{ "resourceType": "Bundle", "type": "transaction", "entry": [ { "fullUrl": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "resource": { "resourceType": "Patient", "id": "4b633a8e-a312-8675-4af4-3519bfa6b00e", "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: 367384980029923136 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": "Alexis664 Goyette777" }, { "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex", "valueCode": "M" }, { "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace", "valueAddress": { "city": "Boston", "state": "Massachusetts", "country": "US" } }, { "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years", "valueDecimal": 0.0 }, { "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years", "valueDecimal": 1.0 } ], "identifier": [ { "system": "https://github.com/synthetichealth/synthea", "value": "4b633a8e-a312-8675-4af4-3519bfa6b00e" }, { "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": "4b633a8e-a312-8675-4af4-3519bfa6b00e" }, { "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": "999-97-7776" } ], "name": [ { "use": "official", "family": "Wilkinson796", "given": [ "Armand155" ] } ], "telecom": [ { "system": "phone", "value": "555-822-7644", "use": "home" } ], "gender": "male", "birthDate": "2021-03-03", "address": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/geolocation", "extension": [ { "url": "latitude", "valueDecimal": 42.407802270896035 }, { "url": "longitude", "valueDecimal": -71.19016454933393 } ] } ], "line": [ "100 Kohler Drive" ], "city": "Waltham", "state": "MA", "postalCode": "02451", "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:68b70cd6-53ae-90fb-ea0f-dec4f461f213", "resource": { "resourceType": "Encounter", "id": "68b70cd6-53ae-90fb-ea0f-dec4f461f213", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "68b70cd6-53ae-90fb-ea0f-dec4f461f213" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-03-03T00:31:56+01:00", "end": "2021-03-03T00:46:56+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } } ], "period": { "start": "2021-03-03T00:31:56+01:00", "end": "2021-03-03T00:46:56+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:47f6931f-9200-0a15-25ac-b6cc89937d1f", "resource": { "resourceType": "Condition", "id": "47f6931f-9200-0a15-25ac-b6cc89937d1f", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "onsetDateTime": "2021-03-03T00:31:56+01:00", "abatementDateTime": "2021-06-09T01:31:56+02:00", "recordedDate": "2021-03-03T00:31:56+01:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:cb56088d-7bca-d3b8-6439-a14eb399f87c", "resource": { "resourceType": "Observation", "id": "cb56088d-7bca-d3b8-6439-a14eb399f87c", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 52.1, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cd811737-5c8c-9518-571a-67df571b67ba", "resource": { "resourceType": "Observation", "id": "cd811737-5c8c-9518-571a-67df571b67ba", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 4, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cba333f6-7e4b-6354-4d33-4f198b431368", "resource": { "resourceType": "Observation", "id": "cba333f6-7e4b-6354-4d33-4f198b431368", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 4.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c4f85979-e296-ab98-a96e-02f2260f2c3e", "resource": { "resourceType": "Observation", "id": "c4f85979-e296-ab98-a96e-02f2260f2c3e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-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": "77606-2", "display": "Weight-for-length Per age and sex" } ], "text": "Weight-for-length Per age and sex" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 62.594, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d7dcbfaa-4aa2-2736-890b-eaf1f5fd760c", "resource": { "resourceType": "Observation", "id": "d7dcbfaa-4aa2-2736-890b-eaf1f5fd760c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ] }, "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": "8289-1", "display": "Head Occipital-frontal circumference Percentile" } ], "text": "Head Occipital-frontal circumference Percentile" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 43.17, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4e3ad673-b78e-baf2-f94b-c6f27c9ce82a", "resource": { "resourceType": "Observation", "id": "4e3ad673-b78e-baf2-f94b-c6f27c9ce82a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ] }, "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": "9843-4", "display": "Head Occipital-frontal circumference" } ], "text": "Head Occipital-frontal circumference" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 35.49, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bdcc44fa-d45c-25e5-7532-f703fa4558f2", "resource": { "resourceType": "Observation", "id": "bdcc44fa-d45c-25e5-7532-f703fa4558f2", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 76, "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": 113, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a2db060c-397c-d845-18ed-b604730c9ab0", "resource": { "resourceType": "Observation", "id": "a2db060c-397c-d845-18ed-b604730c9ab0", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 89, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:50cf69f2-2659-0545-8f12-97b62a7c9ff8", "resource": { "resourceType": "Observation", "id": "50cf69f2-2659-0545-8f12-97b62a7c9ff8", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:80a80015-e1e1-a06f-99ec-256ea1328cc3", "resource": { "resourceType": "Observation", "id": "80a80015-e1e1-a06f-99ec-256ea1328cc3", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 7.2507, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0da10e13-cbc1-6240-ca1a-bd4115f6dbe8", "resource": { "resourceType": "Observation", "id": "0da10e13-cbc1-6240-ca1a-bd4115f6dbe8", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 4.1159, "unit": "10*6/uL", "system": "http://unitsofmeasure.org", "code": "10*6/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7a0edee0-26a7-c92e-4023-bcf6593cd486", "resource": { "resourceType": "Observation", "id": "7a0edee0-26a7-c92e-4023-bcf6593cd486", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 14.511, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:21d48ba5-8789-26ac-c684-b34d3e31b94b", "resource": { "resourceType": "Observation", "id": "21d48ba5-8789-26ac-c684-b34d3e31b94b", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 35.601, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5cf8bb36-22de-b1d8-e974-3e68a4b327ac", "resource": { "resourceType": "Observation", "id": "5cf8bb36-22de-b1d8-e974-3e68a4b327ac", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 92.089, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4f97dcf9-1c49-afca-a6ad-c5ccad21a035", "resource": { "resourceType": "Observation", "id": "4f97dcf9-1c49-afca-a6ad-c5ccad21a035", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 29.11, "unit": "pg", "system": "http://unitsofmeasure.org", "code": "pg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:21444b45-8d9b-ac74-fb3a-bb7de4acd78b", "resource": { "resourceType": "Observation", "id": "21444b45-8d9b-ac74-fb3a-bb7de4acd78b", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 34.514, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:74bf2223-77a0-a75d-3c8a-731c48133231", "resource": { "resourceType": "Observation", "id": "74bf2223-77a0-a75d-3c8a-731c48133231", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 42.67, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ec0deedc-0435-bda0-94f6-e719eb057d3b", "resource": { "resourceType": "Observation", "id": "ec0deedc-0435-bda0-94f6-e719eb057d3b", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 419.39, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:21c1f9fa-2a51-4eec-6b89-c3590ec4246a", "resource": { "resourceType": "Observation", "id": "21c1f9fa-2a51-4eec-6b89-c3590ec4246a", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 508.06, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b503a079-6772-6d80-c1a4-11cd3a67e267", "resource": { "resourceType": "Observation", "id": "b503a079-6772-6d80-c1a4-11cd3a67e267", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "valueQuantity": { "value": 10.077, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d833c0ff-ba08-c21b-cc18-41cc363285eb", "resource": { "resourceType": "Observation", "id": "d833c0ff-ba08-c21b-cc18-41cc363285eb", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+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:7ab5a10c-ad31-038a-16bd-c99375315990", "resource": { "resourceType": "Immunization", "id": "7ab5a10c-ad31-038a-16bd-c99375315990", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "08", "display": "Hep B, adolescent or pediatric" } ], "text": "Hep B, adolescent or pediatric" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "occurrenceDateTime": "2021-03-03T00:31:56+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:a1cb8dbd-e433-29e6-efa6-4a508c71a953", "resource": { "resourceType": "DiagnosticReport", "id": "a1cb8dbd-e433-29e6-efa6-4a508c71a953", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } ], "result": [ { "reference": "urn:uuid:80a80015-e1e1-a06f-99ec-256ea1328cc3", "display": "Leukocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:0da10e13-cbc1-6240-ca1a-bd4115f6dbe8", "display": "Erythrocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:7a0edee0-26a7-c92e-4023-bcf6593cd486", "display": "Hemoglobin [Mass/volume] in Blood" }, { "reference": "urn:uuid:21d48ba5-8789-26ac-c684-b34d3e31b94b", "display": "Hematocrit [Volume Fraction] of Blood by Automated count" }, { "reference": "urn:uuid:5cf8bb36-22de-b1d8-e974-3e68a4b327ac", "display": "MCV [Entitic volume] by Automated count" }, { "reference": "urn:uuid:4f97dcf9-1c49-afca-a6ad-c5ccad21a035", "display": "MCH [Entitic mass] by Automated count" }, { "reference": "urn:uuid:21444b45-8d9b-ac74-fb3a-bb7de4acd78b", "display": "MCHC [Mass/volume] by Automated count" }, { "reference": "urn:uuid:74bf2223-77a0-a75d-3c8a-731c48133231", "display": "Erythrocyte distribution width [Entitic volume] by Automated count" }, { "reference": "urn:uuid:ec0deedc-0435-bda0-94f6-e719eb057d3b", "display": "Platelets [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:21c1f9fa-2a51-4eec-6b89-c3590ec4246a", "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" }, { "reference": "urn:uuid:b503a079-6772-6d80-c1a4-11cd3a67e267", "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:481ce5df-0a7a-f049-e99d-869f0561b997", "resource": { "resourceType": "DiagnosticReport", "id": "481ce5df-0a7a-f049-e99d-869f0561b997", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, "effectiveDateTime": "2021-03-03T00:31:56+01:00", "issued": "2021-03-03T00:31:56.064+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:01bea918-0222-56ae-3809-1e2407285685", "resource": { "resourceType": "DocumentReference", "id": "01bea918-0222-56ae-3809-1e2407285685", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:481ce5df-0a7a-f049-e99d-869f0561b997" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2021-03-03T00:31:56.064+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "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:68b70cd6-53ae-90fb-ea0f-dec4f461f213" } ], "period": { "start": "2021-03-03T00:31:56+01:00", "end": "2021-03-03T00:46:56+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:aec1a7b5-a758-67e1-76bc-cc490bcf39f7", "resource": { "resourceType": "Claim", "id": "aec1a7b5-a758-67e1-76bc-cc490bcf39f7", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2021-03-03T00:31:56+01:00", "end": "2021-03-03T00:46:56+01:00" }, "created": "2021-03-03T00:46:56+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:7ab5a10c-ad31-038a-16bd-c99375315990" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:47f6931f-9200-0a15-25ac-b6cc89937d1f" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "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:68b70cd6-53ae-90fb-ea0f-dec4f461f213" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "08", "display": "Hep B, adolescent or pediatric" } ], "text": "Hep B, adolescent or pediatric" }, "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, "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" } } ], "total": { "value": 347.38, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:beb5523a-ca5c-b367-2b61-bba75f0ab316", "resource": { "resourceType": "ExplanationOfBenefit", "id": "beb5523a-ca5c-b367-2b61-bba75f0ab316", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "aec1a7b5-a758-67e1-76bc-cc490bcf39f7" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2021-03-03T00:46:56+01:00", "end": "2022-03-03T00:46:56+01:00" }, "created": "2021-03-03T00:46:56+01:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "claim": { "reference": "urn:uuid:aec1a7b5-a758-67e1-76bc-cc490bcf39f7" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:47f6931f-9200-0a15-25ac-b6cc89937d1f" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2021-03-03T00:31:56+01:00", "end": "2021-03-03T00:46:56+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" } ] }, { "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": "08", "display": "Hep B, adolescent or pediatric" } ], "text": "Hep B, adolescent or pediatric" }, "servicedPeriod": { "start": "2021-03-03T00:31:56+01:00", "end": "2021-03-03T00:46:56+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": "2021-03-03T00:31:56+01:00", "end": "2021-03-03T00:46:56+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 4, "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": "2021-03-03T00:31:56+01:00", "end": "2021-03-03T00:46:56+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": 347.38, "currency": "USD" } } ], "payment": { "amount": { "value": 168.464, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b", "resource": { "resourceType": "Encounter", "id": "32f2c544-f292-bddd-61e7-59fc9160551b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "32f2c544-f292-bddd-61e7-59fc9160551b" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-04-07T01:31:56+02:00", "end": "2021-04-07T01:46:56+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } } ], "period": { "start": "2021-04-07T01:31:56+02:00", "end": "2021-04-07T01:46:56+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:997b6ee6-7ff2-52c5-2f33-6fa215568031", "resource": { "resourceType": "Observation", "id": "997b6ee6-7ff2-52c5-2f33-6fa215568031", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+02:00", "valueQuantity": { "value": 56.1, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d9e98df6-c845-ecbf-2e90-263f94a57f47", "resource": { "resourceType": "Observation", "id": "d9e98df6-c845-ecbf-2e90-263f94a57f47", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+02:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4937034f-6635-7663-272e-8f543a91f98a", "resource": { "resourceType": "Observation", "id": "4937034f-6635-7663-272e-8f543a91f98a", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+02:00", "valueQuantity": { "value": 5, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:879e1e02-d979-0909-d5bb-7f6184ce7075", "resource": { "resourceType": "Observation", "id": "879e1e02-d979-0909-d5bb-7f6184ce7075", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-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": "77606-2", "display": "Weight-for-length Per age and sex" } ], "text": "Weight-for-length