MILA_public/medax_pipeline
0
0
Fork 0
Code Issues Pull Requests Actions Packages Projects Releases 1 Wiki Activity
medax_pipeline/testData/Marlana402_Hansen121_8c570871-8d00-8c04-5da3-1ef43ed00f76.json
Tom Gebhardt a9db0be88a release commit
2025-04-16 22:12:19 +02:00

25183 lines
831 KiB
JSON
Raw Permalink Blame History

{
"resourceType": "Bundle",
"type": "transaction",
"entry": [ {
"fullUrl": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"resource": {
"resourceType": "Patient",
"id": "8c570871-8d00-8c04-5da3-1ef43ed00f76",
"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: -4956723760329843766 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": "Magda24 Jacobson885"
}, {
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
"valueCode": "F"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
"valueAddress": {
"city": "Beverly",
"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": 16.0
} ],
"identifier": [ {
"system": "https://github.com/synthetichealth/synthea",
"value": "8c570871-8d00-8c04-5da3-1ef43ed00f76"
}, {
"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": "8c570871-8d00-8c04-5da3-1ef43ed00f76"
}, {
"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": "999-88-8136"
}, {
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "DL",
"display": "Driver's license number"
} ],
"text": "Driver's license number"
},
"system": "urn:oid:2.16.840.1.113883.4.3.25",
"value": "S99980374"
} ],
"name": [ {
"use": "official",
"family": "Hansen121",
"given": [ "Marlana402", "Tiera511" ]
} ],
"telecom": [ {
"system": "phone",
"value": "555-110-2347",
"use": "home"
} ],
"gender": "female",
"birthDate": "2006-01-17",
"address": [ {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/geolocation",
"extension": [ {
"url": "latitude",
"valueDecimal": 42.1831453697455
}, {
"url": "longitude",
"valueDecimal": -72.12647729867271
} ]
} ],
"line": [ "739 Deckow Throughway" ],
"city": "Brookfield",
"state": "MA",
"postalCode": "01506",
"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:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce",
"resource": {
"resourceType": "Encounter",
"id": "d6914177-7f04-f8a7-10b9-ee21bdc2a5ce",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2014-01-14T16:58:25+01:00",
"end": "2014-01-14T17:13:25+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
}
} ],
"period": {
"start": "2014-01-14T16:58:25+01:00",
"end": "2014-01-14T17:13:25+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:c28907fa-84e7-e9e4-c5ef-7b1c4cd1993b",
"resource": {
"resourceType": "Condition",
"id": "c28907fa-84e7-e9e4-c5ef-7b1c4cd1993b",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"onsetDateTime": "2014-01-14T16:58:25+01:00",
"abatementDateTime": "2015-02-10T16:58:25+01:00",
"recordedDate": "2014-01-14T16:58:25+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:2bfb3718-ae46-4f6c-8529-8eee0fe05d34",
"resource": {
"resourceType": "Observation",
"id": "2bfb3718-ae46-4f6c-8529-8eee0fe05d34",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"effectiveDateTime": "2014-01-14T16:58:25+01:00",
"issued": "2014-01-14T16:58:25.518+01:00",
"valueQuantity": {
"value": 115.9,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:80fddf18-f2e3-89a7-9393-a286e1ff01a4",
"resource": {
"resourceType": "Observation",
"id": "80fddf18-f2e3-89a7-9393-a286e1ff01a4",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"effectiveDateTime": "2014-01-14T16:58:25+01:00",
"issued": "2014-01-14T16:58:25.518+01:00",
"valueQuantity": {
"value": 4,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0f1744b1-d41e-c595-1004-65b6c48bc0d3",
"resource": {
"resourceType": "Observation",
"id": "0f1744b1-d41e-c595-1004-65b6c48bc0d3",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"effectiveDateTime": "2014-01-14T16:58:25+01:00",
"issued": "2014-01-14T16:58:25.518+01:00",
"valueQuantity": {
"value": 18.8,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c9beac79-c1cf-1258-dd21-f9ea66d6eee7",
"resource": {
"resourceType": "Observation",
"id": "c9beac79-c1cf-1258-dd21-f9ea66d6eee7",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"effectiveDateTime": "2014-01-14T16:58:25+01:00",
"issued": "2014-01-14T16:58:25.518+01:00",
"valueQuantity": {
"value": 13.99,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9e83c0ae-7b98-c0b1-bde9-0c7f4258b48c",
"resource": {
"resourceType": "Observation",
"id": "9e83c0ae-7b98-c0b1-bde9-0c7f4258b48c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"effectiveDateTime": "2014-01-14T16:58:25+01:00",
"issued": "2014-01-14T16:58:25.518+01:00",
"valueQuantity": {
"value": 10.952,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:86113400-714d-a9d8-0af6-7cefc2028cf6",
"resource": {
"resourceType": "Observation",
"id": "86113400-714d-a9d8-0af6-7cefc2028cf6",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"effectiveDateTime": "2014-01-14T16:58:25+01:00",
"issued": "2014-01-14T16:58:25.518+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 85,
"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:c2f95e3b-623c-d27e-e883-47369ab4624b",
"resource": {
"resourceType": "Observation",
"id": "c2f95e3b-623c-d27e-e883-47369ab4624b",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"effectiveDateTime": "2014-01-14T16:58:25+01:00",
"issued": "2014-01-14T16:58:25.518+01:00",
"valueQuantity": {
"value": 81,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f7f1916e-b91c-30c5-06cf-6d330c614d08",
"resource": {
"resourceType": "Observation",
"id": "f7f1916e-b91c-30c5-06cf-6d330c614d08",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"effectiveDateTime": "2014-01-14T16:58:25+01:00",
"issued": "2014-01-14T16:58:25.518+01:00",
"valueQuantity": {
"value": 13,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c02ba134-6658-c0d9-221a-884c76e505a5",
"resource": {
"resourceType": "Observation",
