MILA_public/medax_pipeline
0
0
Fork 0
Code Issues Pull Requests Actions Packages Projects Releases 1 Wiki Activity
medax_pipeline/testData/Johnny786_Schoen8_a7a285c0-4714-dd3c-4837-8719c9b67873.json
Tom Gebhardt a9db0be88a release commit
2025-04-16 22:12:19 +02:00

15350 lines
494 KiB
JSON
Raw Permalink Blame History

{
"resourceType": "Bundle",
"type": "transaction",
"entry": [ {
"fullUrl": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"resource": {
"resourceType": "Patient",
"id": "a7a285c0-4714-dd3c-4837-8719c9b67873",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient" ]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated by <a href=\"https://github.com/synthetichealth/synthea\">Synthea</a>.Version identifier: 3c23908\n . Person seed: -5557164924473669144 Population seed: 1693908535569</div>"
},
"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": "Leana211 Sauer652"
}, {
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
"valueCode": "M"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
"valueAddress": {
"city": "Quincy",
"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": "a7a285c0-4714-dd3c-4837-8719c9b67873"
}, {
"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": "a7a285c0-4714-dd3c-4837-8719c9b67873"
}, {
"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": "999-89-9528"
} ],
"name": [ {
"use": "official",
"family": "Schoen8",
"given": [ "Johnny786", "Vince741" ]
} ],
"telecom": [ {
"system": "phone",
"value": "555-753-6560",
"use": "home"
} ],
"gender": "male",
"birthDate": "2021-05-22",
"address": [ {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/geolocation",
"extension": [ {
"url": "latitude",
"valueDecimal": 42.05921178859317
}, {
"url": "longitude",
"valueDecimal": -70.79219595855132
} ]
} ],
"line": [ "463 Rempel Ranch Unit 81" ],
"city": "Pembroke",
"state": "MA",
"postalCode": "00000",
"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:0eb53bda-2881-5e8e-3597-87a9430af96a",
"resource": {
"resourceType": "Encounter",
"id": "0eb53bda-2881-5e8e-3597-87a9430af96a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "0eb53bda-2881-5e8e-3597-87a9430af96a"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-05-22T00:13:45+02:00",
"end": "2021-05-22T00:28:45+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
}
} ],
"period": {
"start": "2021-05-22T00:13:45+02:00",
"end": "2021-05-22T00:28:45+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:0cbe2cef-86a6-e86a-e5c3-86b60142e5eb",
"resource": {
"resourceType": "Condition",
"id": "0cbe2cef-86a6-e86a-e5c3-86b60142e5eb",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"onsetDateTime": "2021-05-22T00:13:45+02:00",
"abatementDateTime": "2021-10-30T00:13:45+02:00",
"recordedDate": "2021-05-22T00:13:45+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:247d0aa4-e125-bd0a-e113-c8ef39713ba5",
"resource": {
"resourceType": "Observation",
"id": "247d0aa4-e125-bd0a-e113-c8ef39713ba5",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 50.8,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2c5658db-0ba4-e276-3188-fc8034e243ab",
"resource": {
"resourceType": "Observation",
"id": "2c5658db-0ba4-e276-3188-fc8034e243ab",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:4d8ad025-3b81-93a1-069f-76b7bddef092",
"resource": {
"resourceType": "Observation",
"id": "4d8ad025-3b81-93a1-069f-76b7bddef092",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 4.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ab80cff7-16a1-f26e-951f-38ee4769be2a",
"resource": {
"resourceType": "Observation",
"id": "ab80cff7-16a1-f26e-951f-38ee4769be2a",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 86.667,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e78d01c3-c3bd-f8d5-4c97-c21e285d5e20",
"resource": {
"resourceType": "Observation",
"id": "e78d01c3-c3bd-f8d5-4c97-c21e285d5e20",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 25,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1d43ca9d-4bb6-ca40-2a08-a9435ead0d4f",
"resource": {
"resourceType": "Observation",
"id": "1d43ca9d-4bb6-ca40-2a08-a9435ead0d4f",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 34.47,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6a6ed92a-4f7a-e1b9-57a2-1daaaa1ec7ae",
"resource": {
"resourceType": "Observation",
"id": "6a6ed92a-4f7a-e1b9-57a2-1daaaa1ec7ae",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 71,
"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": 96,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1f995897-7e15-5521-0b9f-fbea7bba33f0",
"resource": {
"resourceType": "Observation",
"id": "1f995897-7e15-5521-0b9f-fbea7bba33f0",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 84,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:68b4e6c8-9364-0567-a3dc-a341e325eacb",
"resource": {
"resourceType": "Observation",
"id": "68b4e6c8-9364-0567-a3dc-a341e325eacb",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 16,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c0d18de1-a36c-853f-1eeb-043a7994580d",
"resource": {
"resourceType": "Observation",
"id": "c0d18de1-a36c-853f-1eeb-043a7994580d",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 8.9083,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:480f84dd-bab5-3140-5db5-3d60b153ec56",
"resource": {
"resourceType": "Observation",
"id": "480f84dd-bab5-3140-5db5-3d60b153ec56",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 5.428,
"unit": "10*6/uL",
"system": "http://unitsofmeasure.org",
"code": "10*6/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d2b070b6-8391-3c6e-3eaf-d35815477e46",
"resource": {
"resourceType": "Observation",
"id": "d2b070b6-8391-3c6e-3eaf-d35815477e46",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 14.382,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9740622e-3972-4322-eada-c8c3e841fcbf",
"resource": {
"resourceType": "Observation",
"id": "9740622e-3972-4322-eada-c8c3e841fcbf",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 46.047,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0de03ab3-5eef-d4f7-70b9-f62d42b5228c",
"resource": {
"resourceType": "Observation",
"id": "0de03ab3-5eef-d4f7-70b9-f62d42b5228c",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 92.448,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:547bd11b-68e5-0a61-cd5d-6226693fdfa9",
"resource": {
"resourceType": "Observation",
"id": "547bd11b-68e5-0a61-cd5d-6226693fdfa9",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 30.824,
"unit": "pg",
"system": "http://unitsofmeasure.org",
"code": "pg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1d2e9f88-8a18-f075-88bb-9efb0bec335b",
"resource": {
"resourceType": "Observation",
"id": "1d2e9f88-8a18-f075-88bb-9efb0bec335b",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 35.587,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:283d391d-9857-018e-cfbf-ca1e5d43188e",
"resource": {
"resourceType": "Observation",
"id": "283d391d-9857-018e-cfbf-ca1e5d43188e",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 44.237,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:da43913c-cb13-ebc5-2f11-a703a456da38",
"resource": {
"resourceType": "Observation",
"id": "da43913c-cb13-ebc5-2f11-a703a456da38",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 218.5,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:37458f8a-6c33-9e89-8d8e-4239059a37af",
"resource": {
"resourceType": "Observation",
"id": "37458f8a-6c33-9e89-8d8e-4239059a37af",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 356.55,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:608352fa-ab62-8ead-36b9-e2c9019a413a",
"resource": {
"resourceType": "Observation",
"id": "608352fa-ab62-8ead-36b9-e2c9019a413a",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"valueQuantity": {
"value": 12.142,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:aa059f57-d05e-533f-dd55-5900a571a9ad",
"resource": {
"resourceType": "Observation",
"id": "aa059f57-d05e-533f-dd55-5900a571a9ad",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+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:a23b80bc-eeff-614d-c84f-5711cb8e26d0",
"resource": {
"resourceType": "Immunization",
"id": "a23b80bc-eeff-614d-c84f-5711cb8e26d0",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"occurrenceDateTime": "2021-05-22T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:9c5d0b11-ac87-4a67-9f89-3380174364ca",
"resource": {
"resourceType": "DiagnosticReport",
"id": "9c5d0b11-ac87-4a67-9f89-3380174364ca",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
} ],
"result": [ {
"reference": "urn:uuid:c0d18de1-a36c-853f-1eeb-043a7994580d",
"display": "Leukocytes [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:480f84dd-bab5-3140-5db5-3d60b153ec56",
"display": "Erythrocytes [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:d2b070b6-8391-3c6e-3eaf-d35815477e46",
"display": "Hemoglobin [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:9740622e-3972-4322-eada-c8c3e841fcbf",
"display": "Hematocrit [Volume Fraction] of Blood by Automated count"
}, {
"reference": "urn:uuid:0de03ab3-5eef-d4f7-70b9-f62d42b5228c",
"display": "MCV [Entitic volume] by Automated count"
}, {
"reference": "urn:uuid:547bd11b-68e5-0a61-cd5d-6226693fdfa9",
"display": "MCH [Entitic mass] by Automated count"
}, {
"reference": "urn:uuid:1d2e9f88-8a18-f075-88bb-9efb0bec335b",
"display": "MCHC [Mass/volume] by Automated count"
}, {
"reference": "urn:uuid:283d391d-9857-018e-cfbf-ca1e5d43188e",
"display": "Erythrocyte distribution width [Entitic volume] by Automated count"
}, {
"reference": "urn:uuid:da43913c-cb13-ebc5-2f11-a703a456da38",
"display": "Platelets [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:37458f8a-6c33-9e89-8d8e-4239059a37af",
"display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:608352fa-ab62-8ead-36b9-e2c9019a413a",
"display": "Platelet mean volume [Entitic volume] in Blood by Automated count"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:c4d402a0-fada-aa0a-7596-6b991b4cb626",
"resource": {
"resourceType": "DiagnosticReport",
"id": "c4d402a0-fada-aa0a-7596-6b991b4cb626",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
},
"effectiveDateTime": "2021-05-22T00:13:45+02:00",
"issued": "2021-05-22T00:13:45.770+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:0c092dc1-8ae5-4460-9c6a-0b479e2d0563",
"resource": {
"resourceType": "DocumentReference",
"id": "0c092dc1-8ae5-4460-9c6a-0b479e2d0563",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:c4d402a0-fada-aa0a-7596-6b991b4cb626"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2021-05-22T00:13:45.770+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
} ],
"period": {
"start": "2021-05-22T00:13:45+02:00",
"end": "2021-05-22T00:28:45+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:d613fece-742e-1b95-92f0-3962218788ca",
"resource": {
"resourceType": "Claim",
"id": "d613fece-742e-1b95-92f0-3962218788ca",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2021-05-22T00:13:45+02:00",
"end": "2021-05-22T00:28:45+02:00"
},
"created": "2021-05-22T00:28:45+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:a23b80bc-eeff-614d-c84f-5711cb8e26d0"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:0cbe2cef-86a6-e86a-e5c3-86b60142e5eb"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"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:0eb53bda-2881-5e8e-3597-87a9430af96a"
} ]
}, {
"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:c69c6991-809c-ba33-d641-6c2f0536f83e",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c69c6991-809c-ba33-d641-6c2f0536f83e",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "d613fece-742e-1b95-92f0-3962218788ca"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2021-05-22T00:28:45+02:00",
"end": "2022-05-22T00:28:45+02:00"
},
"created": "2021-05-22T00:28:45+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"claim": {
"reference": "urn:uuid:d613fece-742e-1b95-92f0-3962218788ca"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:0cbe2cef-86a6-e86a-e5c3-86b60142e5eb"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "2021-05-22T00:13:45+02:00",
"end": "2021-05-22T00:28:45+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
} ]
}, {
"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": "2021-05-22T00:13:45+02:00",
"end": "2021-05-22T00:28:45+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": "2021-05-22T00:13:45+02:00",
"end": "2021-05-22T00:28:45+02:00"
},
"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": "2021-05-22T00:13:45+02:00",
"end": "2021-05-22T00:28:45+02:00"
},
"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:8bea2d5d-f366-a451-ba08-d77f859459ec",
"resource": {
"resourceType": "Encounter",