Per age and sex" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+02:00", "valueQuantity": { "value": 51.817, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9e2e298a-2f5e-b724-7e99-089333c472b4", "resource": { "resourceType": "Observation", "id": "9e2e298a-2f5e-b724-7e99-089333c472b4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ] }, "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": "8289-1", "display": "Head Occipital-frontal circumference Percentile" } ], "text": "Head Occipital-frontal circumference Percentile" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+02:00", "valueQuantity": { "value": 43.17, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:31dbbbf9-da1c-52e2-f537-1b4b07a08343", "resource": { "resourceType": "Observation", "id": "31dbbbf9-da1c-52e2-f537-1b4b07a08343", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ] }, "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": "9843-4", "display": "Head Occipital-frontal circumference" } ], "text": "Head Occipital-frontal circumference" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+02:00", "valueQuantity": { "value": 38.93, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:331ccbdb-1c6a-05f9-8654-d6e5bd7d790e", "resource": { "resourceType": "Observation", "id": "331ccbdb-1c6a-05f9-8654-d6e5bd7d790e", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+02:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 78, "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": 124, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3dbad032-7832-9dc2-841e-a5a751eb9616", "resource": { "resourceType": "Observation", "id": "3dbad032-7832-9dc2-841e-a5a751eb9616", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+02:00", "valueQuantity": { "value": 96, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ab6c109b-8133-b885-783d-2fbc2f460860", "resource": { "resourceType": "Observation", "id": "ab6c109b-8133-b885-783d-2fbc2f460860", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+02:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f816f2c6-ba92-0aa9-ae4c-fa78ebd4a146", "resource": { "resourceType": "Observation", "id": "f816f2c6-ba92-0aa9-ae4c-fa78ebd4a146", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+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:6bfc169f-4872-461b-f19f-d81bf700ec50", "resource": { "resourceType": "Immunization", "id": "6bfc169f-4872-461b-f19f-d81bf700ec50", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "08", "display": "Hep B, adolescent or pediatric" } ], "text": "Hep B, adolescent or pediatric" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "occurrenceDateTime": "2021-04-07T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:329ca55f-2f89-96ba-0bc6-798f43a19617", "resource": { "resourceType": "DiagnosticReport", "id": "329ca55f-2f89-96ba-0bc6-798f43a19617", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, "effectiveDateTime": "2021-04-07T01:31:56+02:00", "issued": "2021-04-07T01:31:56.064+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:b723f7f1-9705-dcda-771e-debae5a75d7b", "resource": { "resourceType": "DocumentReference", "id": "b723f7f1-9705-dcda-771e-debae5a75d7b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:329ca55f-2f89-96ba-0bc6-798f43a19617" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2021-04-07T01:31:56.064+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjEtMDQtMDcKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkFybWFuZDE1NQogaXMgYSAxIG1vbnRoLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBtYWxlLiBQYXRpZW50IGhhcyBhIGhpc3Rvcnkgb2YgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgoKClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgSHVtYW5hLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwpObyBBY3RpdmUgTWVkaWNhdGlvbnMuCgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KCgojIyBQbGFuClBhdGllbnQgd2FzIGdpdmVuIHRoZSBmb2xsb3dpbmcgaW1tdW5pemF0aW9uczogaGVwIGIsIGFkb2xlc2NlbnQgb3IgcGVkaWF0cmljLiAK" }, "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:32f2c544-f292-bddd-61e7-59fc9160551b" } ], "period": { "start": "2021-04-07T01:31:56+02:00", "end": "2021-04-07T01:46:56+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:18b9250f-62dc-e368-5dc1-bf9e3922811d", "resource": { "resourceType": "Claim", "id": "18b9250f-62dc-e368-5dc1-bf9e3922811d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2021-04-07T01:31:56+02:00", "end": "2021-04-07T01:46:56+02:00" }, "created": "2021-04-07T01:46:56+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:6bfc169f-4872-461b-f19f-d81bf700ec50" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "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:32f2c544-f292-bddd-61e7-59fc9160551b" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "08", "display": "Hep B, adolescent or pediatric" } ], "text": "Hep B, adolescent or pediatric" }, "net": { "value": 136.00, "currency": "USD" } } ], "total": { "value": 272.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:b3b035db-b7e1-6ef5-9d11-31b7b73e484e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "b3b035db-b7e1-6ef5-9d11-31b7b73e484e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "18b9250f-62dc-e368-5dc1-bf9e3922811d" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2021-04-07T01:46:56+02:00", "end": "2022-04-07T01:46:56+02:00" }, "created": "2021-04-07T01:46:56+02:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "claim": { "reference": "urn:uuid:18b9250f-62dc-e368-5dc1-bf9e3922811d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2021-04-07T01:31:56+02:00", "end": "2021-04-07T01:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" } ] }, { "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": "08", "display": "Hep B, adolescent or pediatric" } ], "text": "Hep B, adolescent or pediatric" }, "servicedPeriod": { "start": "2021-04-07T01:31:56+02:00", "end": "2021-04-07T01:46:56+02:00" }, "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" } ] } } ] } ], "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": 108.80000000000001, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11", "resource": { "resourceType": "Encounter", "id": "f7f74f24-035a-5ced-7cc3-d814d0e1eb11", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "f7f74f24-035a-5ced-7cc3-d814d0e1eb11" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } } ], "period": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:a5b77635-c23d-b012-511c-3680dc8c68d4", "resource": { "resourceType": "Observation", "id": "a5b77635-c23d-b012-511c-3680dc8c68d4", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+02:00", "valueQuantity": { "value": 61.5, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c93c3385-ecb8-207c-6767-efaea4ff9c1d", "resource": { "resourceType": "Observation", "id": "c93c3385-ecb8-207c-6767-efaea4ff9c1d", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+02:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:619cd597-edaf-0c60-ee02-2987fed7dabf", "resource": { "resourceType": "Observation", "id": "619cd597-edaf-0c60-ee02-2987fed7dabf", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+02:00", "valueQuantity": { "value": 6.5, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4e9d617e-dffb-014b-2047-1aff1d8b30c9", "resource": { "resourceType": "Observation", "id": "4e9d617e-dffb-014b-2047-1aff1d8b30c9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-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": "77606-2", "display": "Weight-for-length Per age and sex" } ], "text": "Weight-for-length Per age and sex" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+02:00", "valueQuantity": { "value": 47.435, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c789a68b-07a7-8646-4d07-5fb25003d34a", "resource": { "resourceType": "Observation", "id": "c789a68b-07a7-8646-4d07-5fb25003d34a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ] }, "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": "8289-1", "display": "Head Occipital-frontal circumference Percentile" } ], "text": "Head Occipital-frontal circumference Percentile" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+02:00", "valueQuantity": { "value": 43.17, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7c7119a2-a99c-5419-ca42-7b97ae85e1a5", "resource": { "resourceType": "Observation", "id": "7c7119a2-a99c-5419-ca42-7b97ae85e1a5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ] }, "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": "9843-4", "display": "Head Occipital-frontal circumference" } ], "text": "Head Occipital-frontal circumference" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+02:00", "valueQuantity": { "value": 41.52, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3c6617e5-5ee8-2192-ec7d-0dd0790b9418", "resource": { "resourceType": "Observation", "id": "3c6617e5-5ee8-2192-ec7d-0dd0790b9418", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+02:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 76, "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": 124, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:59fb0df3-e406-7aad-d56d-6b7433a3ecd7", "resource": { "resourceType": "Observation", "id": "59fb0df3-e406-7aad-d56d-6b7433a3ecd7", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+02:00", "valueQuantity": { "value": 92, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b1b6125b-c119-8ea0-0ddb-2dc0e2fa1bfd", "resource": { "resourceType": "Observation", "id": "b1b6125b-c119-8ea0-0ddb-2dc0e2fa1bfd", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+02:00", "valueQuantity": { "value": 15, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a11ee7fb-7db5-701c-8edd-22e37e74dc73", "resource": { "resourceType": "Observation", "id": "a11ee7fb-7db5-701c-8edd-22e37e74dc73", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+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:6aa19090-4d6a-5d50-f505-d26d99987394", "resource": { "resourceType": "Procedure", "id": "6aa19090-4d6a-5d50-f505-d26d99987394", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "performedPeriod": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:fcdfceb0-466f-5e25-c09a-b6b44b6f0f5f", "resource": { "resourceType": "Immunization", "id": "fcdfceb0-466f-5e25-c09a-b6b44b6f0f5f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "49", "display": "Hib (PRP-OMP)" } ], "text": "Hib (PRP-OMP)" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "occurrenceDateTime": "2021-06-09T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:dacd315a-61d4-2aed-d46b-8650d2aa0006", "resource": { "resourceType": "Immunization", "id": "dacd315a-61d4-2aed-d46b-8650d2aa0006", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "119", "display": "rotavirus, monovalent" } ], "text": "rotavirus, monovalent" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "occurrenceDateTime": "2021-06-09T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:c85cb70d-dcdf-1d1d-d6bf-1a064c20ed3f", "resource": { "resourceType": "Immunization", "id": "c85cb70d-dcdf-1d1d-d6bf-1a064c20ed3f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "10", "display": "IPV" } ], "text": "IPV" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "occurrenceDateTime": "2021-06-09T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:97285f95-f330-c213-3704-b0e1c4a5092d", "resource": { "resourceType": "Immunization", "id": "97285f95-f330-c213-3704-b0e1c4a5092d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "20", "display": "DTaP" } ], "text": "DTaP" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "occurrenceDateTime": "2021-06-09T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:679b062f-5219-6f9c-9de0-21870d8cf4d6", "resource": { "resourceType": "Immunization", "id": "679b062f-5219-6f9c-9de0-21870d8cf4d6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "occurrenceDateTime": "2021-06-09T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:d85e04a0-0bbe-b24f-79de-a56006a57b9e", "resource": { "resourceType": "DiagnosticReport", "id": "d85e04a0-0bbe-b24f-79de-a56006a57b9e", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, "effectiveDateTime": "2021-06-09T01:31:56+02:00", "issued": "2021-06-09T01:31:56.064+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:cbcedd9a-0b18-5ec6-0219-52a6101e5e9e", "resource": { "resourceType": "DocumentReference", "id": "cbcedd9a-0b18-5ec6-0219-52a6101e5e9e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:d85e04a0-0bbe-b24f-79de-a56006a57b9e" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2021-06-09T01:31:56.064+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjEtMDYtMDkKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkFybWFuZDE1NQogaXMgYSAzIG1vbnRoLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBtYWxlLiBQYXRpZW50IGhhcyBhIGhpc3Rvcnkgb2YgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgoKClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgSHVtYW5hLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwpObyBBY3RpdmUgTWVkaWNhdGlvbnMuCgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KCgojIyBQbGFuClBhdGllbnQgd2FzIGdpdmVuIHRoZSBmb2xsb3dpbmcgaW1tdW5pemF0aW9uczogaGliIChwcnAtb21wKSwgcm90YXZpcnVzLCBtb25vdmFsZW50LCBpcHYsIGR0YXAsIHBuZXVtb2NvY2NhbCBjb25qdWdhdGUgcGN2IDEzLiAKVGhlIGZvbGxvd2luZyBwcm9jZWR1cmVzIHdlcmUgY29uZHVjdGVkOgotIG1lZGljYXRpb24gcmVjb25jaWxpYXRpb24gKHByb2NlZHVyZSkK" }, "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:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" } ], "period": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:8925f8b1-3a8c-e9ea-c5f4-9f8e21e6e4c8", "resource": { "resourceType": "Claim", "id": "8925f8b1-3a8c-e9ea-c5f4-9f8e21e6e4c8", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "created": "2021-06-09T01:46:56+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:fcdfceb0-466f-5e25-c09a-b6b44b6f0f5f" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:dacd315a-61d4-2aed-d46b-8650d2aa0006" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:c85cb70d-dcdf-1d1d-d6bf-1a064c20ed3f" } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:97285f95-f330-c213-3704-b0e1c4a5092d" } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:679b062f-5219-6f9c-9de0-21870d8cf4d6" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:6aa19090-4d6a-5d50-f505-d26d99987394" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "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:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "49", "display": "Hib (PRP-OMP)" } ], "text": "Hib (PRP-OMP)" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "119", "display": "rotavirus, monovalent" } ], "text": "rotavirus, monovalent" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 4, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "10", "display": "IPV" } ], "text": "IPV" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "20", "display": "DTaP" } ], "text": "DTaP" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 344.41, "currency": "USD" } } ], "total": { "value": 1161.21, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:f3f5c84f-e59b-c82e-a619-a6709d9a81e1", "resource": { "resourceType": "ExplanationOfBenefit", "id": "f3f5c84f-e59b-c82e-a619-a6709d9a81e1", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "8925f8b1-3a8c-e9ea-c5f4-9f8e21e6e4c8" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2021-06-09T01:46:56+02:00", "end": "2022-06-09T01:46:56+02:00" }, "created": "2021-06-09T01:46:56+02:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "claim": { "reference": "urn:uuid:8925f8b1-3a8c-e9ea-c5f4-9f8e21e6e4c8" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" } ] }, { "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": "49", "display": "Hib (PRP-OMP)" } ], "text": "Hib (PRP-OMP)" }, "servicedPeriod": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "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": "119", "display": "rotavirus, monovalent" } ], "text": "rotavirus, monovalent" }, "servicedPeriod": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "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": "10", "display": "IPV" } ], "text": "IPV" }, "servicedPeriod": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "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, "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://hl7.org/fhir/sid/cvx", "code": "20", "display": "DTaP" } ], "text": "DTaP" }, "servicedPeriod": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "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": 6, "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://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "servicedPeriod": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "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": 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": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2021-06-09T01:31:56+02:00", "end": "2021-06-09T01:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 344.41, "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": 68.882, "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": 275.528, "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": 344.41, "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": 344.41, "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": 1161.21, "currency": "USD" } } ], "payment": { "amount": { "value": 819.528, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af", "resource": { "resourceType": "Encounter", "id": "3ca2f3fe-0d57-d84f-aebb-772208f827af", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "3ca2f3fe-0d57-d84f-aebb-772208f827af" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } } ], "period": { "start": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:070f7b67-8eb6-9ee2-2843-4adfa68f6508", "resource": { "resourceType": "Condition", "id": "070f7b67-8eb6-9ee2-2843-4adfa68f6508", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "onsetDateTime": "2021-08-11T01:31:56+02:00", "abatementDateTime": "2022-02-09T00:31:56+01:00", "recordedDate": "2021-08-11T01:31:56+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:1f1addd7-ecef-9428-9f47-0ccbf98751a1", "resource": { "resourceType": "Observation", "id": "1f1addd7-ecef-9428-9f47-0ccbf98751a1", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+02:00", "valueQuantity": { "value": 65.5, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:272e7bbb-9b17-f9d8-6dff-86f0babdd05f", "resource": { "resourceType": "Observation", "id": "272e7bbb-9b17-f9d8-6dff-86f0babdd05f", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+02:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b15bdc83-02eb-24a4-502e-2568a52f9548", "resource": { "resourceType": "Observation", "id": "b15bdc83-02eb-24a4-502e-2568a52f9548", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+02:00", "valueQuantity": { "value": 7.8, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:97e24a41-37d5-b235-ce75-4ae754b54ec5", "resource": { "resourceType": "Observation", "id": "97e24a41-37d5-b235-ce75-4ae754b54ec5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-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": "77606-2", "display": "Weight-for-length Per age and sex" } ], "text": "Weight-for-length Per age and sex" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+02:00", "valueQuantity": { "value": 64.772, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cf7cacbb-ae98-cfe1-effd-4e3446a3639c", "resource": { "resourceType": "Observation", "id": "cf7cacbb-ae98-cfe1-effd-4e3446a3639c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ] }, "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": "8289-1", "display": "Head Occipital-frontal circumference Percentile" } ], "text": "Head Occipital-frontal circumference Percentile" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+02:00", "valueQuantity": { "value": 43.17, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f9a7f2a7-3e15-df13-e160-977e5b44809b", "resource": { "resourceType": "Observation", "id": "f9a7f2a7-3e15-df13-e160-977e5b44809b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ] }, "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": "9843-4", "display": "Head Occipital-frontal circumference" } ], "text": "Head Occipital-frontal circumference" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+02:00", "valueQuantity": { "value": 43.17, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c1cc8278-93e5-de68-ffc3-90d46280a1d5", "resource": { "resourceType": "Observation", "id": "c1cc8278-93e5-de68-ffc3-90d46280a1d5", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+02:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 75, "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": 122, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c423a8e7-aec6-cd19-2ad8-7411ab253704", "resource": { "resourceType": "Observation", "id": "c423a8e7-aec6-cd19-2ad8-7411ab253704", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+02:00", "valueQuantity": { "value": 93, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:16afd455-5e46-8b06-9336-db8b58741cfd", "resource": { "resourceType": "Observation", "id": "16afd455-5e46-8b06-9336-db8b58741cfd", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+02:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e3786abc-4353-adfc-9500-25f953930ab2", "resource": { "resourceType": "Observation", "id": "e3786abc-4353-adfc-9500-25f953930ab2", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+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:1620251a-0974-95d7-8b28-fddccd634855", "resource": { "resourceType": "Immunization", "id": "1620251a-0974-95d7-8b28-fddccd634855", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "49", "display": "Hib (PRP-OMP)" } ], "text": "Hib (PRP-OMP)" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "occurrenceDateTime": "2021-08-11T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:2b1d1777-cab2-f8a4-9afb-ed02739a7104", "resource": { "resourceType": "Immunization", "id": "2b1d1777-cab2-f8a4-9afb-ed02739a7104", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "119", "display": "rotavirus, monovalent" } ], "text": "rotavirus, monovalent" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "occurrenceDateTime": "2021-08-11T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:ae63d156-18a0-45c7-aa50-cbe40eb549cd", "resource": { "resourceType": "Immunization", "id": "ae63d156-18a0-45c7-aa50-cbe40eb549cd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "10", "display": "IPV" } ], "text": "IPV" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "occurrenceDateTime": "2021-08-11T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:12e11c6b-f646-d0f4-6850-f4ecfbe0a4a0", "resource": { "resourceType": "Immunization", "id": "12e11c6b-f646-d0f4-6850-f4ecfbe0a4a0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "20", "display": "DTaP" } ], "text": "DTaP" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "occurrenceDateTime": "2021-08-11T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:aa18b10d-fa93-8197-de77-e4c129353bb6", "resource": { "resourceType": "Immunization", "id": "aa18b10d-fa93-8197-de77-e4c129353bb6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "occurrenceDateTime": "2021-08-11T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:3b2c3d4c-3340-f861-d86f-3e8db336c5f3", "resource": { "resourceType": "DiagnosticReport", "id": "3b2c3d4c-3340-f861-d86f-3e8db336c5f3", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, "effectiveDateTime": "2021-08-11T01:31:56+02:00", "issued": "2021-08-11T01:31:56.064+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:7be77f97-1020-4842-2a54-1481282a5442", "resource": { "resourceType": "DocumentReference", "id": "7be77f97-1020-4842-2a54-1481282a5442", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:3b2c3d4c-3340-f861-d86f-3e8db336c5f3" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2021-08-11T01:31:56.064+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "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:3ca2f3fe-0d57-d84f-aebb-772208f827af" } ], "period": { "start": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:4d1e1058-bdac-91a2-368a-84330a459322", "resource": { "resourceType": "Claim", "id": "4d1e1058-bdac-91a2-368a-84330a459322", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+02:00" }, "created": "2021-08-11T01:46:56+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:1620251a-0974-95d7-8b28-fddccd634855" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:2b1d1777-cab2-f8a4-9afb-ed02739a7104" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:ae63d156-18a0-45c7-aa50-cbe40eb549cd" } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:12e11c6b-f646-d0f4-6850-f4ecfbe0a4a0" } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:aa18b10d-fa93-8197-de77-e4c129353bb6" } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:070f7b67-8eb6-9ee2-2843-4adfa68f6508" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "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:3ca2f3fe-0d57-d84f-aebb-772208f827af" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "49", "display": "Hib (PRP-OMP)" } ], "text": "Hib (PRP-OMP)" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "119", "display": "rotavirus, monovalent" } ], "text": "rotavirus, monovalent" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 4, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "10", "display": "IPV" } ], "text": "IPV" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "20", "display": "DTaP" } ], "text": "DTaP" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 7, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } } ], "total": { "value": 816.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:7196a482-0897-2682-a896-7bb85ee5c5cb", "resource": { "resourceType": "ExplanationOfBenefit", "id": "7196a482-0897-2682-a896-7bb85ee5c5cb", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "4d1e1058-bdac-91a2-368a-84330a459322" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2021-08-11T01:46:56+02:00", "end": "2022-08-11T01:46:56+02:00" }, "created": "2021-08-11T01:46:56+02:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "claim": { "reference": "urn:uuid:4d1e1058-bdac-91a2-368a-84330a459322" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:070f7b67-8eb6-9ee2-2843-4adfa68f6508" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" } ] }, { "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": "49", "display": "Hib (PRP-OMP)" } ], "text": "Hib (PRP-OMP)" }, "servicedPeriod": { "start": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+02:00" }, "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": "119", "display": "rotavirus, monovalent" } ], "text": "rotavirus, monovalent" }, "servicedPeriod": { "start": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+02:00" }, "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": "10", "display": "IPV" } ], "text": "IPV" }, "servicedPeriod": { "start": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+02:00" }, "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, "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://hl7.org/fhir/sid/cvx", "code": "20", "display": "DTaP" } ], "text": "DTaP" }, "servicedPeriod": { "start": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+02:00" }, "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": 6, "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://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "servicedPeriod": { "start": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+02:00" }, "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": 7, "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": "2021-08-11T01:31:56+02:00", "end": "2021-08-11T01:46:56+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": 816.80, "currency": "USD" } } ], "payment": { "amount": { "value": 544.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0", "resource": { "resourceType": "Encounter", "id": "7813f993-0731-21cf-16e5-ef74cd207ba0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "7813f993-0731-21cf-16e5-ef74cd207ba0" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-11-10T00:31:56+01:00", "end": "2021-11-10T00:46:56+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } } ], "period": { "start": "2021-11-10T00:31:56+01:00", "end": "2021-11-10T00:46:56+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:93d878de-35a4-7782-0558-d2f36296292e", "resource": { "resourceType": "Observation", "id": "93d878de-35a4-7782-0558-d2f36296292e", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+01:00", "valueQuantity": { "value": 70.3, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:15c32099-af2f-058d-2cf0-632ef56f2b09", "resource": { "resourceType": "Observation", "id": "15c32099-af2f-058d-2cf0-632ef56f2b09", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+01:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:91555edd-7c33-4ead-eb1a-f6b0fb8f2be4", "resource": { "resourceType": "Observation", "id": "91555edd-7c33-4ead-eb1a-f6b0fb8f2be4", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+01:00", "valueQuantity": { "value": 9.2, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:75ae0910-04b6-37b2-50ca-60f01c548f57", "resource": { "resourceType": "Observation", "id": "75ae0910-04b6-37b2-50ca-60f01c548f57", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-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": "77606-2", "display": "Weight-for-length Per age and sex" } ], "text": "Weight-for-length Per age and sex" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+01:00", "valueQuantity": { "value": 81.022, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:05902004-6f17-1e70-267d-b0c5201c92ff", "resource": { "resourceType": "Observation", "id": "05902004-6f17-1e70-267d-b0c5201c92ff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ] }, "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": "8289-1", "display": "Head Occipital-frontal circumference Percentile" } ], "text": "Head Occipital-frontal circumference Percentile" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+01:00", "valueQuantity": { "value": 43.17, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8154babf-db4d-e00c-7059-108fb7a1e3b4", "resource": { "resourceType": "Observation", "id": "8154babf-db4d-e00c-7059-108fb7a1e3b4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ] }, "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": "9843-4", "display": "Head Occipital-frontal circumference" } ], "text": "Head Occipital-frontal circumference" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+01:00", "valueQuantity": { "value": 