"id": "c02ba134-6658-c0d9-221a-884c76e505a5",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"effectiveDateTime": "2014-01-14T16:58:25+01:00",
"issued": "2014-01-14T16:58:25.518+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:82f46ccd-6906-985d-95a2-5783d7e4a7c4",
"resource": {
"resourceType": "Immunization",
"id": "82f46ccd-6906-985d-95a2-5783d7e4a7c4",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"occurrenceDateTime": "2014-01-14T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:d859f2cf-b2fe-c07a-0b3e-28147cd0c003",
"resource": {
"resourceType": "DiagnosticReport",
"id": "d859f2cf-b2fe-c07a-0b3e-28147cd0c003",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
},
"effectiveDateTime": "2014-01-14T16:58:25+01:00",
"issued": "2014-01-14T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:2de2addd-c2e4-237d-bdde-ef74e49649cb",
"resource": {
"resourceType": "DocumentReference",
"id": "2de2addd-c2e4-237d-bdde-ef74e49649cb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:d859f2cf-b2fe-c07a-0b3e-28147cd0c003"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2014-01-14T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"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:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
} ],
"period": {
"start": "2014-01-14T16:58:25+01:00",
"end": "2014-01-14T17:13:25+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:5248f014-a50f-5872-80de-5b792dcb7743",
"resource": {
"resourceType": "Claim",
"id": "5248f014-a50f-5872-80de-5b792dcb7743",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2014-01-14T16:58:25+01:00",
"end": "2014-01-14T17:13:25+01:00"
},
"created": "2014-01-14T17:13:25+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:82f46ccd-6906-985d-95a2-5783d7e4a7c4"
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:c28907fa-84e7-e9e4-c5ef-7b1c4cd1993b"
}
} ],
"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:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
}
} ],
"total": {
"value": 272.80,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:1cacb987-71ee-6110-50de-54502422adad",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "1cacb987-71ee-6110-50de-54502422adad",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "5248f014-a50f-5872-80de-5b792dcb7743"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2014-01-14T17:13:25+01:00",
"end": "2015-01-14T17:13:25+01:00"
},
"created": "2014-01-14T17:13:25+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"claim": {
"reference": "urn:uuid:5248f014-a50f-5872-80de-5b792dcb7743"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:c28907fa-84e7-e9e4-c5ef-7b1c4cd1993b"
},
"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": "2014-01-14T16:58:25+01:00",
"end": "2014-01-14T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
} ]
}, {
"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": "2014-01-14T16:58:25+01:00",
"end": "2014-01-14T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"servicedPeriod": {
"start": "2014-01-14T16:58:25+01:00",
"end": "2014-01-14T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 272.80,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec",
"resource": {
"resourceType": "Encounter",
"id": "33e2ca73-c062-f81a-7805-433e14c328ec",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "33e2ca73-c062-f81a-7805-433e14c328ec"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2015-01-20T16:58:25+01:00",
"end": "2015-01-20T17:13:25+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
}
} ],
"period": {
"start": "2015-01-20T16:58:25+01:00",
"end": "2015-01-20T17:13:25+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:0eec6a84-d883-3448-24d7-8a1ae6386c85",
"resource": {
"resourceType": "Observation",
"id": "0eec6a84-d883-3448-24d7-8a1ae6386c85",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"effectiveDateTime": "2015-01-20T16:58:25+01:00",
"issued": "2015-01-20T16:58:25.518+01:00",
"valueQuantity": {
"value": 120.9,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:080f9c61-e2d5-3ae5-1826-374a73d8c493",
"resource": {
"resourceType": "Observation",
"id": "080f9c61-e2d5-3ae5-1826-374a73d8c493",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"effectiveDateTime": "2015-01-20T16:58:25+01:00",
"issued": "2015-01-20T16:58:25.518+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7ec2a827-e9da-d219-5d17-0c7081e2d4ae",
"resource": {
"resourceType": "Observation",
"id": "7ec2a827-e9da-d219-5d17-0c7081e2d4ae",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"effectiveDateTime": "2015-01-20T16:58:25+01:00",
"issued": "2015-01-20T16:58:25.518+01:00",
"valueQuantity": {
"value": 20.8,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:61f5a871-732e-5ffa-2954-b74a4980f04f",
"resource": {
"resourceType": "Observation",
"id": "61f5a871-732e-5ffa-2954-b74a4980f04f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"effectiveDateTime": "2015-01-20T16:58:25+01:00",
"issued": "2015-01-20T16:58:25.518+01:00",
"valueQuantity": {
"value": 14.21,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6bca7dcb-21f6-b707-a459-6be7cb31e11b",
"resource": {
"resourceType": "Observation",
"id": "6bca7dcb-21f6-b707-a459-6be7cb31e11b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"effectiveDateTime": "2015-01-20T16:58:25+01:00",
"issued": "2015-01-20T16:58:25.518+01:00",
"valueQuantity": {
"value": 10.153,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3d825904-ed09-71df-f618-790ccf53af42",
"resource": {
"resourceType": "Observation",
"id": "3d825904-ed09-71df-f618-790ccf53af42",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"effectiveDateTime": "2015-01-20T16:58:25+01:00",
"issued": "2015-01-20T16:58:25.518+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 84,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 107,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a73dcec2-aff5-eb31-af43-bbf4d04ec547",
"resource": {
"resourceType": "Observation",