"id": "8bea2d5d-f366-a451-ba08-d77f859459ec",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "8bea2d5d-f366-a451-ba08-d77f859459ec"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-06-26T00:13:45+02:00",
"end": "2021-06-26T00:28:45+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
}
} ],
"period": {
"start": "2021-06-26T00:13:45+02:00",
"end": "2021-06-26T00:28:45+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:37cbb2e9-be35-9763-af10-70ee637d697e",
"resource": {
"resourceType": "Observation",
"id": "37cbb2e9-be35-9763-af10-70ee637d697e",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+02:00",
"valueQuantity": {
"value": 54.8,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f5305b10-48ea-02b6-b95e-76a929630682",
"resource": {
"resourceType": "Observation",
"id": "f5305b10-48ea-02b6-b95e-76a929630682",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+02:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a86a1042-84b6-d703-883d-2348197333bf",
"resource": {
"resourceType": "Observation",
"id": "a86a1042-84b6-d703-883d-2348197333bf",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+02:00",
"valueQuantity": {
"value": 5.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8dd7c896-79ce-0bf4-2cbc-6c74bf21a5ae",
"resource": {
"resourceType": "Observation",
"id": "8dd7c896-79ce-0bf4-2cbc-6c74bf21a5ae",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+02:00",
"valueQuantity": {
"value": 83.356,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:49492073-1b0b-63e0-d2c9-206ed053f783",
"resource": {
"resourceType": "Observation",
"id": "49492073-1b0b-63e0-d2c9-206ed053f783",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+02:00",
"valueQuantity": {
"value": 25,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7a729a24-e482-fb19-c945-18ece5c87cfc",
"resource": {
"resourceType": "Observation",
"id": "7a729a24-e482-fb19-c945-18ece5c87cfc",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+02:00",
"valueQuantity": {
"value": 38.08,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ddb29814-0673-6dc7-e699-8fd3276a6ce6",
"resource": {
"resourceType": "Observation",
"id": "ddb29814-0673-6dc7-e699-8fd3276a6ce6",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+02:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 74,
"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": 105,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:305c1d07-37dc-80c7-90a0-32fc2b8e349b",
"resource": {
"resourceType": "Observation",
"id": "305c1d07-37dc-80c7-90a0-32fc2b8e349b",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+02:00",
"valueQuantity": {
"value": 98,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a8d18cef-7492-0209-2657-05cc1b41b886",
"resource": {
"resourceType": "Observation",
"id": "a8d18cef-7492-0209-2657-05cc1b41b886",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+02:00",
"valueQuantity": {
"value": 12,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6e1853b7-1e57-4eaa-3225-d4779ad0239e",
"resource": {
"resourceType": "Observation",
"id": "6e1853b7-1e57-4eaa-3225-d4779ad0239e",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+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:6c8ad62a-b6de-0072-a838-dbff5b01604d",
"resource": {
"resourceType": "Immunization",
"id": "6c8ad62a-b6de-0072-a838-dbff5b01604d",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"occurrenceDateTime": "2021-06-26T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:d608796f-0439-b206-0f0e-8747656e2e17",
"resource": {
"resourceType": "DiagnosticReport",
"id": "d608796f-0439-b206-0f0e-8747656e2e17",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
},
"effectiveDateTime": "2021-06-26T00:13:45+02:00",
"issued": "2021-06-26T00:13:45.770+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:9db3ad6b-a037-458a-4194-2f33d0a60894",
"resource": {
"resourceType": "DocumentReference",
"id": "9db3ad6b-a037-458a-4194-2f33d0a60894",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:d608796f-0439-b206-0f0e-8747656e2e17"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2021-06-26T00:13:45.770+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
} ],
"period": {
"start": "2021-06-26T00:13:45+02:00",
"end": "2021-06-26T00:28:45+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:5fab5b2a-dc69-bd25-4163-5e6d625aaee3",
"resource": {
"resourceType": "Claim",
"id": "5fab5b2a-dc69-bd25-4163-5e6d625aaee3",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2021-06-26T00:13:45+02:00",
"end": "2021-06-26T00:28:45+02:00"
},
"created": "2021-06-26T00:28:45+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:6c8ad62a-b6de-0072-a838-dbff5b01604d"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"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:8bea2d5d-f366-a451-ba08-d77f859459ec"
} ]
}, {
"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:1c931813-4166-e65f-2efc-103f859ce575",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "1c931813-4166-e65f-2efc-103f859ce575",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "5fab5b2a-dc69-bd25-4163-5e6d625aaee3"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2021-06-26T00:28:45+02:00",
"end": "2022-06-26T00:28:45+02:00"
},
"created": "2021-06-26T00:28:45+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"claim": {
"reference": "urn:uuid:5fab5b2a-dc69-bd25-4163-5e6d625aaee3"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "2021-06-26T00:13:45+02:00",
"end": "2021-06-26T00:28:45+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
} ]
}, {
"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": "2021-06-26T00:13:45+02:00",
"end": "2021-06-26T00:28:45+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:028a17b3-fdcb-2545-3f5d-f79f1762a792",
"resource": {
"resourceType": "Encounter",
"id": "028a17b3-fdcb-2545-3f5d-f79f1762a792",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "028a17b3-fdcb-2545-3f5d-f79f1762a792"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-08-28T00:13:45+02:00",
"end": "2021-08-28T00:28:45+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
}
} ],
"period": {
"start": "2021-08-28T00:13:45+02:00",
"end": "2021-08-28T00:28:45+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:163eee94-7232-bf83-db1e-168c668f2257",
"resource": {
"resourceType": "Observation",
"id": "163eee94-7232-bf83-db1e-168c668f2257",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+02:00",
"valueQuantity": {
"value": 60.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:77bd94af-a19f-ee96-8fd3-82ab4d9d5c08",
"resource": {
"resourceType": "Observation",
"id": "77bd94af-a19f-ee96-8fd3-82ab4d9d5c08",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+02:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5a1accc4-966d-e5bf-ffbc-df4da0b570ae",
"resource": {
"resourceType": "Observation",
"id": "5a1accc4-966d-e5bf-ffbc-df4da0b570ae",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+02:00",
"valueQuantity": {
"value": 6.7,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ea220597-3c0c-5053-e971-6b51c2a71ff3",
"resource": {
"resourceType": "Observation",
"id": "ea220597-3c0c-5053-e971-6b51c2a71ff3",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+02:00",
"valueQuantity": {
"value": 87.506,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:53ebacb9-c687-304e-2b5d-543722dc94f6",
"resource": {
"resourceType": "Observation",
"id": "53ebacb9-c687-304e-2b5d-543722dc94f6",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+02:00",
"valueQuantity": {
"value": 25,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:4788f599-265e-f4ac-6f28-6a1b15dab272",
"resource": {
"resourceType": "Observation",
"id": "4788f599-265e-f4ac-6f28-6a1b15dab272",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+02:00",
"valueQuantity": {
"value": 40.78,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e19b543b-7db6-25d2-59a7-c42f618b89fd",
"resource": {
"resourceType": "Observation",
"id": "e19b543b-7db6-25d2-59a7-c42f618b89fd",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+02:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 66,
"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": 97,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0eeef0fb-51f5-bead-494e-e56269e80a9a",
"resource": {
"resourceType": "Observation",
"id": "0eeef0fb-51f5-bead-494e-e56269e80a9a",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+02:00",
"valueQuantity": {
"value": 100,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:da33191c-fd7e-d26d-de93-868c3fdefd9c",
"resource": {
"resourceType": "Observation",
"id": "da33191c-fd7e-d26d-de93-868c3fdefd9c",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+02:00",
"valueQuantity": {
"value": 13,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e00b26b2-b183-ebb1-f6ba-2823a5549fc0",
"resource": {
"resourceType": "Observation",
"id": "e00b26b2-b183-ebb1-f6ba-2823a5549fc0",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+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:8b5bb9db-404e-14d0-ffad-d6601fd44031",
"resource": {
"resourceType": "Immunization",
"id": "8b5bb9db-404e-14d0-ffad-d6601fd44031",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"occurrenceDateTime": "2021-08-28T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:0e677b21-56c8-aa47-3146-7f52bcfb7d87",
"resource": {
"resourceType": "Immunization",
"id": "0e677b21-56c8-aa47-3146-7f52bcfb7d87",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"occurrenceDateTime": "2021-08-28T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:e0cef9d3-d847-a416-f7a9-196712aef7d2",
"resource": {
"resourceType": "Immunization",
"id": "e0cef9d3-d847-a416-f7a9-196712aef7d2",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"occurrenceDateTime": "2021-08-28T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:4d1d583f-9f66-802e-7b75-242d00423177",
"resource": {
"resourceType": "Immunization",
"id": "4d1d583f-9f66-802e-7b75-242d00423177",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"occurrenceDateTime": "2021-08-28T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:0f7d29cd-0bbb-2d73-b612-a8b9d0c28b88",
"resource": {
"resourceType": "Immunization",
"id": "0f7d29cd-0bbb-2d73-b612-a8b9d0c28b88",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"occurrenceDateTime": "2021-08-28T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:ec6bfdc2-9ab0-6f49-c4c9-323eaae97557",
"resource": {
"resourceType": "DiagnosticReport",
"id": "ec6bfdc2-9ab0-6f49-c4c9-323eaae97557",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
},
"effectiveDateTime": "2021-08-28T00:13:45+02:00",
"issued": "2021-08-28T00:13:45.770+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:bed6bb30-ad9a-7301-8707-29f3b73e5383",
"resource": {
"resourceType": "DocumentReference",
"id": "bed6bb30-ad9a-7301-8707-29f3b73e5383",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:ec6bfdc2-9ab0-6f49-c4c9-323eaae97557"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2021-08-28T00:13:45.770+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
} ],
"period": {
"start": "2021-08-28T00:13:45+02:00",
"end": "2021-08-28T00:28:45+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:8d0e7c19-bddc-f981-d8ed-8bf3bff73b05",
"resource": {
"resourceType": "Claim",
"id": "8d0e7c19-bddc-f981-d8ed-8bf3bff73b05",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2021-08-28T00:13:45+02:00",
"end": "2021-08-28T00:28:45+02:00"
},
"created": "2021-08-28T00:28:45+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:8b5bb9db-404e-14d0-ffad-d6601fd44031"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:0e677b21-56c8-aa47-3146-7f52bcfb7d87"
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:e0cef9d3-d847-a416-f7a9-196712aef7d2"
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:4d1d583f-9f66-802e-7b75-242d00423177"
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:0f7d29cd-0bbb-2d73-b612-a8b9d0c28b88"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"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:028a17b3-fdcb-2545-3f5d-f79f1762a792"
} ]
}, {
"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"
}
} ],
"total": {
"value": 816.80,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c2a23579-2387-004c-473c-7384371d615a",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c2a23579-2387-004c-473c-7384371d615a",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "8d0e7c19-bddc-f981-d8ed-8bf3bff73b05"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2021-08-28T00:28:45+02:00",
"end": "2022-08-28T00:28:45+02:00"
},
"created": "2021-08-28T00:28:45+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"claim": {