44.84, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:95351e9d-c461-dfd5-5636-bd977b9d20ae", "resource": { "resourceType": "Observation", "id": "95351e9d-c461-dfd5-5636-bd977b9d20ae", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 77, "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": 124, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2ed1f94d-375a-833c-8a8f-c14fe9085b0a", "resource": { "resourceType": "Observation", "id": "2ed1f94d-375a-833c-8a8f-c14fe9085b0a", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+01:00", "valueQuantity": { "value": 83, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6e794fac-9c66-699b-d931-74f339536b64", "resource": { "resourceType": "Observation", "id": "6e794fac-9c66-699b-d931-74f339536b64", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+01:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b8c2d376-1dee-0c6f-db64-77f381003027", "resource": { "resourceType": "Observation", "id": "b8c2d376-1dee-0c6f-db64-77f381003027", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+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:239b5bec-0dab-891e-5dca-c1fe9eef309e", "resource": { "resourceType": "Immunization", "id": "239b5bec-0dab-891e-5dca-c1fe9eef309e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "10", "display": "IPV" } ], "text": "IPV" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "occurrenceDateTime": "2021-11-10T00:31:56+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:e4055da9-6b62-daf1-982b-d740a8f60b2e", "resource": { "resourceType": "Immunization", "id": "e4055da9-6b62-daf1-982b-d740a8f60b2e", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "occurrenceDateTime": "2021-11-10T00:31:56+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:d3d9d175-78df-eaac-de4e-8224a4bebd0c", "resource": { "resourceType": "Immunization", "id": "d3d9d175-78df-eaac-de4e-8224a4bebd0c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "20", "display": "DTaP" } ], "text": "DTaP" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "occurrenceDateTime": "2021-11-10T00:31:56+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:c377f383-d042-f7a7-faa7-fb8364e225c5", "resource": { "resourceType": "Immunization", "id": "c377f383-d042-f7a7-faa7-fb8364e225c5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "occurrenceDateTime": "2021-11-10T00:31:56+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:5be3fad5-381c-a543-fa5c-4a0e12d29398", "resource": { "resourceType": "Immunization", "id": "5be3fad5-381c-a543-fa5c-4a0e12d29398", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "08", "display": "Hep B, adolescent or pediatric" } ], "text": "Hep B, adolescent or pediatric" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "occurrenceDateTime": "2021-11-10T00:31:56+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:68a7b807-d940-56c1-9ef2-2d13de465698", "resource": { "resourceType": "DiagnosticReport", "id": "68a7b807-d940-56c1-9ef2-2d13de465698", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, "effectiveDateTime": "2021-11-10T00:31:56+01:00", "issued": "2021-11-10T00:31:56.064+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:9d9c7f8c-5bf6-f7a1-cd9b-393eaf9f57c9", "resource": { "resourceType": "DocumentReference", "id": "9d9c7f8c-5bf6-f7a1-cd9b-393eaf9f57c9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:68a7b807-d940-56c1-9ef2-2d13de465698" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2021-11-10T00:31:56.064+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "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:7813f993-0731-21cf-16e5-ef74cd207ba0" } ], "period": { "start": "2021-11-10T00:31:56+01:00", "end": "2021-11-10T00:46:56+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:0eefe86c-1dad-60a1-c4f9-69c4dfd98011", "resource": { "resourceType": "Claim", "id": "0eefe86c-1dad-60a1-c4f9-69c4dfd98011", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2021-11-10T00:31:56+01:00", "end": "2021-11-10T00:46:56+01:00" }, "created": "2021-11-10T00:46:56+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:239b5bec-0dab-891e-5dca-c1fe9eef309e" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:e4055da9-6b62-daf1-982b-d740a8f60b2e" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:d3d9d175-78df-eaac-de4e-8224a4bebd0c" } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:c377f383-d042-f7a7-faa7-fb8364e225c5" } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:5be3fad5-381c-a543-fa5c-4a0e12d29398" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "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:7813f993-0731-21cf-16e5-ef74cd207ba0" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "10", "display": "IPV" } ], "text": "IPV" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "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": 4, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "20", "display": "DTaP" } ], "text": "DTaP" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "08", "display": "Hep B, adolescent or pediatric" } ], "text": "Hep B, adolescent or pediatric" }, "net": { "value": 136.00, "currency": "USD" } } ], "total": { "value": 816.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:de96614f-2ea4-383d-3a95-be28881949b9", "resource": { "resourceType": "ExplanationOfBenefit", "id": "de96614f-2ea4-383d-3a95-be28881949b9", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0eefe86c-1dad-60a1-c4f9-69c4dfd98011" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2021-11-10T00:46:56+01:00", "end": "2022-11-10T00:46:56+01:00" }, "created": "2021-11-10T00:46:56+01:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "claim": { "reference": "urn:uuid:0eefe86c-1dad-60a1-c4f9-69c4dfd98011" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2021-11-10T00:31:56+01:00", "end": "2021-11-10T00:46:56+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" } ] }, { "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": "10", "display": "IPV" } ], "text": "IPV" }, "servicedPeriod": { "start": "2021-11-10T00:31:56+01:00", "end": "2021-11-10T00:46:56+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": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2021-11-10T00:31:56+01:00", "end": "2021-11-10T00:46:56+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": "20", "display": "DTaP" } ], "text": "DTaP" }, "servicedPeriod": { "start": "2021-11-10T00:31:56+01:00", "end": "2021-11-10T00:46:56+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, "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://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "servicedPeriod": { "start": "2021-11-10T00:31:56+01:00", "end": "2021-11-10T00:46:56+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": 6, "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://hl7.org/fhir/sid/cvx", "code": "08", "display": "Hep B, adolescent or pediatric" } ], "text": "Hep B, adolescent or pediatric" }, "servicedPeriod": { "start": "2021-11-10T00:31:56+01:00", "end": "2021-11-10T00:46:56+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" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 816.80, "currency": "USD" } } ], "payment": { "amount": { "value": 544.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546", "resource": { "resourceType": "Encounter", "id": "5bb04285-eef8-9b51-badc-7f5dcfbb7546", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "5bb04285-eef8-9b51-badc-7f5dcfbb7546" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2022-02-09T00:31:56+01:00", "end": "2022-02-09T00:46:56+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } } ], "period": { "start": "2022-02-09T00:31:56+01:00", "end": "2022-02-09T00:46:56+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:9d4cd8c2-9ea9-d12e-db08-42e018e48604", "resource": { "resourceType": "Observation", "id": "9d4cd8c2-9ea9-d12e-db08-42e018e48604", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+01:00", "valueQuantity": { "value": 74.3, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a8db313f-1bca-f848-e520-523bd7d11510", "resource": { "resourceType": "Observation", "id": "a8db313f-1bca-f848-e520-523bd7d11510", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+01:00", "valueQuantity": { "value": 4, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:331bc592-8eaa-a1ea-65aa-593daed404ef", "resource": { "resourceType": "Observation", "id": "331bc592-8eaa-a1ea-65aa-593daed404ef", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+01:00", "valueQuantity": { "value": 10.3, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:43d33a47-4878-319f-ca86-b3706813bcdc", "resource": { "resourceType": "Observation", "id": "43d33a47-4878-319f-ca86-b3706813bcdc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-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": "77606-2", "display": "Weight-for-length Per age and sex" } ], "text": "Weight-for-length Per age and sex" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+01:00", "valueQuantity": { "value": 83.648, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5b69010a-4a0b-c95c-61c5-6c93809d4e0e", "resource": { "resourceType": "Observation", "id": "5b69010a-4a0b-c95c-61c5-6c93809d4e0e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ] }, "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": "8289-1", "display": "Head Occipital-frontal circumference Percentile" } ], "text": "Head Occipital-frontal circumference Percentile" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+01:00", "valueQuantity": { "value": 43.17, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e335071a-966d-274f-5a84-b773a4d704e5", "resource": { "resourceType": "Observation", "id": "e335071a-966d-274f-5a84-b773a4d704e5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ] }, "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": "9843-4", "display": "Head Occipital-frontal circumference" } ], "text": "Head Occipital-frontal circumference" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+01:00", "valueQuantity": { "value": 45.97, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3825174a-a630-b27d-c30e-4c5de3d8372a", "resource": { "resourceType": "Observation", "id": "3825174a-a630-b27d-c30e-4c5de3d8372a", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 77, "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": 118, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ca55d935-abf9-0ac3-d9d2-88abb417b459", "resource": { "resourceType": "Observation", "id": "ca55d935-abf9-0ac3-d9d2-88abb417b459", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+01:00", "valueQuantity": { "value": 98, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f5999fae-867c-606c-11f9-89fcac92ad4b", "resource": { "resourceType": "Observation", "id": "f5999fae-867c-606c-11f9-89fcac92ad4b", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+01:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3a9388dc-7ad0-d6ad-65c9-3d8750e869bc", "resource": { "resourceType": "Observation", "id": "3a9388dc-7ad0-d6ad-65c9-3d8750e869bc", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+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:84081622-08cf-3817-8513-af53134fcdfa", "resource": { "resourceType": "Procedure", "id": "84081622-08cf-3817-8513-af53134fcdfa", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "performedPeriod": { "start": "2022-02-09T00:31:56+01:00", "end": "2022-02-09T00:46:56+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:a1db0978-a470-c816-88a4-581a25118811", "resource": { "resourceType": "DiagnosticReport", "id": "a1db0978-a470-c816-88a4-581a25118811", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, "effectiveDateTime": "2022-02-09T00:31:56+01:00", "issued": "2022-02-09T00:31:56.064+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:7996a87a-3b0a-9c3e-7f96-7fb0857fa843", "resource": { "resourceType": "DocumentReference", "id": "7996a87a-3b0a-9c3e-7f96-7fb0857fa843", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:a1db0978-a470-c816-88a4-581a25118811" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2022-02-09T00:31:56.064+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjItMDItMDkKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkFybWFuZDE1NQogaXMgYSAxMSBtb250aC1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgbWFsZS4gUGF0aWVudCBoYXMgYSBoaXN0b3J5IG9mIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKS4KCiMgU29jaWFsIEhpc3RvcnkKIFBhdGllbnQgaGFzIG5ldmVyIHNtb2tlZC4KCgpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgoKUGF0aWVudCBjdXJyZW50bHkgaGFzIEh1bWFuYS4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKTm8gQWN0aXZlIE1lZGljYXRpb25zLgoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgoKVGhlIGZvbGxvd2luZyBwcm9jZWR1cmVzIHdlcmUgY29uZHVjdGVkOgotIG1lZGljYXRpb24gcmVjb25jaWxpYXRpb24gKHByb2NlZHVyZSkK" }, "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:5bb04285-eef8-9b51-badc-7f5dcfbb7546" } ], "period": { "start": "2022-02-09T00:31:56+01:00", "end": "2022-02-09T00:46:56+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:0b49154d-9b33-8fe5-207d-48691e52914d", "resource": { "resourceType": "Claim", "id": "0b49154d-9b33-8fe5-207d-48691e52914d", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2022-02-09T00:31:56+01:00", "end": "2022-02-09T00:46:56+01:00" }, "created": "2022-02-09T00:46:56+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:84081622-08cf-3817-8513-af53134fcdfa" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "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:5bb04285-eef8-9b51-badc-7f5dcfbb7546" } ] }, { "sequence": 2, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 388.79, "currency": "USD" } } ], "total": { "value": 525.59, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:83f97241-1967-eaf2-7e56-90010f35808d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "83f97241-1967-eaf2-7e56-90010f35808d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0b49154d-9b33-8fe5-207d-48691e52914d" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2022-02-09T00:46:56+01:00", "end": "2023-02-09T00:46:56+01:00" }, "created": "2022-02-09T00:46:56+01:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "claim": { "reference": "urn:uuid:0b49154d-9b33-8fe5-207d-48691e52914d" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2022-02-09T00:31:56+01:00", "end": "2022-02-09T00:46:56+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" } ] }, { "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": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2022-02-09T00:31:56+01:00", "end": "2022-02-09T00:46:56+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 388.79, "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": 77.75800000000001, "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": 311.03200000000004, "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": 388.79, "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": 388.79, "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": 525.59, "currency": "USD" } } ], "payment": { "amount": { "value": 311.03200000000004, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e", "resource": { "resourceType": "Encounter", "id": "7394bf37-6fbc-a015-ab89-4e7912c7588e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "7394bf37-6fbc-a015-ab89-4e7912c7588e" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } } ], "period": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:8313cf27-1012-ccf1-2a83-7f677304bedf", "resource": { "resourceType": "Condition", "id": "8313cf27-1012-ccf1-2a83-7f677304bedf", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "onsetDateTime": "2022-05-11T01:31:56+02:00", "abatementDateTime": "2022-05-11T01:31:56+02:00", "recordedDate": "2022-05-11T01:31:56+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:000effa3-ffb2-cdd8-736a-8dc6ffa25038", "resource": { "resourceType": "Observation", "id": "000effa3-ffb2-cdd8-736a-8dc6ffa25038", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+02:00", "valueQuantity": { "value": 77.