"id": "a73dcec2-aff5-eb31-af43-bbf4d04ec547",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"effectiveDateTime": "2015-01-20T16:58:25+01:00",
"issued": "2015-01-20T16:58:25.518+01:00",
"valueQuantity": {
"value": 78,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5f4cc762-e5e6-2ef8-0f17-00e7dbd25039",
"resource": {
"resourceType": "Observation",
"id": "5f4cc762-e5e6-2ef8-0f17-00e7dbd25039",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"effectiveDateTime": "2015-01-20T16:58:25+01:00",
"issued": "2015-01-20T16:58:25.518+01:00",
"valueQuantity": {
"value": 12,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8d8fd4a5-4ce7-0845-891d-78f1d9a553e1",
"resource": {
"resourceType": "Observation",
"id": "8d8fd4a5-4ce7-0845-891d-78f1d9a553e1",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"effectiveDateTime": "2015-01-20T16:58:25+01:00",
"issued": "2015-01-20T16:58:25.518+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:410552d1-8d61-b531-2ce1-eb297be4d546",
"resource": {
"resourceType": "Immunization",
"id": "410552d1-8d61-b531-2ce1-eb297be4d546",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"occurrenceDateTime": "2015-01-20T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:b1c1846a-0db9-52bc-93ce-3d779eebc73c",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b1c1846a-0db9-52bc-93ce-3d779eebc73c",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
},
"effectiveDateTime": "2015-01-20T16:58:25+01:00",
"issued": "2015-01-20T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMTUtMDEtMjAKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCk1hcmxhbmE0MDIKIGlzIGEgOSB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbikuCgojIFNvY2lhbCBIaXN0b3J5CiBQYXRpZW50IGhhcyBuZXZlciBzbW9rZWQuCgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KClBhdGllbnQgY3VycmVudGx5IGhhcyBNZWRpY2FpZC4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKTm8gQWN0aXZlIE1lZGljYXRpb25zLgoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgpQYXRpZW50IHdhcyBnaXZlbiB0aGUgZm9sbG93aW5nIGltbXVuaXphdGlvbnM6IGluZmx1ZW56YSwgc2Vhc29uYWwsIGluamVjdGFibGUsIHByZXNlcnZhdGl2ZSBmcmVlLiAK"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:c0cca943-d2e0-269a-5470-a85438a89324",
"resource": {
"resourceType": "DocumentReference",
"id": "c0cca943-d2e0-269a-5470-a85438a89324",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:b1c1846a-0db9-52bc-93ce-3d779eebc73c"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2015-01-20T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"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:33e2ca73-c062-f81a-7805-433e14c328ec"
} ],
"period": {
"start": "2015-01-20T16:58:25+01:00",
"end": "2015-01-20T17:13:25+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:0deb9114-3c2d-7240-2475-7bc0420f2b56",
"resource": {
"resourceType": "Claim",
"id": "0deb9114-3c2d-7240-2475-7bc0420f2b56",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2015-01-20T16:58:25+01:00",
"end": "2015-01-20T17:13:25+01:00"
},
"created": "2015-01-20T17:13:25+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:410552d1-8d61-b531-2ce1-eb297be4d546"
}
} ],
"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:33e2ca73-c062-f81a-7805-433e14c328ec"
} ]
}, {
"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:9e38cc46-121c-1861-adb5-5d59396942a2",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "9e38cc46-121c-1861-adb5-5d59396942a2",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "0deb9114-3c2d-7240-2475-7bc0420f2b56"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2015-01-20T17:13:25+01:00",
"end": "2016-01-20T17:13:25+01:00"
},
"created": "2015-01-20T17:13:25+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"claim": {
"reference": "urn:uuid:0deb9114-3c2d-7240-2475-7bc0420f2b56"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"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": "2015-01-20T16:58:25+01:00",
"end": "2015-01-20T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2015-01-20T16:58:25+01:00",
"end": "2015-01-20T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 272.80,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb",
"resource": {
"resourceType": "Encounter",
"id": "6987fe87-9179-7d41-d6c0-9debc99b16bb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "6987fe87-9179-7d41-d6c0-9debc99b16bb"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2015-02-02T03:58:25+01:00",
"end": "2015-02-02T04:21:16+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
}
} ],
"period": {
"start": "2015-02-02T03:58:25+01:00",
"end": "2015-02-02T04:21:16+01:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "10509002",
"display": "Acute bronchitis (disorder)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:878b2645-4c2f-20b7-d801-c0e0228bde02",
"resource": {
"resourceType": "Condition",
"id": "878b2645-4c2f-20b7-d801-c0e0228bde02",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "10509002",
"display": "Acute bronchitis (disorder)"
} ],
"text": "Acute bronchitis (disorder)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb"
},
"onsetDateTime": "2015-02-02T03:58:25+01:00",
"abatementDateTime": "2015-02-21T04:21:16+01:00",
"recordedDate": "2015-02-02T03:58:25+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:8940ff77-9645-94c7-f67d-eb8de3597fc3",
"resource": {
"resourceType": "Procedure",
"id": "8940ff77-9645-94c7-f67d-eb8de3597fc3",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "23426006",
"display": "Measurement of respiratory function (procedure)"
} ],
"text": "Measurement of respiratory function (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb"
},
"performedPeriod": {
"start": "2015-02-02T03:58:25+01:00",
"end": "2015-02-02T04:21:16+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"reasonReference": [ {
"reference": "urn:uuid:878b2645-4c2f-20b7-d801-c0e0228bde02",
"display": "Acute bronchitis (disorder)"
} ]