"reference": "urn:uuid:8d0e7c19-bddc-f981-d8ed-8bf3bff73b05"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "2021-08-28T00:13:45+02:00",
"end": "2021-08-28T00:28:45+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
} ]
}, {
"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": "2021-08-28T00:13:45+02:00",
"end": "2021-08-28T00:28:45+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": "2021-08-28T00:13:45+02:00",
"end": "2021-08-28T00:28:45+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": "2021-08-28T00:13:45+02:00",
"end": "2021-08-28T00:28:45+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": "2021-08-28T00:13:45+02:00",
"end": "2021-08-28T00:28:45+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": "2021-08-28T00:13:45+02:00",
"end": "2021-08-28T00:28:45+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": 816.80,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 544.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41",
"resource": {
"resourceType": "Encounter",
"id": "962cfa87-5151-d1e3-dad0-8fe2d57ddd41",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
}
} ],
"period": {
"start": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:1383f7a6-79c8-d875-ffe3-a3f9194eb64a",
"resource": {
"resourceType": "Observation",
"id": "1383f7a6-79c8-d875-ffe3-a3f9194eb64a",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 64.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:cd3ad09b-ff00-6c36-1d28-8fd1edaacab8",
"resource": {
"resourceType": "Observation",
"id": "cd3ad09b-ff00-6c36-1d28-8fd1edaacab8",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:24bee111-c09a-3332-d0dc-241853bf0eec",
"resource": {
"resourceType": "Observation",
"id": "24bee111-c09a-3332-d0dc-241853bf0eec",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 8,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e1e25dc7-03e4-066d-2d4b-69b18847beb8",
"resource": {
"resourceType": "Observation",
"id": "e1e25dc7-03e4-066d-2d4b-69b18847beb8",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 91.781,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1f9c77bc-9f9b-a68c-1ec9-0d4e8cf6db03",
"resource": {
"resourceType": "Observation",
"id": "1f9c77bc-9f9b-a68c-1ec9-0d4e8cf6db03",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 25,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:fcd653ae-ecaf-f003-fe41-f98172b0d062",
"resource": {
"resourceType": "Observation",
"id": "fcd653ae-ecaf-f003-fe41-f98172b0d062",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 42.49,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:586343ab-746b-d9e1-a7b6-ffc8012cc895",
"resource": {
"resourceType": "Observation",
"id": "586343ab-746b-d9e1-a7b6-ffc8012cc895",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+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": 96,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:93daf562-aac3-54bd-ccf0-b1ac2e0ecfa7",
"resource": {
"resourceType": "Observation",
"id": "93daf562-aac3-54bd-ccf0-b1ac2e0ecfa7",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 76,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3deebadd-a66c-196c-5807-45d3070257e1",
"resource": {
"resourceType": "Observation",
"id": "3deebadd-a66c-196c-5807-45d3070257e1",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 15,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6204b573-5b1e-4aa6-d21b-0355cc93c74d",
"resource": {
"resourceType": "Observation",
"id": "6204b573-5b1e-4aa6-d21b-0355cc93c74d",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+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:f986a934-0f79-7731-772c-da6fd36b82a9",
"resource": {
"resourceType": "Procedure",
"id": "f986a934-0f79-7731-772c-da6fd36b82a9",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"performedPeriod": {
"start": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:35820d65-eed1-2954-e6eb-babeaabcc923",
"resource": {
"resourceType": "Immunization",
"id": "35820d65-eed1-2954-e6eb-babeaabcc923",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"occurrenceDateTime": "2021-10-30T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:b4aa9d26-a58e-9b5b-ac3e-6382bb833485",
"resource": {
"resourceType": "Immunization",
"id": "b4aa9d26-a58e-9b5b-ac3e-6382bb833485",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"occurrenceDateTime": "2021-10-30T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:f3652776-2dd2-a07a-4a3f-b80717915f12",
"resource": {
"resourceType": "Immunization",
"id": "f3652776-2dd2-a07a-4a3f-b80717915f12",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"occurrenceDateTime": "2021-10-30T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:fe1aba3a-2922-fe74-2e8e-f37f846e7cc8",
"resource": {
"resourceType": "Immunization",
"id": "fe1aba3a-2922-fe74-2e8e-f37f846e7cc8",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"occurrenceDateTime": "2021-10-30T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:85643829-6437-645c-cf11-a83e11afa076",
"resource": {
"resourceType": "Immunization",
"id": "85643829-6437-645c-cf11-a83e11afa076",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"occurrenceDateTime": "2021-10-30T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:65ce11c0-f91c-4456-c742-e3b13a005c8d",
"resource": {
"resourceType": "DiagnosticReport",
"id": "65ce11c0-f91c-4456-c742-e3b13a005c8d",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
},
"effectiveDateTime": "2021-10-30T00:13:45+02:00",
"issued": "2021-10-30T00:13:45.770+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:cf946263-571e-987c-f056-1d6f7dae1a83",
"resource": {
"resourceType": "DocumentReference",
"id": "cf946263-571e-987c-f056-1d6f7dae1a83",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:65ce11c0-f91c-4456-c742-e3b13a005c8d"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2021-10-30T00:13:45.770+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
} ],
"period": {
"start": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:87e01d1a-dbf1-cab7-7793-075fb2f33499",
"resource": {
"resourceType": "Claim",
"id": "87e01d1a-dbf1-cab7-7793-075fb2f33499",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+02:00"
},
"created": "2021-10-30T00:28:45+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:35820d65-eed1-2954-e6eb-babeaabcc923"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:b4aa9d26-a58e-9b5b-ac3e-6382bb833485"
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:f3652776-2dd2-a07a-4a3f-b80717915f12"
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:fe1aba3a-2922-fe74-2e8e-f37f846e7cc8"
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:85643829-6437-645c-cf11-a83e11afa076"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:f986a934-0f79-7731-772c-da6fd36b82a9"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"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:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
} ]
}, {
"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": 369.50,
"currency": "USD"
}
} ],
"total": {
"value": 1186.30,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:d8a5fe4c-11be-b033-ff35-8111998f4594",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "d8a5fe4c-11be-b033-ff35-8111998f4594",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "87e01d1a-dbf1-cab7-7793-075fb2f33499"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2021-10-30T00:28:45+02:00",
"end": "2022-10-30T00:28:45+02:00"
},
"created": "2021-10-30T00:28:45+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"claim": {
"reference": "urn:uuid:87e01d1a-dbf1-cab7-7793-075fb2f33499"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
} ]
}, {
"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": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+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": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+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": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+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": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+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": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+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": "2021-10-30T00:13:45+02:00",
"end": "2021-10-30T00:28:45+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 369.50,
"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": 73.9,
"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": 295.6,
"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": 369.50,
"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": 369.50,
"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": 1186.30,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 839.6,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838",
"resource": {
"resourceType": "Encounter",
"id": "27479e33-365c-5df8-1b18-6f6ccc351838",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "27479e33-365c-5df8-1b18-6f6ccc351838"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-11-17T23:13:45+01:00",
"end": "2021-11-17T23:28:45+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693",
"display": "Dr. Riley817 Prohaska837"
}
} ],
"period": {
"start": "2021-11-17T23:13:45+01:00",
"end": "2021-11-17T23:28:45+01:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "65363002",
"display": "Otitis media"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|c64ea29a-9c02-31a6-9721-2c245c1c085d",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|7b20d1c4-c56b-3647-801c-5e4e13679073",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:dd7dc119-b434-8f95-fdfc-012b9319e09c",
"resource": {
"resourceType": "Condition",
"id": "dd7dc119-b434-8f95-fdfc-012b9319e09c",
"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": "65363002",
"display": "Otitis media"
} ],
"text": "Otitis media"
},
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
},
"onsetDateTime": "2021-11-17T23:13:45+01:00",
"abatementDateTime": "2022-01-28T23:13:45+01:00",
"recordedDate": "2021-11-17T23:13:45+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:06ef82cc-07da-6189-211d-ac11f39a71d8",
"resource": {
"resourceType": "MedicationRequest",
"id": "06ef82cc-07da-6189-211d-ac11f39a71d8",
"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": "308192",
"display": "Amoxicillin 500 MG Oral Tablet"
} ],
"text": "Amoxicillin 500 MG Oral Tablet"
},
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
},
"authoredOn": "2021-11-17T23:13:45+01:00",
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693",
"display": "Dr. Riley817 Prohaska837"
},
"dosageInstruction": [ {
"sequence": 1,
"text": "Take at regular intervals. Complete the prescribed course unless otherwise directed (qualifier value)",
"additionalInstruction": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "418577003",
"display": "Take at regular intervals. Complete the prescribed course unless otherwise directed (qualifier value)"
} ],
"text": "Take at regular intervals. Complete the prescribed course unless otherwise directed (qualifier value)"
} ],
"timing": {
"repeat": {
"frequency": 3,
"period": 1.0,
"periodUnit": "d"
}
},
"asNeededBoolean": false,
"doseAndRate": [ {
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/dose-rate-type",
"code": "ordered",
"display": "Ordered"
} ]
},
"doseQuantity": {
"value": 1.0
}
} ]
} ]
},
"request": {
"method": "POST",
"url": "MedicationRequest"
}
}, {
"fullUrl": "urn:uuid:72eb0798-f87c-0244-f848-f6605188726e",
"resource": {
"resourceType": "Claim",
"id": "72eb0798-f87c-0244-f848-f6605188726e",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2021-11-17T23:13:45+01:00",
"end": "2021-11-17T23:28:45+01:00"
},
"created": "2021-11-17T23:28:45+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|7b20d1c4-c56b-3647-801c-5e4e13679073",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"prescription": {
"reference": "urn:uuid:06ef82cc-07da-6189-211d-ac11f39a71d8"
},
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "308192",
"display": "Amoxicillin 500 MG Oral Tablet"
} ],
"text": "Amoxicillin 500 MG Oral Tablet"
},
"encounter": [ {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
} ]
} ],
"total": {
"value": 144.43,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:f56e21b2-cab1-efc2-1473-ad2444b0b110",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "f56e21b2-cab1-efc2-1473-ad2444b0b110",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "72eb0798-f87c-0244-f848-f6605188726e"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2021-11-17T23:28:45+01:00",
"end": "2022-11-17T23:28:45+01:00"
},
"created": "2021-11-17T23:28:45+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|c64ea29a-9c02-31a6-9721-2c245c1c085d",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"claim": {