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:35ab68be-427a-3217-0b65-194d576930b6", "resource": { "resourceType": "Observation", "id": "35ab68be-427a-3217-0b65-194d576930b6", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+02:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9f05348d-104c-545b-4c45-f24181a89620", "resource": { "resourceType": "Observation", "id": "9f05348d-104c-545b-4c45-f24181a89620", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+02:00", "valueQuantity": { "value": 11.2, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ab6dcc31-e1b4-698e-6ef7-d6191d152ac6", "resource": { "resourceType": "Observation", "id": "ab6dcc31-e1b4-698e-6ef7-d6191d152ac6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-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": "77606-2", "display": "Weight-for-length Per age and sex" } ], "text": "Weight-for-length Per age and sex" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+02:00", "valueQuantity": { "value": 81.294, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:fa6b7e7d-b30b-2718-ad1e-ca8219e2eb06", "resource": { "resourceType": "Observation", "id": "fa6b7e7d-b30b-2718-ad1e-ca8219e2eb06", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ] }, "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": "8289-1", "display": "Head Occipital-frontal circumference Percentile" } ], "text": "Head Occipital-frontal circumference Percentile" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+02:00", "valueQuantity": { "value": 43.17, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f5530f1c-6966-4bf6-f4b5-346260668126", "resource": { "resourceType": "Observation", "id": "f5530f1c-6966-4bf6-f4b5-346260668126", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ] }, "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": "9843-4", "display": "Head Occipital-frontal circumference" } ], "text": "Head Occipital-frontal circumference" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+02:00", "valueQuantity": { "value": 46.81, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c23b4080-d0a2-a3b8-3e50-ce0f8626e548", "resource": { "resourceType": "Observation", "id": "c23b4080-d0a2-a3b8-3e50-ce0f8626e548", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+02:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 69, "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": 120, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:01b85179-06f6-4bd3-959b-c9052294977c", "resource": { "resourceType": "Observation", "id": "01b85179-06f6-4bd3-959b-c9052294977c", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+02:00", "valueQuantity": { "value": 71, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8649828b-6a1d-b72a-d61a-87c8c7051554", "resource": { "resourceType": "Observation", "id": "8649828b-6a1d-b72a-d61a-87c8c7051554", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+02:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cbe88db8-7781-444c-1b52-774eb823a8ba", "resource": { "resourceType": "Observation", "id": "cbe88db8-7781-444c-1b52-774eb823a8ba", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+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:071f6f03-8f48-cceb-e8fb-83bb7c1a3ba1", "resource": { "resourceType": "Procedure", "id": "071f6f03-8f48-cceb-e8fb-83bb7c1a3ba1", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "performedPeriod": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:684200db-600e-e7f5-2d97-12c9e3eb0734", "resource": { "resourceType": "Immunization", "id": "684200db-600e-e7f5-2d97-12c9e3eb0734", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "49", "display": "Hib (PRP-OMP)" } ], "text": "Hib (PRP-OMP)" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "occurrenceDateTime": "2022-05-11T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:e8c22c47-5732-ce61-3b06-67de6c1c0c1a", "resource": { "resourceType": "Immunization", "id": "e8c22c47-5732-ce61-3b06-67de6c1c0c1a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "21", "display": "varicella" } ], "text": "varicella" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "occurrenceDateTime": "2022-05-11T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:c65efd3b-425f-c94d-3ca7-fd5f5d4cb343", "resource": { "resourceType": "Immunization", "id": "c65efd3b-425f-c94d-3ca7-fd5f5d4cb343", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "03", "display": "MMR" } ], "text": "MMR" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "occurrenceDateTime": "2022-05-11T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:3d095e69-0ea4-dfc9-cf10-a71b8c48fc8d", "resource": { "resourceType": "Immunization", "id": "3d095e69-0ea4-dfc9-cf10-a71b8c48fc8d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "occurrenceDateTime": "2022-05-11T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:f907aa90-ef34-35e7-c858-7ec11b9deeab", "resource": { "resourceType": "Immunization", "id": "f907aa90-ef34-35e7-c858-7ec11b9deeab", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "83", "display": "Hep A, ped/adol, 2 dose" } ], "text": "Hep A, ped/adol, 2 dose" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "occurrenceDateTime": "2022-05-11T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:2657b7ad-be96-719d-70cc-c3b2c49648d3", "resource": { "resourceType": "DiagnosticReport", "id": "2657b7ad-be96-719d-70cc-c3b2c49648d3", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, "effectiveDateTime": "2022-05-11T01:31:56+02:00", "issued": "2022-05-11T01:31:56.064+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjItMDUtMTEKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkFybWFuZDE1NQogaXMgYSAxIHllYXItb2xkIG5vbmhpc3BhbmljIHdoaXRlIG1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbikuCgojIFNvY2lhbCBIaXN0b3J5CiBQYXRpZW50IGhhcyBuZXZlciBzbW9rZWQuCgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KClBhdGllbnQgY3VycmVudGx5IGhhcyBIdW1hbmEuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCk5vIEFjdGl2ZSBNZWRpY2F0aW9ucy4KCiMgQXNzZXNzbWVudCBhbmQgUGxhbgpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbikuIAoKIyMgUGxhbgpQYXRpZW50IHdhcyBnaXZlbiB0aGUgZm9sbG93aW5nIGltbXVuaXphdGlvbnM6IGhpYiAocHJwLW9tcCksIHZhcmljZWxsYSwgbW1yLCBwbmV1bW9jb2NjYWwgY29uanVnYXRlIHBjdiAxMywgaGVwIGEsIHBlZC9hZG9sLCAyIGRvc2UuIApUaGUgZm9sbG93aW5nIHByb2NlZHVyZXMgd2VyZSBjb25kdWN0ZWQ6Ci0gbWVkaWNhdGlvbiByZWNvbmNpbGlhdGlvbiAocHJvY2VkdXJlKQo=" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:a121b45f-f476-458f-9fdb-66b39cd66dbf", "resource": { "resourceType": "DocumentReference", "id": "a121b45f-f476-458f-9fdb-66b39cd66dbf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:2657b7ad-be96-719d-70cc-c3b2c49648d3" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2022-05-11T01:31:56.064+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "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:7394bf37-6fbc-a015-ab89-4e7912c7588e" } ], "period": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:c6474326-6330-ac45-ed0e-ce499afbd296", "resource": { "resourceType": "Claim", "id": "c6474326-6330-ac45-ed0e-ce499afbd296", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "created": "2022-05-11T01:46:56+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:684200db-600e-e7f5-2d97-12c9e3eb0734" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:e8c22c47-5732-ce61-3b06-67de6c1c0c1a" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:c65efd3b-425f-c94d-3ca7-fd5f5d4cb343" } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:3d095e69-0ea4-dfc9-cf10-a71b8c48fc8d" } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:f907aa90-ef34-35e7-c858-7ec11b9deeab" } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:8313cf27-1012-ccf1-2a83-7f677304bedf" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:071f6f03-8f48-cceb-e8fb-83bb7c1a3ba1" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "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:7394bf37-6fbc-a015-ab89-4e7912c7588e" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "49", "display": "Hib (PRP-OMP)" } ], "text": "Hib (PRP-OMP)" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "21", "display": "varicella" } ], "text": "varicella" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 4, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "03", "display": "MMR" } ], "text": "MMR" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 5, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "83", "display": "Hep A, ped/adol, 2 dose" } ], "text": "Hep A, ped/adol, 2 dose" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 7, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 8, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 659.91, "currency": "USD" } } ], "total": { "value": 1476.71, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:24f012bc-c0ed-9ad1-67d0-0da38bbceca2", "resource": { "resourceType": "ExplanationOfBenefit", "id": "24f012bc-c0ed-9ad1-67d0-0da38bbceca2", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c6474326-6330-ac45-ed0e-ce499afbd296" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2022-05-11T01:46:56+02:00", "end": "2023-05-11T01:46:56+02:00" }, "created": "2022-05-11T01:46:56+02:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "claim": { "reference": "urn:uuid:c6474326-6330-ac45-ed0e-ce499afbd296" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:8313cf27-1012-ccf1-2a83-7f677304bedf" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" } ] }, { "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": "49", "display": "Hib (PRP-OMP)" } ], "text": "Hib (PRP-OMP)" }, "servicedPeriod": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "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": "21", "display": "varicella" } ], "text": "varicella" }, "servicedPeriod": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "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": "03", "display": "MMR" } ], "text": "MMR" }, "servicedPeriod": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "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, "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://hl7.org/fhir/sid/cvx", "code": "133", "display": "Pneumococcal conjugate PCV 13" } ], "text": "Pneumococcal conjugate PCV 13" }, "servicedPeriod": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "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": 6, "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://hl7.org/fhir/sid/cvx", "code": "83", "display": "Hep A, ped/adol, 2 dose" } ], "text": "Hep A, ped/adol, 2 dose" }, "servicedPeriod": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "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": 7, "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": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "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": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2022-05-11T01:31:56+02:00", "end": "2022-05-11T01:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 659.91, "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": 131.982, "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": 527.928, "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": 659.91, "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": 659.91, "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": 1476.71, "currency": "USD" } } ], "payment": { "amount": { "value": 1071.9279999999999, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:120c62c0-9421-01bb-04a7-2772658e4725", "resource": { "resourceType": "Encounter", "id": "120c62c0-9421-01bb-04a7-2772658e4725", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "120c62c0-9421-01bb-04a7-2772658e4725" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2022-05-29T07:31:56+02:00", "end": "2022-05-29T07:46:56+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590", "display": "Dr. Lynsey2 Lemke654" } } ], "period": { "start": "2022-05-29T07:31:56+02:00", "end": "2022-05-29T07:46:56+02:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "43878008", "display": "Streptococcal sore throat (disorder)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|29551fe0-34ff-3ae2-bb60-e92b77f4e60d", "display": "MOUNT AUBURN HOSPITAL" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|d0894f6b-78d7-338d-82ad-b63de4d40014", "display": "MOUNT AUBURN HOSPITAL" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:28a12ff5-969c-467f-ef3c-a70b6a80aaab", "resource": { "resourceType": "Condition", "id": "28a12ff5-969c-467f-ef3c-a70b6a80aaab", "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": "43878008", "display": "Streptococcal sore throat (disorder)" } ], "text": "Streptococcal sore throat (disorder)" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:120c62c0-9421-01bb-04a7-2772658e4725" }, "onsetDateTime": "2022-05-29T07:31:56+02:00", "abatementDateTime": "2022-06-07T15:31:56+02:00", "recordedDate": "2022-05-29T07:31:56+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:3c3b8080-4406-6fa2-0c63-0cb74bde68b3", "resource": { "resourceType": "Observation", "id": "3c3b8080-4406-6fa2-0c63-0cb74bde68b3", "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": "8310-5", "display": "Body temperature" }, { "system": "http://loinc.org", "code": "8331-1", "display": "Oral temperature" } ], "text": "Body temperature" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:120c62c0-9421-01bb-04a7-2772658e4725" }, "effectiveDateTime": "2022-05-29T07:31:56+02:00", "issued": "2022-05-29T07:31:56.064+02:00", "valueQuantity": { "value": 38.66, "unit": "Cel", "system": "http://unitsofmeasure.org", "code": "Cel" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:401536a6-6cbe-1765-d494-a056e8440913", "resource": { "resourceType": "MedicationRequest", "id": "401536a6-6cbe-1765-d494-a056e8440913", "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": "834061", "display": "Penicillin V Potassium 250 MG Oral Tablet" } ], "text": "Penicillin V Potassium 250 MG Oral Tablet" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:120c62c0-9421-01bb-04a7-2772658e4725" }, "authoredOn": "2022-05-29T07:31:56+02:00", "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590", "display": "Dr. Lynsey2 Lemke654" }, "reasonReference": [ { "reference": "urn:uuid:28a12ff5-969c-467f-ef3c-a70b6a80aaab", "display": "Streptococcal sore throat (disorder)" } ] }, "request": { "method": "POST", "url": "MedicationRequest" } }, { "fullUrl": "urn:uuid:8457a4c0-d716-664e-9b1a-147898f1ad3a", "resource": { "resourceType": "Claim", "id": "8457a4c0-d716-664e-9b1a-147898f1ad3a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2022-05-29T07:31:56+02:00", "end": "2022-05-29T07:46:56+02:00" }, "created": "2022-05-29T07:46:56+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|d0894f6b-78d7-338d-82ad-b63de4d40014", "display": "MOUNT