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:4fab8d2e-aea3-6590-fc89-0312f4f0c90e",
"resource": {
"resourceType": "MedicationRequest",
"id": "4fab8d2e-aea3-6590-fc89-0312f4f0c90e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest" ]
},
"status": "stopped",
"intent": "order",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "community",
"display": "Community"
} ],
"text": "Community"
} ],
"medicationCodeableConcept": {
"coding": [ {
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "313782",
"display": "Acetaminophen 325 MG Oral Tablet"
} ],
"text": "Acetaminophen 325 MG Oral Tablet"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb"
},
"authoredOn": "2015-02-02T04:21:16+01:00",
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
},
"reasonReference": [ {
"reference": "urn:uuid:878b2645-4c2f-20b7-d801-c0e0228bde02",
"display": "Acute bronchitis (disorder)"
} ]
},
"request": {
"method": "POST",
"url": "MedicationRequest"
}
}, {
"fullUrl": "urn:uuid:5d596c1b-5938-ee97-92ec-a032ab32c57d",
"resource": {
"resourceType": "Claim",
"id": "5d596c1b-5938-ee97-92ec-a032ab32c57d",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2015-02-02T03:58:25+01:00",
"end": "2015-02-02T04:21:16+01:00"
},
"created": "2015-02-02T04:21:16+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"prescription": {
"reference": "urn:uuid:4fab8d2e-aea3-6590-fc89-0312f4f0c90e"
},
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "313782",
"display": "Acetaminophen 325 MG Oral Tablet"
} ],
"text": "Acetaminophen 325 MG Oral Tablet"
},
"encounter": [ {
"reference": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb"
} ]
} ],
"total": {
"value": 74.79,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:b9a632d1-8765-22bc-3b00-4e1651386d8d",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "b9a632d1-8765-22bc-3b00-4e1651386d8d",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "5d596c1b-5938-ee97-92ec-a032ab32c57d"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2015-02-02T04:21:16+01:00",
"end": "2016-02-02T04:21:16+01:00"
},
"created": "2015-02-02T04:21:16+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"claim": {
"reference": "urn:uuid:5d596c1b-5938-ee97-92ec-a032ab32c57d"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"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": "313782",
"display": "Acetaminophen 325 MG Oral Tablet"
} ],
"text": "Acetaminophen 325 MG Oral Tablet"
},
"servicedPeriod": {
"start": "2015-02-02T03:58:25+01:00",
"end": "2015-02-02T04:21:16+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb"
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 74.79,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:6879c868-cf66-1e52-c295-0d32a2b0eed3",
"resource": {
"resourceType": "CareTeam",
"id": "6879c868-cf66-1e52-c295-0d32a2b0eed3",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ]
},
"status": "inactive",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb"
},
"period": {
"start": "2015-02-02T04:21:16+01:00",
"end": "2016-01-26T16:58:25+01:00"
},
"participant": [ {
"role": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "116154003",
"display": "Patient"
} ],
"text": "Patient"
} ],
"member": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
}
}, {
"role": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "223366009",
"display": "Healthcare professional (occupation)"
} ],
"text": "Healthcare professional (occupation)"
} ],
"member": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
}
}, {
"role": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "224891009",
"display": "Healthcare services (qualifier value)"
} ],
"text": "Healthcare services (qualifier value)"
} ],
"member": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
}
} ],
"managingOrganization": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
} ]
},
"request": {
"method": "POST",
"url": "CareTeam"
}
}, {
"fullUrl": "urn:uuid:1616a49f-884c-bb5d-e02d-966007b866b4",
"resource": {
"resourceType": "CarePlan",
"id": "1616a49f-884c-bb5d-e02d-966007b866b4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan" ]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Care Plan for Respiratory therapy.<br/>Activities: <ul><li>Respiratory therapy</li><li>Respiratory therapy</li></ul></div>"
},
"status": "completed",
"intent": "order",
"category": [ {
"coding": [ {
"system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category",
"code": "assess-plan"
} ]
}, {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "53950000",
"display": "Respiratory therapy"
} ],
"text": "Respiratory therapy"
} ],
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb"
},
"period": {
"start": "2015-02-02T04:21:16+01:00",
"end": "2016-01-26T16:58:25+01:00"
},
"careTeam": [ {
"reference": "urn:uuid:6879c868-cf66-1e52-c295-0d32a2b0eed3"
} ],
"activity": [ {
"detail": {
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "304510005",
"display": "Recommendation to avoid exercise"
} ],
"text": "Recommendation to avoid exercise"
},
"status": "completed",
"location": {
"display": "BAYSTATE MEDICAL CENTER"
}
}
}, {
"detail": {
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "371605008",
"display": "Deep breathing and coughing exercises"
} ],
"text": "Deep breathing and coughing exercises"
},
"status": "completed",
"location": {
"display": "BAYSTATE MEDICAL CENTER"
}
}
} ]
},
"request": {
"method": "POST",
"url": "CarePlan"
}
}, {
"fullUrl": "urn:uuid:5418b0d1-c4a7-d1fe-5329-169a313165a2",
"resource": {
"resourceType": "DiagnosticReport",
"id": "5418b0d1-c4a7-d1fe-5329-169a313165a2",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb"
},
"effectiveDateTime": "2015-02-02T03:58:25+01:00",
"issued": "2015-02-02T03:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:d0ba4f6e-73bc-74ed-1d57-6f66f6eab842",
"resource": {
"resourceType": "DocumentReference",