"reference": "urn:uuid:72eb0798-f87c-0244-f848-f6605188726e"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "308192",
"display": "Amoxicillin 500 MG Oral Tablet"
} ],
"text": "Amoxicillin 500 MG Oral Tablet"
},
"servicedPeriod": {
"start": "2021-11-17T23:13:45+01:00",
"end": "2021-11-17T23:28:45+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 144.43,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:fae42441-4c38-b1eb-aafa-9fa6581fc44c",
"resource": {
"resourceType": "MedicationRequest",
"id": "fae42441-4c38-b1eb-aafa-9fa6581fc44c",
"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": "313820",
"display": "Acetaminophen 160 MG Chewable Tablet"
} ],
"text": "Acetaminophen 160 MG Chewable Tablet"
},
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
},
"authoredOn": "2021-11-17T23:13:45+01:00",
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693",
"display": "Dr. Riley817 Prohaska837"
},
"dosageInstruction": [ {
"sequence": 1,
"text": "Take as needed.",
"asNeededBoolean": true
} ]
},
"request": {
"method": "POST",
"url": "MedicationRequest"
}
}, {
"fullUrl": "urn:uuid:6482acc5-5507-22d2-4735-56119b1f0abe",
"resource": {
"resourceType": "Claim",
"id": "6482acc5-5507-22d2-4735-56119b1f0abe",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2021-11-17T23:13:45+01:00",
"end": "2021-11-17T23:28:45+01:00"
},
"created": "2021-11-17T23:28:45+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|7b20d1c4-c56b-3647-801c-5e4e13679073",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"prescription": {
"reference": "urn:uuid:fae42441-4c38-b1eb-aafa-9fa6581fc44c"
},
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "313820",
"display": "Acetaminophen 160 MG Chewable Tablet"
} ],
"text": "Acetaminophen 160 MG Chewable Tablet"
},
"encounter": [ {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
} ]
} ],
"total": {
"value": 63.57,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:75ad6ba1-3b56-8cbd-565e-d9d07b2ed661",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "75ad6ba1-3b56-8cbd-565e-d9d07b2ed661",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "6482acc5-5507-22d2-4735-56119b1f0abe"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2021-11-17T23:28:45+01:00",
"end": "2022-11-17T23:28:45+01:00"
},
"created": "2021-11-17T23:28:45+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|c64ea29a-9c02-31a6-9721-2c245c1c085d",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"claim": {
"reference": "urn:uuid:6482acc5-5507-22d2-4735-56119b1f0abe"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "313820",
"display": "Acetaminophen 160 MG Chewable Tablet"
} ],
"text": "Acetaminophen 160 MG Chewable Tablet"
},
"servicedPeriod": {
"start": "2021-11-17T23:13:45+01:00",
"end": "2021-11-17T23:28:45+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 63.57,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:6d6ce063-fbd3-e487-8dde-ec7fac964d7f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "6d6ce063-fbd3-e487-8dde-ec7fac964d7f",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
},
"effectiveDateTime": "2021-11-17T23:13:45+01:00",
"issued": "2021-11-17T23:13:45.770+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693",
"display": "Dr. Riley817 Prohaska837"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:4caaf283-ddbb-f779-5ff2-b3876e1cd4ff",
"resource": {
"resourceType": "DocumentReference",
"id": "4caaf283-ddbb-f779-5ff2-b3876e1cd4ff",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:6d6ce063-fbd3-e487-8dde-ec7fac964d7f"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2021-11-17T23:13:45.770+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693",
"display": "Dr. Riley817 Prohaska837"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|7b20d1c4-c56b-3647-801c-5e4e13679073",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMjEtMTEtMTcKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkpvaG5ueTc4NgogaXMgYSA1IG1vbnRoLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBtYWxlLiBQYXRpZW50IGhhcyBhIGhpc3Rvcnkgb2YgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLgoKIyBTb2NpYWwgSGlzdG9yeQogUGF0aWVudCBoYXMgbmV2ZXIgc21va2VkLgoKClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCgpQYXRpZW50IGN1cnJlbnRseSBoYXMgTWVkaWNhaWQuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCk5vIEFjdGl2ZSBNZWRpY2F0aW9ucy4KCiMgQXNzZXNzbWVudCBhbmQgUGxhbgpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBvdGl0aXMgbWVkaWEuIAoKIyMgUGxhbgoKVGhlIHBhdGllbnQgd2FzIHByZXNjcmliZWQgdGhlIGZvbGxvd2luZyBtZWRpY2F0aW9uczoKLSBhbW94aWNpbGxpbiA1MDAgbWcgb3JhbCB0YWJsZXQKLSBhY2V0YW1pbm9waGVuIDE2MCBtZyBjaGV3YWJsZSB0YWJsZXQK"
},
"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:27479e33-365c-5df8-1b18-6f6ccc351838"
} ],
"period": {
"start": "2021-11-17T23:13:45+01:00",
"end": "2021-11-17T23:28:45+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:76380eb7-5e3f-b75a-038d-dbe1b3d6ff6a",
"resource": {
"resourceType": "Claim",
"id": "76380eb7-5e3f-b75a-038d-dbe1b3d6ff6a",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2021-11-17T23:13:45+01:00",
"end": "2021-11-17T23:28:45+01:00"
},
"created": "2021-11-17T23:28:45+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|7b20d1c4-c56b-3647-801c-5e4e13679073",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|c64ea29a-9c02-31a6-9721-2c245c1c085d",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:dd7dc119-b434-8f95-fdfc-012b9319e09c"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "65363002",
"display": "Otitis media"
} ],
"text": "Otitis media"
}
} ],
"total": {
"value": 85.55,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:65e3069b-f2bb-23d2-0021-11b2d5af2157",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "65e3069b-f2bb-23d2-0021-11b2d5af2157",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "76380eb7-5e3f-b75a-038d-dbe1b3d6ff6a"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2021-11-17T23:28:45+01:00",
"end": "2022-11-17T23:28:45+01:00"
},
"created": "2021-11-17T23:28:45+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|c64ea29a-9c02-31a6-9721-2c245c1c085d",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"claim": {
"reference": "urn:uuid:76380eb7-5e3f-b75a-038d-dbe1b3d6ff6a"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999992693"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:dd7dc119-b434-8f95-fdfc-012b9319e09c"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"servicedPeriod": {
"start": "2021-11-17T23:13:45+01:00",
"end": "2021-11-17T23:28:45+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
} ]
}, {
"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": "65363002",
"display": "Otitis media"
} ],
"text": "Otitis media"
},
"servicedPeriod": {
"start": "2021-11-17T23:13:45+01:00",
"end": "2021-11-17T23:28:45+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
}
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 85.55,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed",
"resource": {
"resourceType": "Encounter",
"id": "e1b2c182-cf0a-09fc-94ea-e7f393be3fed",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
}
} ],
"period": {
"start": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:a82fcb9d-b732-c257-f99a-ec2dfb817d0a",
"resource": {
"resourceType": "Condition",
"id": "a82fcb9d-b732-c257-f99a-ec2dfb817d0a",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"onsetDateTime": "2022-01-28T23:13:45+01:00",
"abatementDateTime": "2022-07-30T00:13:45+02:00",
"recordedDate": "2022-01-28T23:13:45+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:2b1a6b17-be32-5de6-6d33-1159c385c194",
"resource": {
"resourceType": "Observation",
"id": "2b1a6b17-be32-5de6-6d33-1159c385c194",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+01:00",
"valueQuantity": {
"value": 69,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:261c1431-c316-ff39-4b58-8d6be8e5e1f0",
"resource": {
"resourceType": "Observation",
"id": "261c1431-c316-ff39-4b58-8d6be8e5e1f0",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+01:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:91cf5091-e530-44ba-5ff1-0ffbe418c9e1",
"resource": {
"resourceType": "Observation",
"id": "91cf5091-e530-44ba-5ff1-0ffbe418c9e1",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+01:00",
"valueQuantity": {
"value": 9.5,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0dff0498-8865-ce0a-3dab-1c1f989e35c0",
"resource": {
"resourceType": "Observation",
"id": "0dff0498-8865-ce0a-3dab-1c1f989e35c0",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+01:00",
"valueQuantity": {
"value": 93.775,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:63a4a264-f7fd-1b27-dcd3-322a02a9067c",
"resource": {
"resourceType": "Observation",
"id": "63a4a264-f7fd-1b27-dcd3-322a02a9067c",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+01:00",
"valueQuantity": {
"value": 25,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2cb786ea-466b-4059-d9ff-7864e652eacb",
"resource": {
"resourceType": "Observation",
"id": "2cb786ea-466b-4059-d9ff-7864e652eacb",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+01:00",
"valueQuantity": {
"value": 44.19,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2cede333-c91d-385c-3001-279b30c04f82",
"resource": {
"resourceType": "Observation",
"id": "2cede333-c91d-385c-3001-279b30c04f82",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+01:00",
"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": 99,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5b7d91c6-06a3-9604-d1d7-b826b90b4ed2",
"resource": {
"resourceType": "Observation",
"id": "5b7d91c6-06a3-9604-d1d7-b826b90b4ed2",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+01:00",
"valueQuantity": {
"value": 63,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e2579714-7d6c-0903-f851-a045a0568277",
"resource": {
"resourceType": "Observation",
"id": "e2579714-7d6c-0903-f851-a045a0568277",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+01:00",
"valueQuantity": {
"value": 16,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:de7c2f10-dcff-f23c-a86b-6e1c7315eb15",
"resource": {
"resourceType": "Observation",
"id": "de7c2f10-dcff-f23c-a86b-6e1c7315eb15",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+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:5fe08f28-262d-b3c6-7b1d-4ca017e8050e",
"resource": {
"resourceType": "Immunization",
"id": "5fe08f28-262d-b3c6-7b1d-4ca017e8050e",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"occurrenceDateTime": "2022-01-28T23:13:45+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:10919739-c2b3-560f-bfac-daaeec3287e0",
"resource": {
"resourceType": "Immunization",
"id": "10919739-c2b3-560f-bfac-daaeec3287e0",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"occurrenceDateTime": "2022-01-28T23:13:45+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:804748c9-d72c-abf0-232e-5947522db9c6",
"resource": {
"resourceType": "Immunization",
"id": "804748c9-d72c-abf0-232e-5947522db9c6",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"occurrenceDateTime": "2022-01-28T23:13:45+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:4d903c7c-1166-6d35-7a34-3f799e687830",
"resource": {
"resourceType": "Immunization",
"id": "4d903c7c-1166-6d35-7a34-3f799e687830",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"occurrenceDateTime": "2022-01-28T23:13:45+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:731171ca-eae5-4baa-90fd-aff3d0c32d27",
"resource": {
"resourceType": "Immunization",
"id": "731171ca-eae5-4baa-90fd-aff3d0c32d27",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"occurrenceDateTime": "2022-01-28T23:13:45+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:19cfa295-3608-8811-20bb-d32f7410a494",
"resource": {
"resourceType": "DiagnosticReport",
"id": "19cfa295-3608-8811-20bb-d32f7410a494",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
},
"effectiveDateTime": "2022-01-28T23:13:45+01:00",
"issued": "2022-01-28T23:13:45.770+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:b15e3704-63cd-d1ec-f242-4f3bc542a3dc",
"resource": {
"resourceType": "DocumentReference",
"id": "b15e3704-63cd-d1ec-f242-4f3bc542a3dc",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:19cfa295-3608-8811-20bb-d32f7410a494"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2022-01-28T23:13:45.770+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
} ],
"period": {
"start": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:613e494f-9fc7-4fb8-f49c-83c4cae74c72",
"resource": {
"resourceType": "Claim",
"id": "613e494f-9fc7-4fb8-f49c-83c4cae74c72",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+01:00"
},
