26eb957" }, { "reference": "urn:uuid:89c0b0b6-90f2-529f-5bd2-fd5da5e583a7" }, { "reference": "urn:uuid:8afb85ae-dd2e-eaf3-224e-0695c207e3e1" }, { "reference": "urn:uuid:392d0c5a-bfc4-13f5-c37b-2a3b2ee96905" }, { "reference": "urn:uuid:de817ade-3f88-c74f-8a78-4f074eff2b6e" }, { "reference": "urn:uuid:4bfcbc4c-49cb-6c79-0b7b-78cf1c43d728" }, { "reference": "urn:uuid:395578c4-72e2-f16a-f28e-284ac8b5ba74" }, { "reference": "urn:uuid:45d477a8-6ba3-ff45-3ab7-e68e0cb6e6b0" }, { "reference": "urn:uuid:61596278-009c-0263-12c5-6824d8d5b64f" }, { "reference": "urn:uuid:eb78c37e-d423-dff9-9db5-0ad52c491de4" }, { "reference": "urn:uuid:92f01777-c43e-14d2-6516-1e61eb2d6994" }, { "reference": "urn:uuid:0ef28b03-cdef-4da9-f184-356ce6acbfd2" }, { "reference": "urn:uuid:4ed0d319-0907-6456-78e9-eec04587fc7d" }, { "reference": "urn:uuid:127502cc-8cba-4d38-b942-717f25427104" }, { "reference": "urn:uuid:aa49407f-0f66-9844-6143-dae7ee9881ca" }, { "reference": "urn:uuid:24e647a9-fa29-9e3f-c42b-624b8dc2d493" }, { "reference": "urn:uuid:ac190e73-9d0f-7638-29b7-d0a3d0494048" }, { "reference": "urn:uuid:fea70d4e-1332-605f-d5e6-48a69d02c1ac" }, { "reference": "urn:uuid:9248d8ca-635f-6056-324a-fdf760030af2" }, { "reference": "urn:uuid:bd0cb3ca-3b92-f1ba-b701-ee201211134c" }, { "reference": "urn:uuid:84af651f-d8e1-3320-3c3a-209483fbb5a4" }, { "reference": "urn:uuid:bc992670-4e5d-20c1-11f6-268177c505df" }, { "reference": "urn:uuid:4ece19bf-dcdd-3fd9-82e8-a61f29d23af7" }, { "reference": "urn:uuid:77e59295-cec0-3196-522b-5a4e42ec9662" }, { "reference": "urn:uuid:233e34c9-30db-120e-0b3e-be147003fcb5" }, { "reference": "urn:uuid:e5f9500c-15c6-f332-6c0b-bcdf991c5dd2" }, { "reference": "urn:uuid:f70a1dcf-4ee2-c278-9913-5fb5b09fe4bd" }, { "reference": "urn:uuid:4aafa301-c73f-5e27-df75-8e8d9ed65bbc" }, { "reference": "urn:uuid:09a2b164-ed87-4550-ece6-25d8803db4b5" }, { "reference": "urn:uuid:3231463a-e0f3-7e2c-ccd3-3fb0d6c37f32" }, { "reference": "urn:uuid:caac76c8-4309-7229-4ab4-ab9d52d52198" }, { "reference": "urn:uuid:e3dcf26e-7988-3126-69f6-311b9f251164" }, { "reference": "urn:uuid:f095d77d-23cf-eedf-5f15-e011d7c27d8a" }, { "reference": "urn:uuid:0424c435-5a87-8f14-149e-fd7c46a497ea" }, { "reference": "urn:uuid:e0ef4c99-1356-38fc-20f3-67039b3c10b4" }, { "reference": "urn:uuid:1031557c-9d1c-a37e-3eef-0f7cbdeff7bd" }, { "reference": "urn:uuid:d9161ea3-41e9-a8bd-1c05-e2c8df382b91" }, { "reference": "urn:uuid:68ec2f12-bd22-c99a-d4b6-9d92c5b8e94f" }, { "reference": "urn:uuid:b6da441e-e46a-3cb9-ad45-1184fd2a68db" }, { "reference": "urn:uuid:c6572d4f-6c36-3329-9e0b-4e8fbff0c11f" }, { "reference": "urn:uuid:652dce63-8bbb-aa8d-1b63-1306614c305f" }, { "reference": "urn:uuid:683bd7b1-f4b5-1baa-4b90-954ea720e138" }, { "reference": "urn:uuid:44a37c5d-71d4-adbe-2f0e-042b1e260f59" }, { "reference": "urn:uuid:ad2d2911-24ec-88e4-54eb-359d6b881ebd" }, { "reference": "urn:uuid:2ba136c4-11e3-c22b-ebf4-5a02585ccf7f" }, { "reference": "urn:uuid:cd9df49e-ba1c-60d7-a27d-bf7cab1971cd" }, { "reference": "urn:uuid:b23ae238-b1e5-35ab-c575-9cca26758f9f" }, { "reference": "urn:uuid:a722af60-a0bc-97fa-2d33-4af4c1e52c8c" }, { "reference": "urn:uuid:329b7d6e-0b5b-5482-9943-da78162c7950" }, { "reference": "urn:uuid:efaf2998-4891-cee4-b3bc-bfc9cf603192" }, { "reference": "urn:uuid:8d74b41d-9522-bf87-8ce9-20502abac3d8" }, { "reference": "urn:uuid:5791814f-f1c4-3a70-bf8c-1bb2d2254b26" }, { "reference": "urn:uuid:4cf819f3-e7b9-a074-3192-cbc9a06be4e8" }, { "reference": "urn:uuid:0e297e6b-92d6-d940-1a4e-30681cbf60bf" }, { "reference": "urn:uuid:db84a27d-cd17-248b-087e-ef17cdfee0e7" }, { "reference": "urn:uuid:3da61c44-e6fc-b63f-2d35-95eb7777073c" }, { "reference": "urn:uuid:5875234c-27dc-18c1-fb1f-6392f6df1c66" }, { "reference": "urn:uuid:f4f969df-bb42-9e43-d17d-dd2c4e66fbc5" }, { "reference": "urn:uuid:bc0c1beb-a424-a6cf-5e97-8c5e0f2b61ff" }, { "reference": "urn:uuid:b8d7a59c-0e03-7e2d-f148-bed372386b01" }, { "reference": "urn:uuid:0eff68db-831e-b807-1b74-beab84318a3a" }, { "reference": "urn:uuid:0e9d5dca-0ddf-b274-0764-94cb21ee5b0b" }, { "reference": "urn:uuid:290da7b0-f500-6c82-7c55-7ad1a629287c" }, { "reference": "urn:uuid:0d186a55-e7e2-b82d-b17e-83408382ba52" }, { "reference": "urn:uuid:de59f296-593c-f7ed-0684-48f824f62f5d" }, { "reference": "urn:uuid:7e99064c-c11f-ef36-f3f8-ccf8803b5ab5" }, { "reference": "urn:uuid:ae319c62-bb79-15b1-ae76-50ef7e966925" }, { "reference": "urn:uuid:74204b40-5c21-8218-b3d8-2480f6182260" }, { "reference": "urn:uuid:1d2bdc4f-fb6b-2257-c3e2-480993da3860" }, { "reference": "urn:uuid:5a01eb39-939c-0897-605b-c18292f3c3db" }, { "reference": "urn:uuid:e20d8539-7e21-1226-6bf3-e2a94d8e53f6" }, { "reference": "urn:uuid:d5a8a492-3365-7538-4b9e-74933a001732" }, { "reference": "urn:uuid:22629e47-f079-5cba-f772-69f75ef964ee" }, { "reference": "urn:uuid:0fae6a12-0bd4-7223-e6b6-5d7eb068cc5b" }, { "reference": "urn:uuid:076e3247-9bc4-9e2e-9431-4f9b0fc4e2e2" } ], "recorded": "2023-09-09T02:33:04.492+02:00", "agent": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type", "code": "author", "display": "Author" } ], "text": "Author" }, "who": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "onBehalfOf": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type", "code": "transmitter", "display": "Transmitter" } ], "text": "Transmitter" }, "who": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944694", "display": "Dr. Ronald408 Huels583" }, "onBehalfOf": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cabc0f0d-dcca-34a2-bc6b-519ed1cc7f74", "display": "ACHIEVE WELLNESS, LLC" } } ] }, "request": { "method": "POST", "url": "Provenance" } } ] }