"id": "d0ba4f6e-73bc-74ed-1d57-6f66f6eab842",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:5418b0d1-c4a7-d1fe-5329-169a313165a2"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2015-02-02T03:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"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:6987fe87-9179-7d41-d6c0-9debc99b16bb"
} ],
"period": {
"start": "2015-02-02T03:58:25+01:00",
"end": "2015-02-02T04:21:16+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:5bf1fd3d-e58e-d43d-3fda-f60b94c926dc",
"resource": {
"resourceType": "Claim",
"id": "5bf1fd3d-e58e-d43d-3fda-f60b94c926dc",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2015-02-02T03:58:25+01:00",
"end": "2015-02-02T04:21:16+01:00"
},
"created": "2015-02-02T04:21:16+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:878b2645-4c2f-20b7-d801-c0e0228bde02"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:8940ff77-9645-94c7-f67d-eb8de3597fc3"
}
} ],
"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:6987fe87-9179-7d41-d6c0-9debc99b16bb"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "10509002",
"display": "Acute bronchitis (disorder)"
} ],
"text": "Acute bronchitis (disorder)"
}
}, {
"sequence": 3,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "23426006",
"display": "Measurement of respiratory function (procedure)"
} ],
"text": "Measurement of respiratory function (procedure)"
},
"net": {
"value": 206.56,
"currency": "USD"
}
} ],
"total": {
"value": 292.11,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:ceef7e92-4026-17c0-5788-b8fb9a33a595",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "ceef7e92-4026-17c0-5788-b8fb9a33a595",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "5bf1fd3d-e58e-d43d-3fda-f60b94c926dc"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2015-02-02T04:21:16+01:00",
"end": "2016-02-02T04:21:16+01:00"
},
"created": "2015-02-02T04:21:16+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"claim": {
"reference": "urn:uuid:5bf1fd3d-e58e-d43d-3fda-f60b94c926dc"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:878b2645-4c2f-20b7-d801-c0e0228bde02"
},
"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": "2015-02-02T03:58:25+01:00",
"end": "2015-02-02T04:21:16+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "10509002",
"display": "Acute bronchitis (disorder)"
} ],
"text": "Acute bronchitis (disorder)"
},
"servicedPeriod": {
"start": "2015-02-02T03:58:25+01:00",
"end": "2015-02-02T04:21:16+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "23426006",
"display": "Measurement of respiratory function (procedure)"
} ],
"text": "Measurement of respiratory function (procedure)"
},
"servicedPeriod": {
"start": "2015-02-02T03:58:25+01:00",
"end": "2015-02-02T04:21:16+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 206.56,
"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": 41.312000000000005,
"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": 165.24800000000002,
"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": 206.56,
"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": 206.56,
"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": 292.11,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 165.24800000000002,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962",
"resource": {
"resourceType": "Encounter",
"id": "6271dff0-ad6e-4041-e035-7258ce93e962",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "6271dff0-ad6e-4041-e035-7258ce93e962"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185349003",
"display": "Encounter for check up (procedure)"
} ],
"text": "Encounter for check up (procedure)"
} ],
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2015-02-10T16:58:25+01:00",
"end": "2015-02-10T17:13:25+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
}
} ],
"period": {
"start": "2015-02-10T16:58:25+01:00",
"end": "2015-02-10T17:13:25+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:f714ad82-8a20-7dae-3276-4e24137505b2",
"resource": {
"resourceType": "Observation",
"id": "f714ad82-8a20-7dae-3276-4e24137505b2",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"effectiveDateTime": "2015-02-10T16:58:25+01:00",
"issued": "2015-02-10T16:58:25.518+01:00",
"valueQuantity": {
"value": 120.9,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2e1b3e0e-0463-8652-cf38-9d976c4996b2",
"resource": {
"resourceType": "Observation",
"id": "2e1b3e0e-0463-8652-cf38-9d976c4996b2",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"effectiveDateTime": "2015-02-10T16:58:25+01:00",
"issued": "2015-02-10T16:58:25.518+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:677ec8b7-246d-d89a-ed41-fbf640840392",
"resource": {
"resourceType": "Observation",
"id": "677ec8b7-246d-d89a-ed41-fbf640840392",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"effectiveDateTime": "2015-02-10T16:58:25+01:00",
"issued": "2015-02-10T16:58:25.518+01:00",
"valueQuantity": {
"value": 20.8,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d7208010-3146-1823-a9a5-433b8a29a356",
"resource": {
"resourceType": "Observation",
"id": "d7208010-3146-1823-a9a5-433b8a29a356",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"effectiveDateTime": "2015-02-10T16:58:25+01:00",
"issued": "2015-02-10T16:58:25.518+01:00",
"valueQuantity": {
"value": 14.21,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:abe1401b-b3d7-3639-a328-55f5cab1e26c",
"resource": {
"resourceType": "Observation",
"id": "abe1401b-b3d7-3639-a328-55f5cab1e26c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"effectiveDateTime": "2015-02-10T16:58:25+01:00",
"issued": "2015-02-10T16:58:25.518+01:00",
"valueQuantity": {
"value": 10.153,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1312c37e-c26e-58a2-4514-dfb13bab4aa5",
"resource": {
"resourceType": "Observation",
"id": "1312c37e-c26e-58a2-4514-dfb13bab4aa5",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"effectiveDateTime": "2015-02-10T16:58:25+01:00",