"created": "2022-01-28T23:28:45+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:5fe08f28-262d-b3c6-7b1d-4ca017e8050e"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:10919739-c2b3-560f-bfac-daaeec3287e0"
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:804748c9-d72c-abf0-232e-5947522db9c6"
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:4d903c7c-1166-6d35-7a34-3f799e687830"
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:731171ca-eae5-4baa-90fd-aff3d0c32d27"
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:a82fcb9d-b732-c257-f99a-ec2dfb817d0a"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"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:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
} ]
}, {
"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"
}
}, {
"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:b8d8f4ed-8a06-258a-5cb9-a68a1281fdd4",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "b8d8f4ed-8a06-258a-5cb9-a68a1281fdd4",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "613e494f-9fc7-4fb8-f49c-83c4cae74c72"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2022-01-28T23:28:45+01:00",
"end": "2023-01-28T23:28:45+01:00"
},
"created": "2022-01-28T23:28:45+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"claim": {
"reference": "urn:uuid:613e494f-9fc7-4fb8-f49c-83c4cae74c72"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:a82fcb9d-b732-c257-f99a-ec2dfb817d0a"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
} ]
}, {
"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": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+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": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+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": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+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": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+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": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+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": 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": "2022-01-28T23:13:45+01:00",
"end": "2022-01-28T23:28:45+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 816.80,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 544.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404",
"resource": {
"resourceType": "Encounter",
"id": "44c47092-2848-c3e1-f493-5a8f58759404",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "44c47092-2848-c3e1-f493-5a8f58759404"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-04-30T00:13:45+02:00",
"end": "2022-04-30T00:28:45+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
}
} ],
"period": {
"start": "2022-04-30T00:13:45+02:00",
"end": "2022-04-30T00:28:45+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:1c5d9888-7598-8a7e-28b7-ecdcddaaf9fc",
"resource": {
"resourceType": "Observation",
"id": "1c5d9888-7598-8a7e-28b7-ecdcddaaf9fc",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 72.8,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8ec9f057-67de-84f8-070a-99767caf5b32",
"resource": {
"resourceType": "Observation",
"id": "8ec9f057-67de-84f8-070a-99767caf5b32",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 4,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9ee520ea-a9e0-c9d7-569b-b99d9f11f98c",
"resource": {
"resourceType": "Observation",
"id": "9ee520ea-a9e0-c9d7-569b-b99d9f11f98c",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 10.6,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a344c83b-1afa-abce-41ce-444b0cb1655c",
"resource": {
"resourceType": "Observation",
"id": "a344c83b-1afa-abce-41ce-444b0cb1655c",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 94.292,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:36276cb5-da66-a5ad-23c5-1fa8e685a15c",
"resource": {
"resourceType": "Observation",
"id": "36276cb5-da66-a5ad-23c5-1fa8e685a15c",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 25,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ac14abf4-bd74-9e74-d0dd-825c0601fcfa",
"resource": {
"resourceType": "Observation",
"id": "ac14abf4-bd74-9e74-d0dd-825c0601fcfa",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 45.34,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1eea174f-157f-0257-ba73-fe3abce43816",
"resource": {
"resourceType": "Observation",
"id": "1eea174f-157f-0257-ba73-fe3abce43816",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+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": 103,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:85e602ff-2bfa-56e7-4d75-d99b7541f112",
"resource": {
"resourceType": "Observation",
"id": "85e602ff-2bfa-56e7-4d75-d99b7541f112",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 79,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:568f6e52-4ec9-8804-a52b-d7081a41698e",
"resource": {
"resourceType": "Observation",
"id": "568f6e52-4ec9-8804-a52b-d7081a41698e",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 13,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:db076eaa-9fdf-5068-2918-cb3bb38a4e77",
"resource": {
"resourceType": "Observation",
"id": "db076eaa-9fdf-5068-2918-cb3bb38a4e77",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+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:a9c6fdfb-9223-a153-12bf-1e6d9e3f5216",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a9c6fdfb-9223-a153-12bf-1e6d9e3f5216",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
},
"effectiveDateTime": "2022-04-30T00:13:45+02:00",
"issued": "2022-04-30T00:13:45.770+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:f4a549fc-f458-d349-d22b-5d44b55c63aa",
"resource": {
"resourceType": "DocumentReference",
"id": "f4a549fc-f458-d349-d22b-5d44b55c63aa",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:a9c6fdfb-9223-a153-12bf-1e6d9e3f5216"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2022-04-30T00:13:45.770+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
} ],
"period": {
"start": "2022-04-30T00:13:45+02:00",
"end": "2022-04-30T00:28:45+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:b7d8c590-5430-0505-af1c-0cf9a8c6f947",
"resource": {
"resourceType": "Claim",
"id": "b7d8c590-5430-0505-af1c-0cf9a8c6f947",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2022-04-30T00:13:45+02:00",
"end": "2022-04-30T00:28:45+02:00"
},
"created": "2022-04-30T00:28:45+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"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:44c47092-2848-c3e1-f493-5a8f58759404"
} ]
} ],
"total": {
"value": 136.80,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:e0a99ee0-1c59-5f4a-5670-d3762ec25777",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "e0a99ee0-1c59-5f4a-5670-d3762ec25777",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "b7d8c590-5430-0505-af1c-0cf9a8c6f947"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2022-04-30T00:28:45+02:00",
"end": "2023-04-30T00:28:45+02:00"
},
"created": "2022-04-30T00:28:45+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"claim": {
"reference": "urn:uuid:b7d8c590-5430-0505-af1c-0cf9a8c6f947"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "2022-04-30T00:13:45+02:00",
"end": "2022-04-30T00:28:45+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 136.80,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b",
"resource": {
"resourceType": "Encounter",
"id": "5cd33c3f-a347-5e3c-b5f2-e0237c0a575b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
}
} ],
"period": {
"start": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:30fd1bbb-2551-5f1a-17c6-d7fa2eefe206",
"resource": {
"resourceType": "Observation",
"id": "30fd1bbb-2551-5f1a-17c6-d7fa2eefe206",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 76.2,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:092af7ac-7de0-2c0e-d291-0c2509ce6602",
"resource": {
"resourceType": "Observation",
"id": "092af7ac-7de0-2c0e-d291-0c2509ce6602",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:da2b21cb-4983-fe52-a3bd-f642df03e485",
"resource": {
"resourceType": "Observation",
"id": "da2b21cb-4983-fe52-a3bd-f642df03e485",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 11.5,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:4d964229-27f7-6a73-ec71-b5a24c6ca41d",
"resource": {
"resourceType": "Observation",
"id": "4d964229-27f7-6a73-ec71-b5a24c6ca41d",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 95.602,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f8e87464-adf6-90b3-2de5-411d7fa3e274",
"resource": {
"resourceType": "Observation",
"id": "f8e87464-adf6-90b3-2de5-411d7fa3e274",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 25,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ae5d0e49-1a11-e483-a25e-3b086d12e8e8",
"resource": {
"resourceType": "Observation",
"id": "ae5d0e49-1a11-e483-a25e-3b086d12e8e8",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 46.16,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:809c85c0-d633-a6c9-dba2-e11054b8bbe0",
"resource": {
"resourceType": "Observation",
"id": "809c85c0-d633-a6c9-dba2-e11054b8bbe0",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+02:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 65,
"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": 101,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1c117d81-1d9b-e95e-9695-50f3bffa410e",
"resource": {
"resourceType": "Observation",
"id": "1c117d81-1d9b-e95e-9695-50f3bffa410e",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 79,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3b96839e-53e1-6e78-7d6d-a8b9007e176b",
"resource": {
"resourceType": "Observation",
"id": "3b96839e-53e1-6e78-7d6d-a8b9007e176b",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+02:00",
"valueQuantity": {
"value": 13,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:93117a0f-cd2c-e0b5-aa60-8920c4b624e3",
"resource": {
"resourceType": "Observation",
"id": "93117a0f-cd2c-e0b5-aa60-8920c4b624e3",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+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:73b8832d-72c0-a3cb-86bb-1a88706d39df",
"resource": {
"resourceType": "Procedure",
"id": "73b8832d-72c0-a3cb-86bb-1a88706d39df",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"performedPeriod": {
"start": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:b89ecbc0-2c54-461d-4734-346e5fff8065",
"resource": {
"resourceType": "Immunization",
"id": "b89ecbc0-2c54-461d-4734-346e5fff8065",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"occurrenceDateTime": "2022-07-30T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:5464bcdb-3216-9971-858e-32174fd50088",
"resource": {
"resourceType": "Immunization",
"id": "5464bcdb-3216-9971-858e-32174fd50088",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"occurrenceDateTime": "2022-07-30T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:8df0435f-4701-4083-243f-ae6166bf80a9",
"resource": {
"resourceType": "Immunization",
"id": "8df0435f-4701-4083-243f-ae6166bf80a9",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"occurrenceDateTime": "2022-07-30T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:d019e18b-c21c-c425-e486-08b2c0b2cd37",
"resource": {
"resourceType": "Immunization",
"id": "d019e18b-c21c-c425-e486-08b2c0b2cd37",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"occurrenceDateTime": "2022-07-30T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:077d3847-f2ab-e44c-2bf0-c5f605e2b09a",
"resource": {
"resourceType": "Immunization",
"id": "077d3847-f2ab-e44c-2bf0-c5f605e2b09a",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"occurrenceDateTime": "2022-07-30T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:b3f4ff45-893c-b267-0114-0353cac0287f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b3f4ff45-893c-b267-0114-0353cac0287f",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
},
"effectiveDateTime": "2022-07-30T00:13:45+02:00",
"issued": "2022-07-30T00:13:45.770+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:00869452-160c-bb21-1c37-56bb0e2d2d2d",
"resource": {
"resourceType": "DocumentReference",
"id": "00869452-160c-bb21-1c37-56bb0e2d2d2d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:b3f4ff45-893c-b267-0114-0353cac0287f"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2022-07-30T00:13:45.770+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
} ],
"period": {
"start": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:a2ca7466-56df-0e73-3ea3-3526472123df",
"resource": {
"resourceType": "Claim",
"id": "a2ca7466-56df-0e73-3ea3-3526472123df",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+02:00"
},