AUBURN HOSPITAL" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "prescription": { "reference": "urn:uuid:401536a6-6cbe-1765-d494-a056e8440913" }, "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "834061", "display": "Penicillin V Potassium 250 MG Oral Tablet" } ], "text": "Penicillin V Potassium 250 MG Oral Tablet" }, "encounter": [ { "reference": "urn:uuid:120c62c0-9421-01bb-04a7-2772658e4725" } ] } ], "total": { "value": 126.11, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:0330274a-0aec-932c-d0c5-c6a9a5905321", "resource": { "resourceType": "ExplanationOfBenefit", "id": "0330274a-0aec-932c-d0c5-c6a9a5905321", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "8457a4c0-d716-664e-9b1a-147898f1ad3a" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2022-05-29T07:46:56+02:00", "end": "2023-05-29T07:46:56+02:00" }, "created": "2022-05-29T07:46:56+02:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|29551fe0-34ff-3ae2-bb60-e92b77f4e60d", "display": "MOUNT AUBURN HOSPITAL" }, "claim": { "reference": "urn:uuid:8457a4c0-d716-664e-9b1a-147898f1ad3a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "834061", "display": "Penicillin V Potassium 250 MG Oral Tablet" } ], "text": "Penicillin V Potassium 250 MG Oral Tablet" }, "servicedPeriod": { "start": "2022-05-29T07:31:56+02:00", "end": "2022-05-29T07:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:120c62c0-9421-01bb-04a7-2772658e4725" } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 126.11, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d1636330-581d-a4fd-2004-e3d118188bc7", "resource": { "resourceType": "DiagnosticReport", "id": "d1636330-581d-a4fd-2004-e3d118188bc7", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:120c62c0-9421-01bb-04a7-2772658e4725" }, "effectiveDateTime": "2022-05-29T07:31:56+02:00", "issued": "2022-05-29T07:31:56.064+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590", "display": "Dr. Lynsey2 Lemke654" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:3870d569-f234-7616-0fa7-1fdefe397c16", "resource": { "resourceType": "DocumentReference", "id": "3870d569-f234-7616-0fa7-1fdefe397c16", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:d1636330-581d-a4fd-2004-e3d118188bc7" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2022-05-29T07:31:56.064+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590", "display": "Dr. Lynsey2 Lemke654" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|d0894f6b-78d7-338d-82ad-b63de4d40014", "display": "MOUNT AUBURN HOSPITAL" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjItMDUtMjkKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkFybWFuZDE1NQogaXMgYSAxIHllYXItb2xkIG5vbmhpc3BhbmljIHdoaXRlIG1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbikuCgojIFNvY2lhbCBIaXN0b3J5CiBQYXRpZW50IGhhcyBuZXZlciBzbW9rZWQuCgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KClBhdGllbnQgY3VycmVudGx5IGhhcyBIdW1hbmEuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCk5vIEFjdGl2ZSBNZWRpY2F0aW9ucy4KCiMgQXNzZXNzbWVudCBhbmQgUGxhbgpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBzdHJlcHRvY29jY2FsIHNvcmUgdGhyb2F0IChkaXNvcmRlcikuIAoKIyMgUGxhbgoKVGhlIHBhdGllbnQgd2FzIHByZXNjcmliZWQgdGhlIGZvbGxvd2luZyBtZWRpY2F0aW9uczoKLSBwZW5pY2lsbGluIHYgcG90YXNzaXVtIDI1MCBtZyBvcmFsIHRhYmxldAo=" }, "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:120c62c0-9421-01bb-04a7-2772658e4725" } ], "period": { "start": "2022-05-29T07:31:56+02:00", "end": "2022-05-29T07:46:56+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:fba9ecdb-e7f5-d388-15a9-314a625f9b3e", "resource": { "resourceType": "Claim", "id": "fba9ecdb-e7f5-d388-15a9-314a625f9b3e", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2022-05-29T07:31:56+02:00", "end": "2022-05-29T07:46:56+02:00" }, "created": "2022-05-29T07:46:56+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|d0894f6b-78d7-338d-82ad-b63de4d40014", "display": "MOUNT AUBURN HOSPITAL" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|29551fe0-34ff-3ae2-bb60-e92b77f4e60d", "display": "MOUNT AUBURN HOSPITAL" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:28a12ff5-969c-467f-ef3c-a70b6a80aaab" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "encounter": [ { "reference": "urn:uuid:120c62c0-9421-01bb-04a7-2772658e4725" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "43878008", "display": "Streptococcal sore throat (disorder)" } ], "text": "Streptococcal sore throat (disorder)" } } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:0e6599b2-e5d1-ef03-0433-2f52456c92c3", "resource": { "resourceType": "ExplanationOfBenefit", "id": "0e6599b2-e5d1-ef03-0433-2f52456c92c3", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "fba9ecdb-e7f5-d388-15a9-314a625f9b3e" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2022-05-29T07:46:56+02:00", "end": "2023-05-29T07:46:56+02:00" }, "created": "2022-05-29T07:46:56+02:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|29551fe0-34ff-3ae2-bb60-e92b77f4e60d", "display": "MOUNT AUBURN HOSPITAL" }, "claim": { "reference": "urn:uuid:fba9ecdb-e7f5-d388-15a9-314a625f9b3e" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999994590" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:28a12ff5-969c-467f-ef3c-a70b6a80aaab" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2022-05-29T07:31:56+02:00", "end": "2022-05-29T07:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:120c62c0-9421-01bb-04a7-2772658e4725" } ] }, { "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": "43878008", "display": "Streptococcal sore throat (disorder)" } ], "text": "Streptococcal sore throat (disorder)" }, "servicedPeriod": { "start": "2022-05-29T07:31:56+02:00", "end": "2022-05-29T07:46:56+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:fd2afbea-81c5-9545-be6c-07b54c91111d", "resource": { "resourceType": "Encounter", "id": "fd2afbea-81c5-9545-be6c-07b54c91111d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "fd2afbea-81c5-9545-be6c-07b54c91111d" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2022-08-10T01:31:56+02:00", "end": "2022-08-10T01:46:56+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } } ], "period": { "start": "2022-08-10T01:31:56+02:00", "end": "2022-08-10T01:46:56+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:f7f0dc6f-ada8-2564-21e1-7cea87d1eff2", "resource": { "resourceType": "Condition", "id": "f7f0dc6f-ada8-2564-21e1-7cea87d1eff2", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "onsetDateTime": "2022-08-10T01:31:56+02:00", "abatementDateTime": "2023-02-08T00:31:56+01:00", "recordedDate": "2022-08-10T01:31:56+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:a04de614-779f-9b5e-902f-02af047bae25", "resource": { "resourceType": "Observation", "id": "a04de614-779f-9b5e-902f-02af047bae25", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+02:00", "valueQuantity": { "value": 80.7, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a48af20b-c6b6-9987-5169-9e6b27d61faa", "resource": { "resourceType": "Observation", "id": "a48af20b-c6b6-9987-5169-9e6b27d61faa", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+02:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:374310aa-d2a9-e3ec-73a0-af36aafcbb1d", "resource": { "resourceType": "Observation", "id": "374310aa-d2a9-e3ec-73a0-af36aafcbb1d", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+02:00", "valueQuantity": { "value": 11.8, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e912dce4-0615-879a-915f-2cba3439abd3", "resource": { "resourceType": "Observation", "id": "e912dce4-0615-879a-915f-2cba3439abd3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-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": "77606-2", "display": "Weight-for-length Per age and sex" } ], "text": "Weight-for-length Per age and sex" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+02:00", "valueQuantity": { "value": 77.71, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:6da565de-0363-5a96-f6c1-58ab5b476582", "resource": { "resourceType": "Observation", "id": "6da565de-0363-5a96-f6c1-58ab5b476582", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ] }, "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": "8289-1", "display": "Head Occipital-frontal circumference Percentile" } ], "text": "Head Occipital-frontal circumference Percentile" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+02:00", "valueQuantity": { "value": 43.17, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9baa4143-7943-6447-3437-c117187073a9", "resource": { "resourceType": "Observation", "id": "9baa4143-7943-6447-3437-c117187073a9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ] }, "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": "9843-4", "display": "Head Occipital-frontal circumference" } ], "text": "Head Occipital-frontal circumference" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+02:00", "valueQuantity": { "value": 47.45, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:01c7cf1b-412a-4dcc-4ef1-050ea0200591", "resource": { "resourceType": "Observation", "id": "01c7cf1b-412a-4dcc-4ef1-050ea0200591", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+02:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 76, "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": 125, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d7b55de2-d9d2-146b-4d6a-c41d8273280a", "resource": { "resourceType": "Observation", "id": "d7b55de2-d9d2-146b-4d6a-c41d8273280a", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+02:00", "valueQuantity": { "value": 98, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:34bb151d-ac37-e4f8-fffc-805d7659efcb", "resource": { "resourceType": "Observation", "id": "34bb151d-ac37-e4f8-fffc-805d7659efcb", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+02:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c9936e5b-1a90-1117-7567-78cc527a51b4", "resource": { "resourceType": "Observation", "id": "c9936e5b-1a90-1117-7567-78cc527a51b4", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+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:8317b2d7-f5c4-1756-aa09-f5dfcdc3d890", "resource": { "resourceType": "Immunization", "id": "8317b2d7-f5c4-1756-aa09-f5dfcdc3d890", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "20", "display": "DTaP" } ], "text": "DTaP" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "occurrenceDateTime": "2022-08-10T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:b6cdde14-cbf7-b639-5e1e-9e652bf5299e", "resource": { "resourceType": "DiagnosticReport", "id": "b6cdde14-cbf7-b639-5e1e-9e652bf5299e", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, "effectiveDateTime": "2022-08-10T01:31:56+02:00", "issued": "2022-08-10T01:31:56.064+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:20b4eb25-da7e-2009-0c50-10606080a309", "resource": { "resourceType": "DocumentReference", "id": "20b4eb25-da7e-2009-0c50-10606080a309", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:b6cdde14-cbf7-b639-5e1e-9e652bf5299e" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2022-08-10T01:31:56.064+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjIwMjItMDgtMTAKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkFybWFuZDE1NQogaXMgYSAxIHllYXItb2xkIG5vbmhpc3BhbmljIHdoaXRlIG1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBzdHJlcHRvY29jY2FsIHNvcmUgdGhyb2F0IChkaXNvcmRlciksIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKS4KCiMgU29jaWFsIEhpc3RvcnkKIFBhdGllbnQgaGFzIG5ldmVyIHNtb2tlZC4KCgpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgoKUGF0aWVudCBjdXJyZW50bHkgaGFzIEh1bWFuYS4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKcGVuaWNpbGxpbiB2IHBvdGFzc2l1bSAyNTAgbWcgb3JhbCB0YWJsZXQKCiMgQXNzZXNzbWVudCBhbmQgUGxhbgpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbikuIAoKIyMgUGxhbgpQYXRpZW50IHdhcyBnaXZlbiB0aGUgZm9sbG93aW5nIGltbXVuaXphdGlvbnM6IGR0YXAuIAo=" }, "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:fd2afbea-81c5-9545-be6c-07b54c91111d" } ], "period": { "start": "2022-08-10T01:31:56+02:00", "end": "2022-08-10T01:46:56+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:9f553073-eb20-f48d-4b93-6751c988fbf2", "resource": { "resourceType": "Claim", "id": "9f553073-eb20-f48d-4b93-6751c988fbf2", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2022-08-10T01:31:56+02:00", "end": "2022-08-10T01:46:56+02:00" }, "created": "2022-08-10T01:46:56+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:8317b2d7-f5c4-1756-aa09-f5dfcdc3d890" } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:f7f0dc6f-ada8-2564-21e1-7cea87d1eff2" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "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:fd2afbea-81c5-9545-be6c-07b54c91111d" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "20", "display": "DTaP" } ], "text": "DTaP" }, "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)" } } ], "total": { "value": 272.80, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:1b700242-c1f2-3716-82af-7042705ee428", "resource": { "resourceType": "ExplanationOfBenefit", "id": "1b700242-c1f2-3716-82af-7042705ee428", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "9f553073-eb20-f48d-4b93-6751c988fbf2" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2022-08-10T01:46:56+02:00", "end": "2023-08-10T01:46:56+02:00" }, "created": "2022-08-10T01:46:56+02:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "claim": { "reference": "urn:uuid:9f553073-eb20-f48d-4b93-6751c988fbf2" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:f7f0dc6f-ada8-2564-21e1-7cea87d1eff2" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2022-08-10T01:31:56+02:00", "end": "2022-08-10T01:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" } ] }, { "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": "20", "display": "DTaP" } ], "text": "DTaP" }, "servicedPeriod": { "start": "2022-08-10T01:31:56+02:00", "end": "2022-08-10T01:46:56+02:00" }, "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": "2022-08-10T01:31:56+02:00", "end": "2022-08-10T01:46:56+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": 108.80000000000001, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306", "resource": { "resourceType": "Encounter", "id": "ed98979c-f06b-bb16-beec-379913878306", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "ed98979c-f06b-bb16-beec-379913878306" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2023-02-08T00:31:56+01:00", "end": "2023-02-08T00:46:56+01:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } } ], "period": { "start": "2023-02-08T00:31:56+01:00", "end": "2023-02-08T00:46:56+01:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:e1a1c434-460e-ba85-5243-1730ca421121", "resource": { "resourceType": "Observation", "id": "e1a1c434-460e-ba85-5243-1730ca421121", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+01:00", "valueQuantity": { "value": 86, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:bc54507a-4019-da84-c27d-a70b29351997", "resource": { "resourceType": "Observation", "id": "bc54507a-4019-da84-c27d-a70b29351997", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+01:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:21d6a26d-1a7e-44f0-ef18-fecb5498c187", "resource": { "resourceType": "Observation", "id": "21d6a26d-1a7e-44f0-ef18-fecb5498c187", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+01:00", "valueQuantity": { "value": 