"issued": "2015-02-10T16:58:25.518+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 83,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 106,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d0b8d09a-e870-a238-3443-09a0b0efc5d3",
"resource": {
"resourceType": "Observation",
"id": "d0b8d09a-e870-a238-3443-09a0b0efc5d3",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"effectiveDateTime": "2015-02-10T16:58:25+01:00",
"issued": "2015-02-10T16:58:25.518+01:00",
"valueQuantity": {
"value": 70,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2665fce9-a277-dc3a-1408-baa01f4dfd15",
"resource": {
"resourceType": "Observation",
"id": "2665fce9-a277-dc3a-1408-baa01f4dfd15",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"effectiveDateTime": "2015-02-10T16:58:25+01:00",
"issued": "2015-02-10T16:58:25.518+01:00",
"valueQuantity": {
"value": 14,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7dce3e24-ad20-664f-833b-59883f3e3f23",
"resource": {
"resourceType": "Observation",
"id": "7dce3e24-ad20-664f-833b-59883f3e3f23",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"effectiveDateTime": "2015-02-10T16:58:25+01:00",
"issued": "2015-02-10T16:58:25.518+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:f977589e-2e44-3eeb-19e6-a267d6ce162e",
"resource": {
"resourceType": "Procedure",
"id": "f977589e-2e44-3eeb-19e6-a267d6ce162e",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"performedPeriod": {
"start": "2015-02-10T16:58:25+01:00",
"end": "2015-02-10T17:13:25+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:c9e751ac-014d-8d81-eab2-e2851474d57f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "c9e751ac-014d-8d81-eab2-e2851474d57f",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
},
"effectiveDateTime": "2015-02-10T16:58:25+01:00",
"issued": "2015-02-10T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:c6f589ab-a65a-cd83-0135-7ab202e1961d",
"resource": {
"resourceType": "DocumentReference",
"id": "c6f589ab-a65a-cd83-0135-7ab202e1961d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:c9e751ac-014d-8d81-eab2-e2851474d57f"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2015-02-10T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"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:6271dff0-ad6e-4041-e035-7258ce93e962"
} ],
"period": {
"start": "2015-02-10T16:58:25+01:00",
"end": "2015-02-10T17:13:25+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:47f69879-da9f-144e-3248-dc525be236ca",
"resource": {
"resourceType": "Claim",
"id": "47f69879-da9f-144e-3248-dc525be236ca",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2015-02-10T16:58:25+01:00",
"end": "2015-02-10T17:13:25+01:00"
},
"created": "2015-02-10T17:13:25+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:f977589e-2e44-3eeb-19e6-a267d6ce162e"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185349003",
"display": "Encounter for check up (procedure)"
} ],
"text": "Encounter for check up (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 530.95,
"currency": "USD"
}
} ],
"total": {
"value": 616.50,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:ba5b9d1a-0d14-2ce3-7975-f7e31e46a1b6",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "ba5b9d1a-0d14-2ce3-7975-f7e31e46a1b6",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "47f69879-da9f-144e-3248-dc525be236ca"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2015-02-10T17:13:25+01:00",
"end": "2016-02-10T17:13:25+01:00"
},
"created": "2015-02-10T17:13:25+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"claim": {
"reference": "urn:uuid:47f69879-da9f-144e-3248-dc525be236ca"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"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": "185349003",
"display": "Encounter for check up (procedure)"
} ],
"text": "Encounter for check up (procedure)"
},
"servicedPeriod": {
"start": "2015-02-10T16:58:25+01:00",
"end": "2015-02-10T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
} ]
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"servicedPeriod": {
"start": "2015-02-10T16:58:25+01:00",
"end": "2015-02-10T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 530.95,
"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": 106.19000000000001,
"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": 424.76000000000005,
"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": 530.95,
"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": 530.95,
"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": 616.50,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 424.76000000000005,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62",
"resource": {
"resourceType": "Encounter",
"id": "15373422-0753-f927-5cab-dae3023e8f62",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "15373422-0753-f927-5cab-dae3023e8f62"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2016-01-26T16:58:25+01:00",
"end": "2016-01-26T17:13:25+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
}
} ],
"period": {
"start": "2016-01-26T16:58:25+01:00",
"end": "2016-01-26T17:13:25+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:1f6c8a59-f03f-57d5-02ea-f4cab9e1fed6",
"resource": {
"resourceType": "Condition",
"id": "1f6c8a59-f03f-57d5-02ea-f4cab9e1fed6",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"onsetDateTime": "2016-01-26T16:58:25+01:00",
"abatementDateTime": "2017-01-31T16:58:25+01:00",
"recordedDate": "2016-01-26T16:58:25+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:a6ab080a-f048-bf79-bd30-f9067ff2d6b1",
"resource": {
"resourceType": "Observation",
"id": "a6ab080a-f048-bf79-bd30-f9067ff2d6b1",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"effectiveDateTime": "2016-01-26T16:58:25+01:00",
"issued": "2016-01-26T16:58:25.518+01:00",
"valueQuantity": {
"value": 124.9,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5d194f04-5d28-5061-b5b7-c9baf2629029",