"created": "2022-07-30T00:28:45+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:b89ecbc0-2c54-461d-4734-346e5fff8065"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:5464bcdb-3216-9971-858e-32174fd50088"
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:8df0435f-4701-4083-243f-ae6166bf80a9"
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:d019e18b-c21c-c425-e486-08b2c0b2cd37"
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:077d3847-f2ab-e44c-2bf0-c5f605e2b09a"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:73b8832d-72c0-a3cb-86bb-1a88706d39df"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"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:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
} ]
}, {
"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,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 500.63,
"currency": "USD"
}
} ],
"total": {
"value": 1317.43,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:3eaebc03-744e-ac7f-1f60-cdb49d26f623",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "3eaebc03-744e-ac7f-1f60-cdb49d26f623",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "a2ca7466-56df-0e73-3ea3-3526472123df"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2022-07-30T00:28:45+02:00",
"end": "2023-07-30T00:28:45+02:00"
},
"created": "2022-07-30T00:28:45+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"claim": {
"reference": "urn:uuid:a2ca7466-56df-0e73-3ea3-3526472123df"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
} ]
}, {
"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": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+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": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+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": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+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": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+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": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+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": "2022-07-30T00:13:45+02:00",
"end": "2022-07-30T00:28:45+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 500.63,
"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": 100.126,
"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": 400.504,
"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": 500.63,
"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": 500.63,
"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": 1317.43,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 944.504,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597",
"resource": {
"resourceType": "Encounter",
"id": "d105ea97-2d13-e754-9b47-8790b903e597",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "d105ea97-2d13-e754-9b47-8790b903e597"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-10-29T00:13:45+02:00",
"end": "2022-10-29T00:28:45+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
}
} ],
"period": {
"start": "2022-10-29T00:13:45+02:00",
"end": "2022-10-29T00:28:45+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:86364d54-8dbe-7ebd-f313-8b89bbe85937",
"resource": {
"resourceType": "Condition",
"id": "86364d54-8dbe-7ebd-f313-8b89bbe85937",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"onsetDateTime": "2022-10-29T00:13:45+02:00",
"recordedDate": "2022-10-29T00:13:45+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:c765510f-66e1-2283-d9ef-229cfb5e2bd2",
"resource": {
"resourceType": "Observation",
"id": "c765510f-66e1-2283-d9ef-229cfb5e2bd2",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 79.1,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:92e99d24-8696-95b4-8184-bfb6269ff882",
"resource": {
"resourceType": "Observation",
"id": "92e99d24-8696-95b4-8184-bfb6269ff882",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:381842e0-a98b-577c-8bae-fac70ed11f95",
"resource": {
"resourceType": "Observation",
"id": "381842e0-a98b-577c-8bae-fac70ed11f95",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 12.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f8377723-226f-f2a3-216f-9b8581d07dda",
"resource": {
"resourceType": "Observation",
"id": "f8377723-226f-f2a3-216f-9b8581d07dda",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 95.044,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ca649d4f-2a15-3c55-a3a9-cadf1546b69e",
"resource": {
"resourceType": "Observation",
"id": "ca649d4f-2a15-3c55-a3a9-cadf1546b69e",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 25,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a9443ecf-7e30-be53-88e3-93382d105d52",
"resource": {
"resourceType": "Observation",
"id": "a9443ecf-7e30-be53-88e3-93382d105d52",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 46.79,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c20857e6-f9f1-7e2f-5bb6-c1ffce98e40d",
"resource": {
"resourceType": "Observation",
"id": "c20857e6-f9f1-7e2f-5bb6-c1ffce98e40d",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+02:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 72,
"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": 100,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:faef93d2-dd13-cbdc-df90-f78b0845465e",
"resource": {
"resourceType": "Observation",
"id": "faef93d2-dd13-cbdc-df90-f78b0845465e",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 84,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:21089e5f-9c72-34e0-bbe3-d38494061b97",
"resource": {
"resourceType": "Observation",
"id": "21089e5f-9c72-34e0-bbe3-d38494061b97",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 14,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:30d6a8e9-e7bb-4601-13f7-1dbb79083845",
"resource": {
"resourceType": "Observation",
"id": "30d6a8e9-e7bb-4601-13f7-1dbb79083845",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+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:208bbb4b-e6f9-0dc1-64e0-de329438415d",
"resource": {
"resourceType": "Immunization",
"id": "208bbb4b-e6f9-0dc1-64e0-de329438415d",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"occurrenceDateTime": "2022-10-29T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:c6cc1611-7f4d-bd78-cdec-d7cc8b744cfa",
"resource": {
"resourceType": "DiagnosticReport",
"id": "c6cc1611-7f4d-bd78-cdec-d7cc8b744cfa",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
},
"effectiveDateTime": "2022-10-29T00:13:45+02:00",
"issued": "2022-10-29T00:13:45.770+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:d341147d-cc3e-05a7-07bd-24b6d24bde05",
"resource": {
"resourceType": "DocumentReference",
"id": "d341147d-cc3e-05a7-07bd-24b6d24bde05",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:c6cc1611-7f4d-bd78-cdec-d7cc8b744cfa"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2022-10-29T00:13:45.770+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
} ],
"period": {
"start": "2022-10-29T00:13:45+02:00",
"end": "2022-10-29T00:28:45+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:20984f20-3af3-9f46-3328-1b8d357dbf59",
"resource": {
"resourceType": "Claim",
"id": "20984f20-3af3-9f46-3328-1b8d357dbf59",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2022-10-29T00:13:45+02:00",
"end": "2022-10-29T00:28:45+02:00"
},
"created": "2022-10-29T00:28:45+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:208bbb4b-e6f9-0dc1-64e0-de329438415d"
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:86364d54-8dbe-7ebd-f313-8b89bbe85937"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"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:d105ea97-2d13-e754-9b47-8790b903e597"
} ]
}, {
"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:1c948db2-0e46-ccbf-2efd-85dea1582c95",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "1c948db2-0e46-ccbf-2efd-85dea1582c95",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "20984f20-3af3-9f46-3328-1b8d357dbf59"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2022-10-29T00:28:45+02:00",
"end": "2023-10-29T00:28:45+02:00"
},
"created": "2022-10-29T00:28:45+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"claim": {
"reference": "urn:uuid:20984f20-3af3-9f46-3328-1b8d357dbf59"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:86364d54-8dbe-7ebd-f313-8b89bbe85937"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "2022-10-29T00:13:45+02:00",
"end": "2022-10-29T00:28:45+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
} ]
}, {
"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": "2022-10-29T00:13:45+02:00",
"end": "2022-10-29T00:28:45+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": "2022-10-29T00:13:45+02:00",
"end": "2022-10-29T00:28:45+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:5d6ecfbf-c6ac-ca49-ee1d-51b14683e697",
"resource": {
"resourceType": "Encounter",
"id": "5d6ecfbf-c6ac-ca49-ee1d-51b14683e697",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "5d6ecfbf-c6ac-ca49-ee1d-51b14683e697"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2023-02-19T08:13:45+01:00",
"end": "2023-02-19T08:28:45+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997",
"display": "Dr. Winston220 McCullough561"
}
} ],
"period": {
"start": "2023-02-19T08:13:45+01:00",
"end": "2023-02-19T08:28:45+01:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "444814009",
"display": "Viral sinusitis (disorder)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|69fc5bac-35b9-3671-9b39-e157b58b6207",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|3ff0f58b-7a1f-3334-9449-ff15f68b7d86",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:c81b5c89-58f5-b6e4-ed64-8da406ec14f6",
"resource": {
"resourceType": "Condition",
"id": "c81b5c89-58f5-b6e4-ed64-8da406ec14f6",
"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": "444814009",
"display": "Viral sinusitis (disorder)"
} ],
"text": "Viral sinusitis (disorder)"
},
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5d6ecfbf-c6ac-ca49-ee1d-51b14683e697"
},
"onsetDateTime": "2023-02-19T08:13:45+01:00",
"abatementDateTime": "2023-03-18T08:13:45+01:00",
"recordedDate": "2023-02-19T08:13:45+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:acca7dbf-6a2a-d3a4-8ec3-48e0d873fbfe",
"resource": {
"resourceType": "MedicationRequest",
"id": "acca7dbf-6a2a-d3a4-8ec3-48e0d873fbfe",
"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": "562251",
"display": "Amoxicillin 250 MG / Clavulanate 125 MG Oral Tablet"
} ],
"text": "Amoxicillin 250 MG / Clavulanate 125 MG Oral Tablet"
},
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5d6ecfbf-c6ac-ca49-ee1d-51b14683e697"
},
"authoredOn": "2023-02-19T08:13:45+01:00",
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997",
"display": "Dr. Winston220 McCullough561"
},
"reasonReference": [ {
"reference": "urn:uuid:c81b5c89-58f5-b6e4-ed64-8da406ec14f6",
"display": "Viral sinusitis (disorder)"
} ]
},
"request": {
"method": "POST",
"url": "MedicationRequest"
}
}, {
"fullUrl": "urn:uuid:7b8df0ec-88ac-6753-0fd3-9ef9e8c188d7",
"resource": {
"resourceType": "Claim",
"id": "7b8df0ec-88ac-6753-0fd3-9ef9e8c188d7",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2023-02-19T08:13:45+01:00",
"end": "2023-02-19T08:28:45+01:00"
},
"created": "2023-02-19T08:28:45+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|3ff0f58b-7a1f-3334-9449-ff15f68b7d86",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"prescription": {
"reference": "urn:uuid:acca7dbf-6a2a-d3a4-8ec3-48e0d873fbfe"
},
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "562251",
"display": "Amoxicillin 250 MG / Clavulanate 125 MG Oral Tablet"
} ],
"text": "Amoxicillin 250 MG / Clavulanate 125 MG Oral Tablet"
},
"encounter": [ {
"reference": "urn:uuid:5d6ecfbf-c6ac-ca49-ee1d-51b14683e697"
} ]
} ],
"total": {
"value": 250.60,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:7748abe3-2bde-e17f-c7db-f3a4910963bd",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "7748abe3-2bde-e17f-c7db-f3a4910963bd",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "7b8df0ec-88ac-6753-0fd3-9ef9e8c188d7"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2023-02-19T08:28:45+01:00",
"end": "2024-02-19T08:28:45+01:00"
},
"created": "2023-02-19T08:28:45+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|69fc5bac-35b9-3671-9b39-e157b58b6207",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"claim": {
"reference": "urn:uuid:7b8df0ec-88ac-6753-0fd3-9ef9e8c188d7"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "562251",
"display": "Amoxicillin 250 MG / Clavulanate 125 MG Oral Tablet"
} ],
"text": "Amoxicillin 250 MG / Clavulanate 125 MG Oral Tablet"
},
"servicedPeriod": {
"start": "2023-02-19T08:13:45+01:00",