12.8, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3f3c0af7-a18d-5313-e7d8-55f5e623a546", "resource": { "resourceType": "Observation", "id": "3f3c0af7-a18d-5313-e7d8-55f5e623a546", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-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": "77606-2", "display": "Weight-for-length Per age and sex" } ], "text": "Weight-for-length Per age and sex" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+01:00", "valueQuantity": { "value": 71.827, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9f0d089b-2a83-c511-18ae-22bb8799913d", "resource": { "resourceType": "Observation", "id": "9f0d089b-2a83-c511-18ae-22bb8799913d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ] }, "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": "8289-1", "display": "Head Occipital-frontal circumference Percentile" } ], "text": "Head Occipital-frontal circumference Percentile" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+01:00", "valueQuantity": { "value": 43.17, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:869b6592-ff8f-eee0-c1ea-312f8791f57f", "resource": { "resourceType": "Observation", "id": "869b6592-ff8f-eee0-c1ea-312f8791f57f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ] }, "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": "9843-4", "display": "Head Occipital-frontal circumference" } ], "text": "Head Occipital-frontal circumference" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+01:00", "valueQuantity": { "value": 48.36, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1a9fa7af-2ad9-0394-e3b5-2bca9110e0ad", "resource": { "resourceType": "Observation", "id": "1a9fa7af-2ad9-0394-e3b5-2bca9110e0ad", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+01:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 78, "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": 125, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d4d83f19-a898-be2d-6179-de037aae79eb", "resource": { "resourceType": "Observation", "id": "d4d83f19-a898-be2d-6179-de037aae79eb", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+01:00", "valueQuantity": { "value": 93, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9ee0021d-7941-a707-849d-176f5d6d74c3", "resource": { "resourceType": "Observation", "id": "9ee0021d-7941-a707-849d-176f5d6d74c3", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+01:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b15d2be6-7001-7c08-6538-15985294cc17", "resource": { "resourceType": "Observation", "id": "b15d2be6-7001-7c08-6538-15985294cc17", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+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:0c603ac9-aa63-9ceb-794f-53911225512e", "resource": { "resourceType": "Procedure", "id": "0c603ac9-aa63-9ceb-794f-53911225512e", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "performedPeriod": { "start": "2023-02-08T00:31:56+01:00", "end": "2023-02-08T00:46:56+01:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:962fbeeb-d0e1-f362-2ec0-8a9821d78599", "resource": { "resourceType": "Immunization", "id": "962fbeeb-d0e1-f362-2ec0-8a9821d78599", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "occurrenceDateTime": "2023-02-08T00:31:56+01:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:16510fc8-d55b-4f4d-69f9-6ff1055a08ff", "resource": { "resourceType": "DiagnosticReport", "id": "16510fc8-d55b-4f4d-69f9-6ff1055a08ff", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, "effectiveDateTime": "2023-02-08T00:31:56+01:00", "issued": "2023-02-08T00:31:56.064+01:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:0cbbf76a-3e45-0381-0289-8a0781464501", "resource": { "resourceType": "DocumentReference", "id": "0cbbf76a-3e45-0381-0289-8a0781464501", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:16510fc8-d55b-4f4d-69f9-6ff1055a08ff" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2023-02-08T00:31:56.064+01:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "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:ed98979c-f06b-bb16-beec-379913878306" } ], "period": { "start": "2023-02-08T00:31:56+01:00", "end": "2023-02-08T00:46:56+01:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:0cf49076-3133-f8ff-5185-258a6c3e67e1", "resource": { "resourceType": "Claim", "id": "0cf49076-3133-f8ff-5185-258a6c3e67e1", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2023-02-08T00:31:56+01:00", "end": "2023-02-08T00:46:56+01:00" }, "created": "2023-02-08T00:46:56+01:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:962fbeeb-d0e1-f362-2ec0-8a9821d78599" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:0c603ac9-aa63-9ceb-794f-53911225512e" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "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:ed98979c-f06b-bb16-beec-379913878306" } ] }, { "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": 448.40, "currency": "USD" } } ], "total": { "value": 721.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:e4e9686a-959b-7ade-9a1d-56c24d9a3491", "resource": { "resourceType": "ExplanationOfBenefit", "id": "e4e9686a-959b-7ade-9a1d-56c24d9a3491", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "0cf49076-3133-f8ff-5185-258a6c3e67e1" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2023-02-08T00:46:56+01:00", "end": "2024-02-08T00:46:56+01:00" }, "created": "2023-02-08T00:46:56+01:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "claim": { "reference": "urn:uuid:0cf49076-3133-f8ff-5185-258a6c3e67e1" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2023-02-08T00:31:56+01:00", "end": "2023-02-08T00:46:56+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" } ] }, { "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": "2023-02-08T00:31:56+01:00", "end": "2023-02-08T00:46:56+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": "2023-02-08T00:31:56+01:00", "end": "2023-02-08T00:46:56+01:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 448.40, "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": 89.68, "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": 358.72, "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": 448.40, "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": 448.40, "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": 721.20, "currency": "USD" } } ], "payment": { "amount": { "value": 467.52000000000004, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff", "resource": { "resourceType": "Encounter", "id": "161389b2-47ab-0b3e-196c-d19c9f23e9ff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "161389b2-47ab-0b3e-196c-d19c9f23e9ff" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2023-08-09T01:31:56+02:00", "end": "2023-08-09T01:46:56+02:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } } ], "period": { "start": "2023-08-09T01:31:56+02:00", "end": "2023-08-09T01:46:56+02:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:da5cc37d-eb07-b394-1f60-40ee17d51ec0", "resource": { "resourceType": "Condition", "id": "da5cc37d-eb07-b394-1f60-40ee17d51ec0", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "onsetDateTime": "2023-08-09T01:31:56+02:00", "abatementDateTime": "2023-08-09T01:31:56+02:00", "recordedDate": "2023-08-09T01:31:56+02:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:165d01d1-17d1-9fde-ce96-17af7a6b2ac0", "resource": { "resourceType": "Observation", "id": "165d01d1-17d1-9fde-ce96-17af7a6b2ac0", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "valueQuantity": { "value": 89.8, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a96e09d6-716e-362f-1870-195c42b09dcd", "resource": { "resourceType": "Observation", "id": "a96e09d6-716e-362f-1870-195c42b09dcd", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1e4f9eb8-cf54-9a19-de6d-ad32c5227a8d", "resource": { "resourceType": "Observation", "id": "1e4f9eb8-cf54-9a19-de6d-ad32c5227a8d", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "valueQuantity": { "value": 13.6, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9ebee303-241d-d74a-5cba-cfcdcf64f899", "resource": { "resourceType": "Observation", "id": "9ebee303-241d-d74a-5cba-cfcdcf64f899", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-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": "77606-2", "display": "Weight-for-length Per age and sex" } ], "text": "Weight-for-length Per age and sex" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "valueQuantity": { "value": 66.711, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2fa9bcc6-f0c9-a973-09d9-1d2368847a73", "resource": { "resourceType": "Observation", "id": "2fa9bcc6-f0c9-a973-09d9-1d2368847a73", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ] }, "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": "8289-1", "display": "Head Occipital-frontal circumference Percentile" } ], "text": "Head Occipital-frontal circumference Percentile" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "valueQuantity": { "value": 43.17, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7b5e31c5-4f05-0a1c-ef8b-e94b84be2865", "resource": { "resourceType": "Observation", "id": "7b5e31c5-4f05-0a1c-ef8b-e94b84be2865", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ] }, "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": "9843-4", "display": "Head Occipital-frontal circumference" } ], "text": "Head Occipital-frontal circumference" }, "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "valueQuantity": { "value": 48.96, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:16a84deb-35af-eed9-709c-f4ae3d48fbd8", "resource": { "resourceType": "Observation", "id": "16a84deb-35af-eed9-709c-f4ae3d48fbd8", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "valueQuantity": { "value": 16.9, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2b096e1d-8444-36bb-1bf5-be5e1e53abe5", "resource": { "resourceType": "Observation", "id": "2b096e1d-8444-36bb-1bf5-be5e1e53abe5", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "valueQuantity": { "value": 67.961, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:289f2f4b-7c2d-fbf7-d76e-1562b1ac4734", "resource": { "resourceType": "Observation", "id": "289f2f4b-7c2d-fbf7-d76e-1562b1ac4734", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "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": 124, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:35d7ca76-01b5-a1f6-1d4f-664fc38390c0", "resource": { "resourceType": "Observation", "id": "35d7ca76-01b5-a1f6-1d4f-664fc38390c0", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "valueQuantity": { "value": 78, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:558a52cf-896b-647f-c1fc-8cb5492e52e9", "resource": { "resourceType": "Observation", "id": "558a52cf-896b-647f-c1fc-8cb5492e52e9", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "valueQuantity": { "value": 13, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3627f8af-9f00-24d8-0a51-1f50ca50130d", "resource": { "resourceType": "Observation", "id": "3627f8af-9f00-24d8-0a51-1f50ca50130d", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+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:d567212e-89ff-b227-04c1-6afd234eb62c", "resource": { "resourceType": "Procedure", "id": "d567212e-89ff-b227-04c1-6afd234eb62c", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "performedPeriod": { "start": "2023-08-09T01:31:56+02:00", "end": "2023-08-09T01:46:56+02:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:65ef1d6e-a448-8a1b-e063-c582e721c5f8", "resource": { "resourceType": "Immunization", "id": "65ef1d6e-a448-8a1b-e063-c582e721c5f8", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "83", "display": "Hep A, ped/adol, 2 dose" } ], "text": "Hep A, ped/adol, 2 dose" }, "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "occurrenceDateTime": "2023-08-09T01:31:56+02:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:b723716e-a156-6b79-771e-5837eff7ec1a", "resource": { "resourceType": "DiagnosticReport", "id": "b723716e-a156-6b79-771e-5837eff7ec1a", "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "encounter": { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, "effectiveDateTime": "2023-08-09T01:31:56+02:00", "issued": "2023-08-09T01:31:56.064+02:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:8a76c116-61c1-4fe9-967b-c71638f79a5e", "resource": { "resourceType": "DocumentReference", "id": "8a76c116-61c1-4fe9-967b-c71638f79a5e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:b723716e-a156-6b79-771e-5837eff7ec1a" } ], "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "date": "2023-08-09T01:31:56.064+02:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099", "display": "Dr. Pamelia915 Kilback373" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "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:161389b2-47ab-0b3e-196c-d19c9f23e9ff" } ], "period": { "start": "2023-08-09T01:31:56+02:00", "end": "2023-08-09T01:46:56+02:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:bdd1ce9b-ccaa-ff0e-928d-8b333801843a", "resource": { "resourceType": "Claim", "id": "bdd1ce9b-ccaa-ff0e-928d-8b333801843a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e", "display": "Armand155 Wilkinson796" }, "billablePeriod": { "start": "2023-08-09T01:31:56+02:00", "end": "2023-08-09T01:46:56+02:00" }, "created": "2023-08-09T01:46:56+02:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:65ef1d6e-a448-8a1b-e063-c582e721c5f8" } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:da5cc37d-eb07-b394-1f60-40ee17d51ec0" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:d567212e-89ff-b227-04c1-6afd234eb62c" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "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:161389b2-47ab-0b3e-196c-d19c9f23e9ff" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "83", "display": "Hep A, ped/adol, 2 dose" } ], "text": "Hep A, ped/adol, 2 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": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 471.47, "currency": "USD" } } ], "total": { "value": 744.27, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:2f30150c-412b-bcd0-f610-0ff30c0435ce", "resource": { "resourceType": "ExplanationOfBenefit", "id": "2f30150c-412b-bcd0-f610-0ff30c0435ce", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "bdd1ce9b-ccaa-ff0e-928d-8b333801843a" }, { "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:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, "billablePeriod": { "start": "2023-08-09T01:46:56+02:00", "end": "2024-08-09T01:46:56+02:00" }, "created": "2023-08-09T01:46:56+02:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1", "display": "ONE CALL HEALTHCARE PLLC" }, "claim": { "reference": "urn:uuid:bdd1ce9b-ccaa-ff0e-928d-8b333801843a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:da5cc37d-eb07-b394-1f60-40ee17d51ec0" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "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": "2023-08-09T01:31:56+02:00", "end": "2023-08-09T01:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" } ] }, { "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": "83", "display": "Hep A, ped/adol, 2 dose" } ], "text": "Hep A, ped/adol, 2 