"resource": {
"resourceType": "Observation",
"id": "5d194f04-5d28-5061-b5b7-c9baf2629029",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"effectiveDateTime": "2016-01-26T16:58:25+01:00",
"issued": "2016-01-26T16:58:25.518+01:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ac2a74af-7df3-e7d1-dc45-bf59cf7c8002",
"resource": {
"resourceType": "Observation",
"id": "ac2a74af-7df3-e7d1-dc45-bf59cf7c8002",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"effectiveDateTime": "2016-01-26T16:58:25+01:00",
"issued": "2016-01-26T16:58:25.518+01:00",
"valueQuantity": {
"value": 21.9,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:32d56de6-561a-fbd2-a371-368a3e7c0aba",
"resource": {
"resourceType": "Observation",
"id": "32d56de6-561a-fbd2-a371-368a3e7c0aba",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"effectiveDateTime": "2016-01-26T16:58:25+01:00",
"issued": "2016-01-26T16:58:25.518+01:00",
"valueQuantity": {
"value": 14.04,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c2832e74-1f2c-d42c-3fb7-863f6b38f033",
"resource": {
"resourceType": "Observation",
"id": "c2832e74-1f2c-d42c-3fb7-863f6b38f033",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"effectiveDateTime": "2016-01-26T16:58:25+01:00",
"issued": "2016-01-26T16:58:25.518+01:00",
"valueQuantity": {
"value": 5.0111,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6f181e8d-5fd8-db41-5532-ace4eb00a571",
"resource": {
"resourceType": "Observation",
"id": "6f181e8d-5fd8-db41-5532-ace4eb00a571",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"effectiveDateTime": "2016-01-26T16:58:25+01:00",
"issued": "2016-01-26T16:58:25.518+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 83,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 104,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:90cbd992-9396-3f87-fbd5-2eb3febc65b9",
"resource": {
"resourceType": "Observation",
"id": "90cbd992-9396-3f87-fbd5-2eb3febc65b9",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"effectiveDateTime": "2016-01-26T16:58:25+01:00",
"issued": "2016-01-26T16:58:25.518+01:00",
"valueQuantity": {
"value": 77,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d7a1ed4f-d79e-4e72-3089-45eaec36ef83",
"resource": {
"resourceType": "Observation",
"id": "d7a1ed4f-d79e-4e72-3089-45eaec36ef83",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"effectiveDateTime": "2016-01-26T16:58:25+01:00",
"issued": "2016-01-26T16:58:25.518+01:00",
"valueQuantity": {
"value": 14,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:fbda66bd-7b5e-ae6d-0050-292877c32927",
"resource": {
"resourceType": "Observation",
"id": "fbda66bd-7b5e-ae6d-0050-292877c32927",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"effectiveDateTime": "2016-01-26T16:58:25+01:00",
"issued": "2016-01-26T16:58:25.518+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:27e3df1f-8619-d2d9-b506-03a65e21f83e",
"resource": {
"resourceType": "Immunization",
"id": "27e3df1f-8619-d2d9-b506-03a65e21f83e",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"occurrenceDateTime": "2016-01-26T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:5cec2851-d118-68be-edc5-3b7919168989",
"resource": {
"resourceType": "DiagnosticReport",
"id": "5cec2851-d118-68be-edc5-3b7919168989",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
},
"effectiveDateTime": "2016-01-26T16:58:25+01:00",
"issued": "2016-01-26T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:dea25eb4-eeda-3a17-cfa8-bb3bb7737457",
"resource": {
"resourceType": "DocumentReference",
"id": "dea25eb4-eeda-3a17-cfa8-bb3bb7737457",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:5cec2851-d118-68be-edc5-3b7919168989"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2016-01-26T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"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:15373422-0753-f927-5cab-dae3023e8f62"
} ],
"period": {
"start": "2016-01-26T16:58:25+01:00",
"end": "2016-01-26T17:13:25+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:3353ce82-c876-dc0c-ede4-5d977897c5ae",
"resource": {
"resourceType": "Claim",
"id": "3353ce82-c876-dc0c-ede4-5d977897c5ae",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2016-01-26T16:58:25+01:00",
"end": "2016-01-26T17:13:25+01:00"
},
"created": "2016-01-26T17:13:25+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:27e3df1f-8619-d2d9-b506-03a65e21f83e"
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:1f6c8a59-f03f-57d5-02ea-f4cab9e1fed6"
}
} ],
"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:15373422-0753-f927-5cab-dae3023e8f62"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
}
} ],
"total": {
"value": 272.80,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c6dacfc8-a2d6-6b6e-18e1-aafbc61b3542",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c6dacfc8-a2d6-6b6e-18e1-aafbc61b3542",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "3353ce82-c876-dc0c-ede4-5d977897c5ae"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2016-01-26T17:13:25+01:00",
"end": "2017-01-26T17:13:25+01:00"
},
"created": "2016-01-26T17:13:25+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"claim": {
"reference": "urn:uuid:3353ce82-c876-dc0c-ede4-5d977897c5ae"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:1f6c8a59-f03f-57d5-02ea-f4cab9e1fed6"
},
"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": "2016-01-26T16:58:25+01:00",
"end": "2016-01-26T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2016-01-26T16:58:25+01:00",
"end": "2016-01-26T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"servicedPeriod": {
"start": "2016-01-26T16:58:25+01:00",
"end": "2016-01-26T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 272.80,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a",
"resource": {
"resourceType": "Encounter",
"id": "82aa4225-4f9a-215b-3d1c-fbcc5249894a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "82aa4225-4f9a-215b-3d1c-fbcc5249894a"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