"end": "2023-02-19T08:28:45+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:5d6ecfbf-c6ac-ca49-ee1d-51b14683e697"
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 250.60,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:1c4d4323-d3d3-df87-3cbf-4f3f8496487f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "1c4d4323-d3d3-df87-3cbf-4f3f8496487f",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:5d6ecfbf-c6ac-ca49-ee1d-51b14683e697"
},
"effectiveDateTime": "2023-02-19T08:13:45+01:00",
"issued": "2023-02-19T08:13:45.770+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997",
"display": "Dr. Winston220 McCullough561"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMjMtMDItMTkKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkpvaG5ueTc4NgogaXMgYSAxIHllYXItb2xkIG5vbmhpc3BhbmljIHdoaXRlIG1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIG90aXRpcyBtZWRpYS4KCiMgU29jaWFsIEhpc3RvcnkKIFBhdGllbnQgaGFzIG5ldmVyIHNtb2tlZC4KCgpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgoKUGF0aWVudCBjdXJyZW50bHkgaGFzIE1lZGljYWlkLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwphbW94aWNpbGxpbiA1MDAgbWcgb3JhbCB0YWJsZXQ7IGFjZXRhbWlub3BoZW4gMTYwIG1nIGNoZXdhYmxlIHRhYmxldAoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuClBhdGllbnQgaXMgcHJlc2VudGluZyB3aXRoIHZpcmFsIHNpbnVzaXRpcyAoZGlzb3JkZXIpLiAKCiMjIFBsYW4KClRoZSBwYXRpZW50IHdhcyBwcmVzY3JpYmVkIHRoZSBmb2xsb3dpbmcgbWVkaWNhdGlvbnM6Ci0gYW1veGljaWxsaW4gMjUwIG1nIC8gY2xhdnVsYW5hdGUgMTI1IG1nIG9yYWwgdGFibGV0Cg=="
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:4c94f3c5-60d1-f639-5fdc-b4c8f132d3bf",
"resource": {
"resourceType": "DocumentReference",
"id": "4c94f3c5-60d1-f639-5fdc-b4c8f132d3bf",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:1c4d4323-d3d3-df87-3cbf-4f3f8496487f"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2023-02-19T08:13:45.770+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997",
"display": "Dr. Winston220 McCullough561"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|3ff0f58b-7a1f-3334-9449-ff15f68b7d86",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:5d6ecfbf-c6ac-ca49-ee1d-51b14683e697"
} ],
"period": {
"start": "2023-02-19T08:13:45+01:00",
"end": "2023-02-19T08:28:45+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:8a8bf7df-8f61-2734-3aca-cd732412458e",
"resource": {
"resourceType": "Claim",
"id": "8a8bf7df-8f61-2734-3aca-cd732412458e",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2023-02-19T08:13:45+01:00",
"end": "2023-02-19T08:28:45+01:00"
},
"created": "2023-02-19T08:28:45+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|3ff0f58b-7a1f-3334-9449-ff15f68b7d86",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|69fc5bac-35b9-3671-9b39-e157b58b6207",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:c81b5c89-58f5-b6e4-ed64-8da406ec14f6"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:5d6ecfbf-c6ac-ca49-ee1d-51b14683e697"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "444814009",
"display": "Viral sinusitis (disorder)"
} ],
"text": "Viral sinusitis (disorder)"
}
} ],
"total": {
"value": 85.55,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:47d35cc3-1770-7cc3-52fc-b0d509f51701",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "47d35cc3-1770-7cc3-52fc-b0d509f51701",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "8a8bf7df-8f61-2734-3aca-cd732412458e"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2023-02-19T08:28:45+01:00",
"end": "2024-02-19T08:28:45+01:00"
},
"created": "2023-02-19T08:28:45+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|69fc5bac-35b9-3671-9b39-e157b58b6207",
"display": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC"
},
"claim": {
"reference": "urn:uuid:8a8bf7df-8f61-2734-3aca-cd732412458e"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998997"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:c81b5c89-58f5-b6e4-ed64-8da406ec14f6"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "2023-02-19T08:13:45+01:00",
"end": "2023-02-19T08:28:45+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:5d6ecfbf-c6ac-ca49-ee1d-51b14683e697"
} ]
}, {
"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": "444814009",
"display": "Viral sinusitis (disorder)"
} ],
"text": "Viral sinusitis (disorder)"
},
"servicedPeriod": {
"start": "2023-02-19T08:13:45+01:00",
"end": "2023-02-19T08:28:45+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
}
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 85.55,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b",
"resource": {
"resourceType": "Encounter",
"id": "258878af-43bc-f73b-ab6e-dc85d43ad25b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "258878af-43bc-f73b-ab6e-dc85d43ad25b"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Vince741 Schoen8"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2023-04-29T00:13:45+02:00",
"end": "2023-04-29T00:28:45+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
}
} ],
"period": {
"start": "2023-04-29T00:13:45+02:00",
"end": "2023-04-29T00:28:45+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:19262cff-744f-2bd0-bfec-243f45ebc84c",
"resource": {
"resourceType": "Observation",
"id": "19262cff-744f-2bd0-bfec-243f45ebc84c",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 84.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:870fa5ad-3571-96b0-8410-6af62abed2d0",
"resource": {
"resourceType": "Observation",
"id": "870fa5ad-3571-96b0-8410-6af62abed2d0",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:96ecb04b-83e0-a0cb-dbf2-6945bcc141bd",
"resource": {
"resourceType": "Observation",
"id": "96ecb04b-83e0-a0cb-dbf2-6945bcc141bd",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 13.2,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d62bc671-9cd9-2cca-3e0f-38918df8cdf7",
"resource": {
"resourceType": "Observation",
"id": "d62bc671-9cd9-2cca-3e0f-38918df8cdf7",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 92.213,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ad8cf911-6f88-67b8-6b0c-c42ab876ef6c",
"resource": {
"resourceType": "Observation",
"id": "ad8cf911-6f88-67b8-6b0c-c42ab876ef6c",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 25,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ba408b5d-149b-6a58-7564-2b122ff1dfe6",
"resource": {
"resourceType": "Observation",
"id": "ba408b5d-149b-6a58-7564-2b122ff1dfe6",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 47.65,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:635e4db5-2d93-6ff5-89c2-ab3a76b701db",
"resource": {
"resourceType": "Observation",
"id": "635e4db5-2d93-6ff5-89c2-ab3a76b701db",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+02:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 66,
"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": 100,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:41d9db88-c01c-77c5-7099-0f126b38c94d",
"resource": {
"resourceType": "Observation",
"id": "41d9db88-c01c-77c5-7099-0f126b38c94d",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 80,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:b178276b-ab79-6372-f1c9-0edf6fa62775",
"resource": {
"resourceType": "Observation",
"id": "b178276b-ab79-6372-f1c9-0edf6fa62775",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+02:00",
"valueQuantity": {
"value": 15,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:4f380afd-1ed2-c800-987f-5c99c0f95f33",
"resource": {
"resourceType": "Observation",
"id": "4f380afd-1ed2-c800-987f-5c99c0f95f33",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+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:9a0548d4-e82f-fa82-1a66-f666050dab04",
"resource": {
"resourceType": "Immunization",
"id": "9a0548d4-e82f-fa82-1a66-f666050dab04",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"occurrenceDateTime": "2023-04-29T00:13:45+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:2477442a-a8b9-e67f-324f-a55f24ca1f85",
"resource": {
"resourceType": "DiagnosticReport",
"id": "2477442a-a8b9-e67f-324f-a55f24ca1f85",
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"encounter": {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
},
"effectiveDateTime": "2023-04-29T00:13:45+02:00",
"issued": "2023-04-29T00:13:45.770+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMjMtMDQtMjkKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkpvaG5ueTc4NgogaXMgYSAxIHllYXItb2xkIG5vbmhpc3BhbmljIHdoaXRlIG1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIG90aXRpcyBtZWRpYSwgdmlyYWwgc2ludXNpdGlzIChkaXNvcmRlcikuCgojIFNvY2lhbCBIaXN0b3J5CiBQYXRpZW50IGhhcyBuZXZlciBzbW9rZWQuCgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KClBhdGllbnQgY3VycmVudGx5IGhhcyBNZWRpY2FpZC4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKYW1veGljaWxsaW4gNTAwIG1nIG9yYWwgdGFibGV0OyBhbW94aWNpbGxpbiAyNTAgbWcgLyBjbGF2dWxhbmF0ZSAxMjUgbWcgb3JhbCB0YWJsZXQ7IGFjZXRhbWlub3BoZW4gMTYwIG1nIGNoZXdhYmxlIHRhYmxldAoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgpQYXRpZW50IHdhcyBnaXZlbiB0aGUgZm9sbG93aW5nIGltbXVuaXphdGlvbnM6IGluZmx1ZW56YSwgc2Vhc29uYWwsIGluamVjdGFibGUsIHByZXNlcnZhdGl2ZSBmcmVlLiAK"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:05ef558f-878b-a61e-87b7-85fe4a9549fe",
"resource": {
"resourceType": "DocumentReference",
"id": "05ef558f-878b-a61e-87b7-85fe4a9549fe",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:2477442a-a8b9-e67f-324f-a55f24ca1f85"
} ],
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"date": "2023-04-29T00:13:45.770+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
} ],
"period": {
"start": "2023-04-29T00:13:45+02:00",
"end": "2023-04-29T00:28:45+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:860b1c97-6919-b31f-152a-38321b47b29a",
"resource": {
"resourceType": "Claim",
"id": "860b1c97-6919-b31f-152a-38321b47b29a",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873",
"display": "Johnny786 Schoen8"
},
"billablePeriod": {
"start": "2023-04-29T00:13:45+02:00",
"end": "2023-04-29T00:28:45+02:00"
},
"created": "2023-04-29T00:28:45+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:9a0548d4-e82f-fa82-1a66-f666050dab04"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"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:258878af-43bc-f73b-ab6e-dc85d43ad25b"
} ]
}, {
"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"
}
} ],
"total": {
"value": 272.80,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:1d69d8cd-8a95-6c03-d480-04e25c85c563",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "1d69d8cd-8a95-6c03-d480-04e25c85c563",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "860b1c97-6919-b31f-152a-38321b47b29a"
}, {
"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:a7a285c0-4714-dd3c-4837-8719c9b67873"
},
"billablePeriod": {
"start": "2023-04-29T00:28:45+02:00",
"end": "2024-04-29T00:28:45+02:00"
},
"created": "2023-04-29T00:28:45+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|6e3d04a3-9064-33e4-b8b5-63bb468d7629",
"display": "UNITED MEDICAL CARE LLC"
},
"claim": {
"reference": "urn:uuid:860b1c97-6919-b31f-152a-38321b47b29a"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "Medicaid"
}
} ],
"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": "2023-04-29T00:13:45+02:00",
"end": "2023-04-29T00:28:45+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
} ]
}, {
"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": "2023-04-29T00:13:45+02:00",
"end": "2023-04-29T00:28:45+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:6ab97e60-7680-d052-04f7-89701b836dd7",
"resource": {
"resourceType": "Provenance",
"id": "6ab97e60-7680-d052-04f7-89701b836dd7",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance" ]
},
"target": [ {
"reference": "urn:uuid:a7a285c0-4714-dd3c-4837-8719c9b67873"
}, {
"reference": "urn:uuid:0eb53bda-2881-5e8e-3597-87a9430af96a"
}, {
"reference": "urn:uuid:0cbe2cef-86a6-e86a-e5c3-86b60142e5eb"
}, {
"reference": "urn:uuid:247d0aa4-e125-bd0a-e113-c8ef39713ba5"
}, {
"reference": "urn:uuid:2c5658db-0ba4-e276-3188-fc8034e243ab"
}, {
"reference": "urn:uuid:4d8ad025-3b81-93a1-069f-76b7bddef092"
}, {
"reference": "urn:uuid:ab80cff7-16a1-f26e-951f-38ee4769be2a"
}, {
"reference": "urn:uuid:e78d01c3-c3bd-f8d5-4c97-c21e285d5e20"
}, {
"reference": "urn:uuid:1d43ca9d-4bb6-ca40-2a08-a9435ead0d4f"
}, {
"reference": "urn:uuid:6a6ed92a-4f7a-e1b9-57a2-1daaaa1ec7ae"
}, {
"reference": "urn:uuid:1f995897-7e15-5521-0b9f-fbea7bba33f0"
}, {
"reference": "urn:uuid:68b4e6c8-9364-0567-a3dc-a341e325eacb"
}, {
"reference": "urn:uuid:c0d18de1-a36c-853f-1eeb-043a7994580d"
}, {
"reference": "urn:uuid:480f84dd-bab5-3140-5db5-3d60b153ec56"
}, {
"reference": "urn:uuid:d2b070b6-8391-3c6e-3eaf-d35815477e46"
}, {
"reference": "urn:uuid:9740622e-3972-4322-eada-c8c3e841fcbf"
}, {
"reference": "urn:uuid:0de03ab3-5eef-d4f7-70b9-f62d42b5228c"
}, {