dose" }, "servicedPeriod": { "start": "2023-08-09T01:31:56+02:00", "end": "2023-08-09T01:46:56+02:00" }, "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": "2023-08-09T01:31:56+02:00", "end": "2023-08-09T01:46:56+02:00" }, "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": "2023-08-09T01:31:56+02:00", "end": "2023-08-09T01:46:56+02:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 471.47, "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": 94.29400000000001, "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": 377.17600000000004, "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": 471.47, "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": 471.47, "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": 744.27, "currency": "USD" } } ], "payment": { "amount": { "value": 485.97600000000006, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:0f29f3df-b686-7b03-04f7-896ce41910c3", "resource": { "resourceType": "Provenance", "id": "0f29f3df-b686-7b03-04f7-896ce41910c3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance" ] }, "target": [ { "reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e" }, { "reference": "urn:uuid:68b70cd6-53ae-90fb-ea0f-dec4f461f213" }, { "reference": "urn:uuid:47f6931f-9200-0a15-25ac-b6cc89937d1f" }, { "reference": "urn:uuid:cb56088d-7bca-d3b8-6439-a14eb399f87c" }, { "reference": "urn:uuid:cd811737-5c8c-9518-571a-67df571b67ba" }, { "reference": "urn:uuid:cba333f6-7e4b-6354-4d33-4f198b431368" }, { "reference": "urn:uuid:c4f85979-e296-ab98-a96e-02f2260f2c3e" }, { "reference": "urn:uuid:d7dcbfaa-4aa2-2736-890b-eaf1f5fd760c" }, { "reference": "urn:uuid:4e3ad673-b78e-baf2-f94b-c6f27c9ce82a" }, { "reference": "urn:uuid:bdcc44fa-d45c-25e5-7532-f703fa4558f2" }, { "reference": "urn:uuid:a2db060c-397c-d845-18ed-b604730c9ab0" }, { "reference": "urn:uuid:50cf69f2-2659-0545-8f12-97b62a7c9ff8" }, { "reference": "urn:uuid:80a80015-e1e1-a06f-99ec-256ea1328cc3" }, { "reference": "urn:uuid:0da10e13-cbc1-6240-ca1a-bd4115f6dbe8" }, { "reference": "urn:uuid:7a0edee0-26a7-c92e-4023-bcf6593cd486" }, { "reference": "urn:uuid:21d48ba5-8789-26ac-c684-b34d3e31b94b" }, { "reference": "urn:uuid:5cf8bb36-22de-b1d8-e974-3e68a4b327ac" }, { "reference": "urn:uuid:4f97dcf9-1c49-afca-a6ad-c5ccad21a035" }, { "reference": "urn:uuid:21444b45-8d9b-ac74-fb3a-bb7de4acd78b" }, { "reference": "urn:uuid:74bf2223-77a0-a75d-3c8a-731c48133231" }, { "reference": "urn:uuid:ec0deedc-0435-bda0-94f6-e719eb057d3b" }, { "reference": "urn:uuid:21c1f9fa-2a51-4eec-6b89-c3590ec4246a" }, { "reference": "urn:uuid:b503a079-6772-6d80-c1a4-11cd3a67e267" }, { "reference": "urn:uuid:d833c0ff-ba08-c21b-cc18-41cc363285eb" }, { "reference": "urn:uuid:7ab5a10c-ad31-038a-16bd-c99375315990" }, { "reference": "urn:uuid:a1cb8dbd-e433-29e6-efa6-4a508c71a953" }, { "reference": "urn:uuid:481ce5df-0a7a-f049-e99d-869f0561b997" }, { "reference": "urn:uuid:01bea918-0222-56ae-3809-1e2407285685" }, { "reference": "urn:uuid:aec1a7b5-a758-67e1-76bc-cc490bcf39f7" }, { "reference": "urn:uuid:beb5523a-ca5c-b367-2b61-bba75f0ab316" }, { "reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b" }, { "reference": "urn:uuid:997b6ee6-7ff2-52c5-2f33-6fa215568031" }, { "reference": "urn:uuid:d9e98df6-c845-ecbf-2e90-263f94a57f47" }, { "reference": "urn:uuid:4937034f-6635-7663-272e-8f543a91f98a" }, { "reference": "urn:uuid:879e1e02-d979-0909-d5bb-7f6184ce7075" }, { "reference": "urn:uuid:9e2e298a-2f5e-b724-7e99-089333c472b4" }, { "reference": "urn:uuid:31dbbbf9-da1c-52e2-f537-1b4b07a08343" }, { "reference": "urn:uuid:331ccbdb-1c6a-05f9-8654-d6e5bd7d790e" }, { "reference": "urn:uuid:3dbad032-7832-9dc2-841e-a5a751eb9616" }, { "reference": "urn:uuid:ab6c109b-8133-b885-783d-2fbc2f460860" }, { "reference": "urn:uuid:f816f2c6-ba92-0aa9-ae4c-fa78ebd4a146" }, { "reference": "urn:uuid:6bfc169f-4872-461b-f19f-d81bf700ec50" }, { "reference": "urn:uuid:329ca55f-2f89-96ba-0bc6-798f43a19617" }, { "reference": "urn:uuid:b723f7f1-9705-dcda-771e-debae5a75d7b" }, { "reference": "urn:uuid:18b9250f-62dc-e368-5dc1-bf9e3922811d" }, { "reference": "urn:uuid:b3b035db-b7e1-6ef5-9d11-31b7b73e484e" }, { "reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11" }, { "reference": "urn:uuid:a5b77635-c23d-b012-511c-3680dc8c68d4" }, { "reference": "urn:uuid:c93c3385-ecb8-207c-6767-efaea4ff9c1d" }, { "reference": "urn:uuid:619cd597-edaf-0c60-ee02-2987fed7dabf" }, { "reference": "urn:uuid:4e9d617e-dffb-014b-2047-1aff1d8b30c9" }, { "reference": "urn:uuid:c789a68b-07a7-8646-4d07-5fb25003d34a" }, { "reference": "urn:uuid:7c7119a2-a99c-5419-ca42-7b97ae85e1a5" }, { "reference": "urn:uuid:3c6617e5-5ee8-2192-ec7d-0dd0790b9418" }, { "reference": "urn:uuid:59fb0df3-e406-7aad-d56d-6b7433a3ecd7" }, { "reference": "urn:uuid:b1b6125b-c119-8ea0-0ddb-2dc0e2fa1bfd" }, { "reference": "urn:uuid:a11ee7fb-7db5-701c-8edd-22e37e74dc73" }, { "reference": "urn:uuid:6aa19090-4d6a-5d50-f505-d26d99987394" }, { "reference": "urn:uuid:fcdfceb0-466f-5e25-c09a-b6b44b6f0f5f" }, { "reference": "urn:uuid:dacd315a-61d4-2aed-d46b-8650d2aa0006" }, { "reference": "urn:uuid:c85cb70d-dcdf-1d1d-d6bf-1a064c20ed3f" }, { "reference": "urn:uuid:97285f95-f330-c213-3704-b0e1c4a5092d" }, { "reference": "urn:uuid:679b062f-5219-6f9c-9de0-21870d8cf4d6" }, { "reference": "urn:uuid:d85e04a0-0bbe-b24f-79de-a56006a57b9e" }, { "reference": "urn:uuid:cbcedd9a-0b18-5ec6-0219-52a6101e5e9e" }, { "reference": "urn:uuid:8925f8b1-3a8c-e9ea-c5f4-9f8e21e6e4c8" }, { "reference": "urn:uuid:f3f5c84f-e59b-c82e-a619-a6709d9a81e1" }, { "reference": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af" }, { "reference": "urn:uuid:070f7b67-8eb6-9ee2-2843-4adfa68f6508" }, { "reference": "urn:uuid:1f1addd7-ecef-9428-9f47-0ccbf98751a1" }, { "reference": "urn:uuid:272e7bbb-9b17-f9d8-6dff-86f0babdd05f" }, { "reference": "urn:uuid:b15bdc83-02eb-24a4-502e-2568a52f9548" }, { "reference": "urn:uuid:97e24a41-37d5-b235-ce75-4ae754b54ec5" }, { "reference": "urn:uuid:cf7cacbb-ae98-cfe1-effd-4e3446a3639c" }, { "reference": "urn:uuid:f9a7f2a7-3e15-df13-e160-977e5b44809b" }, { "reference": "urn:uuid:c1cc8278-93e5-de68-ffc3-90d46280a1d5" }, { "reference": "urn:uuid:c423a8e7-aec6-cd19-2ad8-7411ab253704" }, { "reference": "urn:uuid:16afd455-5e46-8b06-9336-db8b58741cfd" }, { "reference": "urn:uuid:e3786abc-4353-adfc-9500-25f953930ab2" }, { "reference": "urn:uuid:1620251a-0974-95d7-8b28-fddccd634855" }, { "reference": "urn:uuid:2b1d1777-cab2-f8a4-9afb-ed02739a7104" }, { "reference": "urn:uuid:ae63d156-18a0-45c7-aa50-cbe40eb549cd" }, { "reference": "urn:uuid:12e11c6b-f646-d0f4-6850-f4ecfbe0a4a0" }, { "reference": "urn:uuid:aa18b10d-fa93-8197-de77-e4c129353bb6" }, { "reference": "urn:uuid:3b2c3d4c-3340-f861-d86f-3e8db336c5f3" }, { "reference": "urn:uuid:7be77f97-1020-4842-2a54-1481282a5442" }, { "reference": "urn:uuid:4d1e1058-bdac-91a2-368a-84330a459322" }, { "reference": "urn:uuid:7196a482-0897-2682-a896-7bb85ee5c5cb" }, { "reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0" }, { "reference": "urn:uuid:93d878de-35a4-7782-0558-d2f36296292e" }, { "reference": "urn:uuid:15c32099-af2f-058d-2cf0-632ef56f2b09" }, { "reference": "urn:uuid:91555edd-7c33-4ead-eb1a-f6b0fb8f2be4" }, { "reference": "urn:uuid:75ae0910-04b6-37b2-50ca-60f01c548f57" }, { "reference": "urn:uuid:05902004-6f17-1e70-267d-b0c5201c92ff" }, { "reference": "urn:uuid:8154babf-db4d-e00c-7059-108fb7a1e3b4" }, { "reference": "urn:uuid:95351e9d-c461-dfd5-5636-bd977b9d20ae" }, { "reference": "urn:uuid:2ed1f94d-375a-833c-8a8f-c14fe9085b0a" }, { "reference": "urn:uuid:6e794fac-9c66-699b-d931-74f339536b64" }, { "reference": "urn:uuid:b8c2d376-1dee-0c6f-db64-77f381003027" }, { "reference": "urn:uuid:239b5bec-0dab-891e-5dca-c1fe9eef309e" }, { "reference": "urn:uuid:e4055da9-6b62-daf1-982b-d740a8f60b2e" }, { "reference": "urn:uuid:d3d9d175-78df-eaac-de4e-8224a4bebd0c" }, { "reference": "urn:uuid:c377f383-d042-f7a7-faa7-fb8364e225c5" }, { "reference": "urn:uuid:5be3fad5-381c-a543-fa5c-4a0e12d29398" }, { "reference": "urn:uuid:68a7b807-d940-56c1-9ef2-2d13de465698" }, { "reference": "urn:uuid:9d9c7f8c-5bf6-f7a1-cd9b-393eaf9f57c9" }, { "reference": "urn:uuid:0eefe86c-1dad-60a1-c4f9-69c4dfd98011" }, { "reference": "urn:uuid:de96614f-2ea4-383d-3a95-be28881949b9" }, { "reference": "urn:uuid:5bb04285-eef8-9b51-badc-7f5dcfbb7546" }, { "reference": "urn:uuid:9d4cd8c2-9ea9-d12e-db08-42e018e48604" }, { "reference": "urn:uuid:a8db313f-1bca-f848-e520-523bd7d11510" }, { "reference": "urn:uuid:331bc592-8eaa-a1ea-65aa-593daed404ef" }, { "reference": "urn:uuid:43d33a47-4878-319f-ca86-b3706813bcdc" }, { "reference": "urn:uuid:5b69010a-4a0b-c95c-61c5-6c93809d4e0e" }, { "reference": "urn:uuid:e335071a-966d-274f-5a84-b773a4d704e5" }, { "reference": "urn:uuid:3825174a-a630-b27d-c30e-4c5de3d8372a" }, { "reference": "urn:uuid:ca55d935-abf9-0ac3-d9d2-88abb417b459" }, { "reference": "urn:uuid:f5999fae-867c-606c-11f9-89fcac92ad4b" }, { "reference": "urn:uuid:3a9388dc-7ad0-d6ad-65c9-3d8750e869bc" }, { "reference": "urn:uuid:84081622-08cf-3817-8513-af53134fcdfa" }, { "reference": "urn:uuid:a1db0978-a470-c816-88a4-581a25118811" }, { "reference": "urn:uuid:7996a87a-3b0a-9c3e-7f96-7fb0857fa843" }, { "reference": "urn:uuid:0b49154d-9b33-8fe5-207d-48691e52914d" }, { "reference": "urn:uuid:83f97241-1967-eaf2-7e56-90010f35808d" }, { "reference": "urn:uuid:7394bf37-6fbc-a015-ab89-4e7912c7588e" }, { "reference": "urn:uuid:8313cf27-1012-ccf1-2a83-7f677304bedf" }, { "reference": "urn:uuid:000effa3-ffb2-cdd8-736a-8dc6ffa25038" }, { "reference": "urn:uuid:35ab68be-427a-3217-0b65-194d576930b6" }, { "reference": "urn:uuid:9f05348d-104c-545b-4c45-f24181a89620" }, { "reference": "urn:uuid:ab6dcc31-e1b4-698e-6ef7-d6191d152ac6" }, { "reference": "urn:uuid:fa6b7e7d-b30b-2718-ad1e-ca8219e2eb06" }, { "reference": "urn:uuid:f5530f1c-6966-4bf6-f4b5-346260668126" }, { "reference": "urn:uuid:c23b4080-d0a2-a3b8-3e50-ce0f8626e548" }, { "reference": "urn:uuid:01b85179-06f6-4bd3-959b-c9052294977c" }, { "reference": "urn:uuid:8649828b-6a1d-b72a-d61a-87c8c7051554" }, { "reference": "urn:uuid:cbe88db8-7781-444c-1b52-774eb823a8ba" }, { "reference": "urn:uuid:071f6f03-8f48-cceb-e8fb-83bb7c1a3ba1" }, { "reference": "urn:uuid:684200db-600e-e7f5-2d97-12c9e3eb0734" }, { "reference": "urn:uuid:e8c22c47-5732-ce61-3b06-67de6c1c0c1a" }, { "reference": "urn:uuid:c65efd3b-425f-c94d-3ca7-fd5f5d4cb343" }, { "reference": "urn:uuid:3d095e69-0ea4-dfc9-cf10-a71b8c48fc8d" }, { "reference": "urn:uuid:f907aa90-ef34-35e7-c858-7ec11b9deeab" }, { "reference": "urn:uuid:2657b7ad-be96-719d-70cc-c3b2c49648d3" }, { "reference": "urn:uuid:a121b45f-f476-458f-9fdb-66b39cd66dbf" }, { "reference": "urn:uuid:c6474326-6330-ac45-ed0e-ce499afbd296" }, { "reference": "urn:uuid:24f012bc-c0ed-9ad1-67d0-0da38bbceca2" }, { "reference": "urn:uuid:120c62c0-9421-01bb-04a7-2772658e4725" }, { "reference": "urn:uuid:28a12ff5-969c-467f-ef3c-a70b6a80aaab" }, { "reference": "urn:uuid:3c3b8080-4406-6fa2-0c63-0cb74bde68b3" }, { "reference": "urn:uuid:401536a6-6cbe-1765-d494-a056e8440913" }, { "reference": "urn:uuid:8457a4c0-d716-664e-9b1a-147898f1ad3a" }, { "reference": "urn:uuid:0330274a-0aec-932c-d0c5-c6a9a5905321" }, { "reference": "urn:uuid:d1636330-581d-a4fd-2004-e3d118188bc7" }, { "reference": "urn:uuid:3870d569-f234-7616-0fa7-1fdefe397c16" }, { "reference": "urn:uuid:fba9ecdb-e7f5-d388-15a9-314a625f9b3e" }, { "reference": "urn:uuid:0e6599b2-e5d1-ef03-0433-2f52456c92c3" }, { "reference": "urn:uuid:fd2afbea-81c5-9545-be6c-07b54c91111d" }, { "reference": "urn:uuid:f7f0dc6f-ada8-2564-21e1-7cea87d1eff2" }, { "reference": "urn:uuid:a04de614-779f-9b5e-902f-02af047bae25" }, { "reference": "urn:uuid:a48af20b-c6b6-9987-5169-9e6b27d61faa" }, { "reference": "urn:uuid:374310aa-d2a9-e3ec-73a0-af36aafcbb1d" }, { "reference": "urn:uuid:e912dce4-0615-879a-915f-2cba3439abd3" }, { "reference": "urn:uuid:6da565de-0363-5a96-f6c1-58ab5b476582" }, { "reference": "urn:uuid:9baa4143-7943-6447-3437-c117187073a9" }, { "reference": "urn:uuid:01c7cf1b-412a-4dcc-4ef1-050ea0200591" }, { "reference": "urn:uuid:d7b55de2-d9d2-146b-4d6a-c41d8273280a" }, { "reference": "urn:uuid:34bb151d-ac37-e4f8-fffc-805d7659efcb" }, { "reference": "urn:uuid:c9936e5b-1a90-1117-7567-78cc527a51b4" }, { "reference": "urn:uuid:8317b2d7-f5c4-1756-aa09-f5dfcdc3d890" }, { "reference": "urn:uuid:b6cdde14-cbf7-b639-5e1e-9e652bf5299e" }, { "reference": "urn:uuid:20b4eb25-da7e-2009-0c50-10606080a309" }, { "reference": "urn:uuid:9f553073-eb20-f48d-4b93-6751c988fbf2" }, { "reference": "urn:uuid:1b700242-c1f2-3716-82af-7042705ee428" }, { "reference": "urn:uuid:ed98979c-f06b-bb16-beec-379913878306" }, { "reference": "urn:uuid:e1a1c434-460e-ba85-5243-1730ca421121" }, { "reference": "urn:uuid:bc54507a-4019-da84-c27d-a70b29351997" }, { "reference": "urn:uuid:21d6a26d-1a7e-44f0-ef18-fecb5498c187" }, { "reference": "urn:uuid:3f3c0af7-a18d-5313-e7d8-55f5e623a546" }, { "reference": "urn:uuid:9f0d089b-2a83-c511-18ae-22bb8799913d" }, { "reference": "urn:uuid:869b6592-ff8f-eee0-c1ea-312f8791f57f" }, { "reference": "urn:uuid:1a9fa7af-2ad9-0394-e3b5-2bca9110e0ad" }, { "reference": "urn:uuid:d4d83f19-a898-be2d-6179-de037aae79eb" }, { "reference": "urn:uuid:9ee0021d-7941-a707-849d-176f5d6d74c3" }, { "reference": "urn:uuid:b15d2be6-7001-7c08-6538-15985294cc17" }, { "reference": "urn:uuid:0c603ac9-aa63-9ceb-794f-53911225512e" }, { "reference": "urn:uuid:962fbeeb-d0e1-f362-2ec0-8a9821d78599" }, { "reference": "urn:uuid:16510fc8-d55b-4f4d-69f9-6ff1055a08ff" }, { "reference": "urn:uuid:0cbbf76a-3e45-0381-0289-8a0781464501" }, { "reference": "urn:uuid:0cf49076-3133-f8ff-5185-258a6c3e67e1" }, { "reference": "urn:uuid:e4e9686a-959b-7ade-9a1d-56c24d9a3491" }, { "reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff" }, { "reference": "urn:uuid:da5cc37d-eb07-b394-1f60-40ee17d51ec0" }, { "reference": "urn:uuid:165d01d1-17d1-9fde-ce96-17af7a6b2ac0" }, { "reference": "urn:uuid:a96e09d6-716e-362f-1870-195c42b09dcd" }, { "reference": "urn:uuid:1e4f9eb8-cf54-9a19-de6d-ad32c5227a8d" }, { "reference": "urn:uuid:9ebee303-241d-d74a-5cba-cfcdcf64f899" }, { "reference": "urn:uuid:2fa9bcc6-f0c9-a973-09d9-1d2368847a73" }, { "reference": "urn:uuid:7b5e31c5-4f05-0a1c-ef8b-e94b84be2865" }, { "reference": "urn:uuid:16a84deb-35af-eed9-709c-f4ae3d48fbd8" }, { "reference": "urn:uuid:2b096e1d-8444-36bb-1bf5-be5e1e53abe5" }, { "reference": "urn:uuid:289f2f4b-7c2d-fbf7-d76e-1562b1ac4734" }, { "reference": "urn:uuid:35d7ca76-01b5-a1f6-1d4f-664fc38390c0" }, { "reference": "urn:uuid:558a52cf-896b-647f-c1fc-8cb5492e52e9" }, { "reference": "urn:uuid:3627f8af-9f00-24d8-0a51-1f50ca50130d" }, { "reference": "urn:uuid:d567212e-89ff-b227-04c1-6afd234eb62c" }, { "reference": "urn:uuid:65ef1d6e-a448-8a1b-e063-c582e721c5f8" }, { "reference": "urn:uuid:b723716e-a156-6b79-771e-5837eff7ec1a" }, { "reference": "urn:uuid:8a76c116-61c1-4fe9-967b-c71638f79a5e" }, { "reference": "urn:uuid:bdd1ce9b-ccaa-ff0e-928d-8b333801843a" }, { "reference": "urn:uuid:2f30150c-412b-bcd0-f610-0ff30c0435ce" } ], "recorded": "2023-09-06T01:31:56.064+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|9999949099", "display": "Dr. Pamelia915 Kilback373" }, "onBehalfOf": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } }, { "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|9999949099", "display": "Dr. Pamelia915 Kilback373" }, "onBehalfOf": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3", "display": "ONE CALL HEALTHCARE PLLC" } } ] }, "request": { "method": "POST", "url": "Provenance" } } ] }