"reference": "urn:uuid:547bd11b-68e5-0a61-cd5d-6226693fdfa9"
}, {
"reference": "urn:uuid:1d2e9f88-8a18-f075-88bb-9efb0bec335b"
}, {
"reference": "urn:uuid:283d391d-9857-018e-cfbf-ca1e5d43188e"
}, {
"reference": "urn:uuid:da43913c-cb13-ebc5-2f11-a703a456da38"
}, {
"reference": "urn:uuid:37458f8a-6c33-9e89-8d8e-4239059a37af"
}, {
"reference": "urn:uuid:608352fa-ab62-8ead-36b9-e2c9019a413a"
}, {
"reference": "urn:uuid:aa059f57-d05e-533f-dd55-5900a571a9ad"
}, {
"reference": "urn:uuid:a23b80bc-eeff-614d-c84f-5711cb8e26d0"
}, {
"reference": "urn:uuid:9c5d0b11-ac87-4a67-9f89-3380174364ca"
}, {
"reference": "urn:uuid:c4d402a0-fada-aa0a-7596-6b991b4cb626"
}, {
"reference": "urn:uuid:0c092dc1-8ae5-4460-9c6a-0b479e2d0563"
}, {
"reference": "urn:uuid:d613fece-742e-1b95-92f0-3962218788ca"
}, {
"reference": "urn:uuid:c69c6991-809c-ba33-d641-6c2f0536f83e"
}, {
"reference": "urn:uuid:8bea2d5d-f366-a451-ba08-d77f859459ec"
}, {
"reference": "urn:uuid:37cbb2e9-be35-9763-af10-70ee637d697e"
}, {
"reference": "urn:uuid:f5305b10-48ea-02b6-b95e-76a929630682"
}, {
"reference": "urn:uuid:a86a1042-84b6-d703-883d-2348197333bf"
}, {
"reference": "urn:uuid:8dd7c896-79ce-0bf4-2cbc-6c74bf21a5ae"
}, {
"reference": "urn:uuid:49492073-1b0b-63e0-d2c9-206ed053f783"
}, {
"reference": "urn:uuid:7a729a24-e482-fb19-c945-18ece5c87cfc"
}, {
"reference": "urn:uuid:ddb29814-0673-6dc7-e699-8fd3276a6ce6"
}, {
"reference": "urn:uuid:305c1d07-37dc-80c7-90a0-32fc2b8e349b"
}, {
"reference": "urn:uuid:a8d18cef-7492-0209-2657-05cc1b41b886"
}, {
"reference": "urn:uuid:6e1853b7-1e57-4eaa-3225-d4779ad0239e"
}, {
"reference": "urn:uuid:6c8ad62a-b6de-0072-a838-dbff5b01604d"
}, {
"reference": "urn:uuid:d608796f-0439-b206-0f0e-8747656e2e17"
}, {
"reference": "urn:uuid:9db3ad6b-a037-458a-4194-2f33d0a60894"
}, {
"reference": "urn:uuid:5fab5b2a-dc69-bd25-4163-5e6d625aaee3"
}, {
"reference": "urn:uuid:1c931813-4166-e65f-2efc-103f859ce575"
}, {
"reference": "urn:uuid:028a17b3-fdcb-2545-3f5d-f79f1762a792"
}, {
"reference": "urn:uuid:163eee94-7232-bf83-db1e-168c668f2257"
}, {
"reference": "urn:uuid:77bd94af-a19f-ee96-8fd3-82ab4d9d5c08"
}, {
"reference": "urn:uuid:5a1accc4-966d-e5bf-ffbc-df4da0b570ae"
}, {
"reference": "urn:uuid:ea220597-3c0c-5053-e971-6b51c2a71ff3"
}, {
"reference": "urn:uuid:53ebacb9-c687-304e-2b5d-543722dc94f6"
}, {
"reference": "urn:uuid:4788f599-265e-f4ac-6f28-6a1b15dab272"
}, {
"reference": "urn:uuid:e19b543b-7db6-25d2-59a7-c42f618b89fd"
}, {
"reference": "urn:uuid:0eeef0fb-51f5-bead-494e-e56269e80a9a"
}, {
"reference": "urn:uuid:da33191c-fd7e-d26d-de93-868c3fdefd9c"
}, {
"reference": "urn:uuid:e00b26b2-b183-ebb1-f6ba-2823a5549fc0"
}, {
"reference": "urn:uuid:8b5bb9db-404e-14d0-ffad-d6601fd44031"
}, {
"reference": "urn:uuid:0e677b21-56c8-aa47-3146-7f52bcfb7d87"
}, {
"reference": "urn:uuid:e0cef9d3-d847-a416-f7a9-196712aef7d2"
}, {
"reference": "urn:uuid:4d1d583f-9f66-802e-7b75-242d00423177"
}, {
"reference": "urn:uuid:0f7d29cd-0bbb-2d73-b612-a8b9d0c28b88"
}, {
"reference": "urn:uuid:ec6bfdc2-9ab0-6f49-c4c9-323eaae97557"
}, {
"reference": "urn:uuid:bed6bb30-ad9a-7301-8707-29f3b73e5383"
}, {
"reference": "urn:uuid:8d0e7c19-bddc-f981-d8ed-8bf3bff73b05"
}, {
"reference": "urn:uuid:c2a23579-2387-004c-473c-7384371d615a"
}, {
"reference": "urn:uuid:962cfa87-5151-d1e3-dad0-8fe2d57ddd41"
}, {
"reference": "urn:uuid:1383f7a6-79c8-d875-ffe3-a3f9194eb64a"
}, {
"reference": "urn:uuid:cd3ad09b-ff00-6c36-1d28-8fd1edaacab8"
}, {
"reference": "urn:uuid:24bee111-c09a-3332-d0dc-241853bf0eec"
}, {
"reference": "urn:uuid:e1e25dc7-03e4-066d-2d4b-69b18847beb8"
}, {
"reference": "urn:uuid:1f9c77bc-9f9b-a68c-1ec9-0d4e8cf6db03"
}, {
"reference": "urn:uuid:fcd653ae-ecaf-f003-fe41-f98172b0d062"
}, {
"reference": "urn:uuid:586343ab-746b-d9e1-a7b6-ffc8012cc895"
}, {
"reference": "urn:uuid:93daf562-aac3-54bd-ccf0-b1ac2e0ecfa7"
}, {
"reference": "urn:uuid:3deebadd-a66c-196c-5807-45d3070257e1"
}, {
"reference": "urn:uuid:6204b573-5b1e-4aa6-d21b-0355cc93c74d"
}, {
"reference": "urn:uuid:f986a934-0f79-7731-772c-da6fd36b82a9"
}, {
"reference": "urn:uuid:35820d65-eed1-2954-e6eb-babeaabcc923"
}, {
"reference": "urn:uuid:b4aa9d26-a58e-9b5b-ac3e-6382bb833485"
}, {
"reference": "urn:uuid:f3652776-2dd2-a07a-4a3f-b80717915f12"
}, {
"reference": "urn:uuid:fe1aba3a-2922-fe74-2e8e-f37f846e7cc8"
}, {
"reference": "urn:uuid:85643829-6437-645c-cf11-a83e11afa076"
}, {
"reference": "urn:uuid:65ce11c0-f91c-4456-c742-e3b13a005c8d"
}, {
"reference": "urn:uuid:cf946263-571e-987c-f056-1d6f7dae1a83"
}, {
"reference": "urn:uuid:87e01d1a-dbf1-cab7-7793-075fb2f33499"
}, {
"reference": "urn:uuid:d8a5fe4c-11be-b033-ff35-8111998f4594"
}, {
"reference": "urn:uuid:27479e33-365c-5df8-1b18-6f6ccc351838"
}, {
"reference": "urn:uuid:dd7dc119-b434-8f95-fdfc-012b9319e09c"
}, {
"reference": "urn:uuid:06ef82cc-07da-6189-211d-ac11f39a71d8"
}, {
"reference": "urn:uuid:72eb0798-f87c-0244-f848-f6605188726e"
}, {
"reference": "urn:uuid:f56e21b2-cab1-efc2-1473-ad2444b0b110"
}, {
"reference": "urn:uuid:fae42441-4c38-b1eb-aafa-9fa6581fc44c"
}, {
"reference": "urn:uuid:6482acc5-5507-22d2-4735-56119b1f0abe"
}, {
"reference": "urn:uuid:75ad6ba1-3b56-8cbd-565e-d9d07b2ed661"
}, {
"reference": "urn:uuid:6d6ce063-fbd3-e487-8dde-ec7fac964d7f"
}, {
"reference": "urn:uuid:4caaf283-ddbb-f779-5ff2-b3876e1cd4ff"
}, {
"reference": "urn:uuid:76380eb7-5e3f-b75a-038d-dbe1b3d6ff6a"
}, {
"reference": "urn:uuid:65e3069b-f2bb-23d2-0021-11b2d5af2157"
}, {
"reference": "urn:uuid:e1b2c182-cf0a-09fc-94ea-e7f393be3fed"
}, {
"reference": "urn:uuid:a82fcb9d-b732-c257-f99a-ec2dfb817d0a"
}, {
"reference": "urn:uuid:2b1a6b17-be32-5de6-6d33-1159c385c194"
}, {
"reference": "urn:uuid:261c1431-c316-ff39-4b58-8d6be8e5e1f0"
}, {
"reference": "urn:uuid:91cf5091-e530-44ba-5ff1-0ffbe418c9e1"
}, {
"reference": "urn:uuid:0dff0498-8865-ce0a-3dab-1c1f989e35c0"
}, {
"reference": "urn:uuid:63a4a264-f7fd-1b27-dcd3-322a02a9067c"
}, {
"reference": "urn:uuid:2cb786ea-466b-4059-d9ff-7864e652eacb"
}, {
"reference": "urn:uuid:2cede333-c91d-385c-3001-279b30c04f82"
}, {
"reference": "urn:uuid:5b7d91c6-06a3-9604-d1d7-b826b90b4ed2"
}, {
"reference": "urn:uuid:e2579714-7d6c-0903-f851-a045a0568277"
}, {
"reference": "urn:uuid:de7c2f10-dcff-f23c-a86b-6e1c7315eb15"
}, {
"reference": "urn:uuid:5fe08f28-262d-b3c6-7b1d-4ca017e8050e"
}, {
"reference": "urn:uuid:10919739-c2b3-560f-bfac-daaeec3287e0"
}, {
"reference": "urn:uuid:804748c9-d72c-abf0-232e-5947522db9c6"
}, {
"reference": "urn:uuid:4d903c7c-1166-6d35-7a34-3f799e687830"
}, {
"reference": "urn:uuid:731171ca-eae5-4baa-90fd-aff3d0c32d27"
}, {
"reference": "urn:uuid:19cfa295-3608-8811-20bb-d32f7410a494"
}, {
"reference": "urn:uuid:b15e3704-63cd-d1ec-f242-4f3bc542a3dc"
}, {
"reference": "urn:uuid:613e494f-9fc7-4fb8-f49c-83c4cae74c72"
}, {
"reference": "urn:uuid:b8d8f4ed-8a06-258a-5cb9-a68a1281fdd4"
}, {
"reference": "urn:uuid:44c47092-2848-c3e1-f493-5a8f58759404"
}, {
"reference": "urn:uuid:1c5d9888-7598-8a7e-28b7-ecdcddaaf9fc"
}, {
"reference": "urn:uuid:8ec9f057-67de-84f8-070a-99767caf5b32"
}, {
"reference": "urn:uuid:9ee520ea-a9e0-c9d7-569b-b99d9f11f98c"
}, {
"reference": "urn:uuid:a344c83b-1afa-abce-41ce-444b0cb1655c"
}, {
"reference": "urn:uuid:36276cb5-da66-a5ad-23c5-1fa8e685a15c"
}, {
"reference": "urn:uuid:ac14abf4-bd74-9e74-d0dd-825c0601fcfa"
}, {
"reference": "urn:uuid:1eea174f-157f-0257-ba73-fe3abce43816"
}, {
"reference": "urn:uuid:85e602ff-2bfa-56e7-4d75-d99b7541f112"
}, {
"reference": "urn:uuid:568f6e52-4ec9-8804-a52b-d7081a41698e"
}, {
"reference": "urn:uuid:db076eaa-9fdf-5068-2918-cb3bb38a4e77"
}, {
"reference": "urn:uuid:a9c6fdfb-9223-a153-12bf-1e6d9e3f5216"
}, {
"reference": "urn:uuid:f4a549fc-f458-d349-d22b-5d44b55c63aa"
}, {
"reference": "urn:uuid:b7d8c590-5430-0505-af1c-0cf9a8c6f947"
}, {
"reference": "urn:uuid:e0a99ee0-1c59-5f4a-5670-d3762ec25777"
}, {
"reference": "urn:uuid:5cd33c3f-a347-5e3c-b5f2-e0237c0a575b"
}, {
"reference": "urn:uuid:30fd1bbb-2551-5f1a-17c6-d7fa2eefe206"
}, {
"reference": "urn:uuid:092af7ac-7de0-2c0e-d291-0c2509ce6602"
}, {
"reference": "urn:uuid:da2b21cb-4983-fe52-a3bd-f642df03e485"
}, {
"reference": "urn:uuid:4d964229-27f7-6a73-ec71-b5a24c6ca41d"
}, {
"reference": "urn:uuid:f8e87464-adf6-90b3-2de5-411d7fa3e274"
}, {
"reference": "urn:uuid:ae5d0e49-1a11-e483-a25e-3b086d12e8e8"
}, {
"reference": "urn:uuid:809c85c0-d633-a6c9-dba2-e11054b8bbe0"
}, {
"reference": "urn:uuid:1c117d81-1d9b-e95e-9695-50f3bffa410e"
}, {
"reference": "urn:uuid:3b96839e-53e1-6e78-7d6d-a8b9007e176b"
}, {
"reference": "urn:uuid:93117a0f-cd2c-e0b5-aa60-8920c4b624e3"
}, {
"reference": "urn:uuid:73b8832d-72c0-a3cb-86bb-1a88706d39df"
}, {
"reference": "urn:uuid:b89ecbc0-2c54-461d-4734-346e5fff8065"
}, {
"reference": "urn:uuid:5464bcdb-3216-9971-858e-32174fd50088"
}, {
"reference": "urn:uuid:8df0435f-4701-4083-243f-ae6166bf80a9"
}, {
"reference": "urn:uuid:d019e18b-c21c-c425-e486-08b2c0b2cd37"
}, {
"reference": "urn:uuid:077d3847-f2ab-e44c-2bf0-c5f605e2b09a"
}, {
"reference": "urn:uuid:b3f4ff45-893c-b267-0114-0353cac0287f"
}, {
"reference": "urn:uuid:00869452-160c-bb21-1c37-56bb0e2d2d2d"
}, {
"reference": "urn:uuid:a2ca7466-56df-0e73-3ea3-3526472123df"
}, {
"reference": "urn:uuid:3eaebc03-744e-ac7f-1f60-cdb49d26f623"
}, {
"reference": "urn:uuid:d105ea97-2d13-e754-9b47-8790b903e597"
}, {
"reference": "urn:uuid:86364d54-8dbe-7ebd-f313-8b89bbe85937"
}, {
"reference": "urn:uuid:c765510f-66e1-2283-d9ef-229cfb5e2bd2"
}, {
"reference": "urn:uuid:92e99d24-8696-95b4-8184-bfb6269ff882"
}, {
"reference": "urn:uuid:381842e0-a98b-577c-8bae-fac70ed11f95"
}, {
"reference": "urn:uuid:f8377723-226f-f2a3-216f-9b8581d07dda"
}, {
"reference": "urn:uuid:ca649d4f-2a15-3c55-a3a9-cadf1546b69e"
}, {
"reference": "urn:uuid:a9443ecf-7e30-be53-88e3-93382d105d52"
}, {
"reference": "urn:uuid:c20857e6-f9f1-7e2f-5bb6-c1ffce98e40d"
}, {
"reference": "urn:uuid:faef93d2-dd13-cbdc-df90-f78b0845465e"
}, {
"reference": "urn:uuid:21089e5f-9c72-34e0-bbe3-d38494061b97"
}, {
"reference": "urn:uuid:30d6a8e9-e7bb-4601-13f7-1dbb79083845"
}, {
"reference": "urn:uuid:208bbb4b-e6f9-0dc1-64e0-de329438415d"
}, {
"reference": "urn:uuid:c6cc1611-7f4d-bd78-cdec-d7cc8b744cfa"
}, {
"reference": "urn:uuid:d341147d-cc3e-05a7-07bd-24b6d24bde05"
}, {
"reference": "urn:uuid:20984f20-3af3-9f46-3328-1b8d357dbf59"
}, {
"reference": "urn:uuid:1c948db2-0e46-ccbf-2efd-85dea1582c95"
}, {
"reference": "urn:uuid:5d6ecfbf-c6ac-ca49-ee1d-51b14683e697"
}, {
"reference": "urn:uuid:c81b5c89-58f5-b6e4-ed64-8da406ec14f6"
}, {
"reference": "urn:uuid:acca7dbf-6a2a-d3a4-8ec3-48e0d873fbfe"
}, {
"reference": "urn:uuid:7b8df0ec-88ac-6753-0fd3-9ef9e8c188d7"
}, {
"reference": "urn:uuid:7748abe3-2bde-e17f-c7db-f3a4910963bd"
}, {
"reference": "urn:uuid:1c4d4323-d3d3-df87-3cbf-4f3f8496487f"
}, {
"reference": "urn:uuid:4c94f3c5-60d1-f639-5fdc-b4c8f132d3bf"
}, {
"reference": "urn:uuid:8a8bf7df-8f61-2734-3aca-cd732412458e"
}, {
"reference": "urn:uuid:47d35cc3-1770-7cc3-52fc-b0d509f51701"
}, {
"reference": "urn:uuid:258878af-43bc-f73b-ab6e-dc85d43ad25b"
}, {
"reference": "urn:uuid:19262cff-744f-2bd0-bfec-243f45ebc84c"
}, {
"reference": "urn:uuid:870fa5ad-3571-96b0-8410-6af62abed2d0"
}, {
"reference": "urn:uuid:96ecb04b-83e0-a0cb-dbf2-6945bcc141bd"
}, {
"reference": "urn:uuid:d62bc671-9cd9-2cca-3e0f-38918df8cdf7"
}, {
"reference": "urn:uuid:ad8cf911-6f88-67b8-6b0c-c42ab876ef6c"
}, {
"reference": "urn:uuid:ba408b5d-149b-6a58-7564-2b122ff1dfe6"
}, {
"reference": "urn:uuid:635e4db5-2d93-6ff5-89c2-ab3a76b701db"
}, {
"reference": "urn:uuid:41d9db88-c01c-77c5-7099-0f126b38c94d"
}, {
"reference": "urn:uuid:b178276b-ab79-6372-f1c9-0edf6fa62775"
}, {
"reference": "urn:uuid:4f380afd-1ed2-c800-987f-5c99c0f95f33"
}, {
"reference": "urn:uuid:9a0548d4-e82f-fa82-1a66-f666050dab04"
}, {
"reference": "urn:uuid:2477442a-a8b9-e67f-324f-a55f24ca1f85"
}, {
"reference": "urn:uuid:05ef558f-878b-a61e-87b7-85fe4a9549fe"
}, {
"reference": "urn:uuid:860b1c97-6919-b31f-152a-38321b47b29a"
}, {
"reference": "urn:uuid:1d69d8cd-8a95-6c03-d480-04e25c85c563"
} ],
"recorded": "2023-09-09T00:13:45.770+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|9999942599",
"display": "Dr. Regenia619 Bosco882"
},
"onBehalfOf": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
}, {
"type": {
"coding": [ {
"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type",
"code": "transmitter",
"display": "Transmitter"
} ],
"text": "Transmitter"
},
"who": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999942599",
"display": "Dr. Regenia619 Bosco882"
},
"onBehalfOf": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e56c7ec-99e5-3023-8e4f-95ad18a03f06",
"display": "UNITED MEDICAL CARE LLC"
}
} ]
},
"request": {
"method": "POST",
"url": "Provenance"
}
} ]
}
Reference in New Issue View Git Blame Copy Permalink