}
} ],
"period": {
"start": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:7623df23-0439-d3c0-8e14-c23de358a9e4",
"resource": {
"resourceType": "Observation",
"id": "7623df23-0439-d3c0-8e14-c23de358a9e4",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 129.5,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:01efcaa8-8576-689c-6e76-89ec046aa68f",
"resource": {
"resourceType": "Observation",
"id": "01efcaa8-8576-689c-6e76-89ec046aa68f",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c4319bab-81a2-f6fd-167f-ea45146426ba",
"resource": {
"resourceType": "Observation",
"id": "c4319bab-81a2-f6fd-167f-ea45146426ba",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 23.8,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a6dcdcf9-5152-5cfa-6f83-a9a17def3987",
"resource": {
"resourceType": "Observation",
"id": "a6dcdcf9-5152-5cfa-6f83-a9a17def3987",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 14.21,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9fe878ac-6ade-1286-eafc-7350e0072202",
"resource": {
"resourceType": "Observation",
"id": "9fe878ac-6ade-1286-eafc-7350e0072202",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 3.6877,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:75b03d9b-34ed-1e6b-4493-279a35a571df",
"resource": {
"resourceType": "Observation",
"id": "75b03d9b-34ed-1e6b-4493-279a35a571df",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 86,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 100,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:eb7b1a11-73f9-0be6-9320-01c01c350119",
"resource": {
"resourceType": "Observation",
"id": "eb7b1a11-73f9-0be6-9320-01c01c350119",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 73,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:db2ae796-3250-3f93-97dc-bdb294d1950b",
"resource": {
"resourceType": "Observation",
"id": "db2ae796-3250-3f93-97dc-bdb294d1950b",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 15,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:27fcf5d9-e996-eacd-d5e7-ec21804ce6c5",
"resource": {
"resourceType": "Observation",
"id": "27fcf5d9-e996-eacd-d5e7-ec21804ce6c5",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 5.3968,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:32e7df1e-e7fd-5e16-3957-982ecdad2d10",
"resource": {
"resourceType": "Observation",
"id": "32e7df1e-e7fd-5e16-3957-982ecdad2d10",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 4.8014,
"unit": "10*6/uL",
"system": "http://unitsofmeasure.org",
"code": "10*6/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3e1143cf-a9d3-4d8a-cc69-c9b032421fc6",
"resource": {
"resourceType": "Observation",
"id": "3e1143cf-a9d3-4d8a-cc69-c9b032421fc6",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 14.146,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f2d2f15d-b88f-0b9c-45ac-b78c0e3358ff",
"resource": {
"resourceType": "Observation",
"id": "f2d2f15d-b88f-0b9c-45ac-b78c0e3358ff",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 49.519,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:bb085731-0577-7cf4-aa19-414e1d301aae",
"resource": {
"resourceType": "Observation",
"id": "bb085731-0577-7cf4-aa19-414e1d301aae",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 93.785,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:67b66b04-bb00-3857-fb7f-0b24004b2a90",
"resource": {
"resourceType": "Observation",
"id": "67b66b04-bb00-3857-fb7f-0b24004b2a90",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 28.817,
"unit": "pg",
"system": "http://unitsofmeasure.org",
"code": "pg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8a21c97b-7f70-1a7b-df61-b0e3b947f954",
"resource": {
"resourceType": "Observation",
"id": "8a21c97b-7f70-1a7b-df61-b0e3b947f954",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 34.319,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8bce3904-0b9b-1612-5546-9fef688563c9",
"resource": {
"resourceType": "Observation",
"id": "8bce3904-0b9b-1612-5546-9fef688563c9",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 40.385,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:03e1447c-c58e-8682-fe74-6902f5daa56a",
"resource": {
"resourceType": "Observation",
"id": "03e1447c-c58e-8682-fe74-6902f5daa56a",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 444.35,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:51adb804-f68b-d7f5-ba2d-9261b44b19ab",
"resource": {
"resourceType": "Observation",
"id": "51adb804-f68b-d7f5-ba2d-9261b44b19ab",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 168.72,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:804b35f9-598f-81ca-1fb2-6fda47df3dcb",
"resource": {
"resourceType": "Observation",
"id": "804b35f9-598f-81ca-1fb2-6fda47df3dcb",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"valueQuantity": {
"value": 11.07,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:64fd1989-4a96-971d-9679-934ab9d33d8d",
"resource": {
"resourceType": "Observation",
"id": "64fd1989-4a96-971d-9679-934ab9d33d8d",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+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:cd82240e-d585-88eb-eed7-9cd4ab970727",
"resource": {
"resourceType": "Procedure",
"id": "cd82240e-d585-88eb-eed7-9cd4ab970727",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"performedPeriod": {
"start": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:aae92b9e-cd64-02d6-c34a-1cd4852d1004",
"resource": {
"resourceType": "Immunization",
"id": "aae92b9e-cd64-02d6-c34a-1cd4852d1004",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "115",
"display": "Tdap"
} ],
"text": "Tdap"
},
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"occurrenceDateTime": "2017-01-31T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:95dd0c5c-2d9a-6e5b-ba3b-41702b567472",
"resource": {
"resourceType": "Immunization",
"id": "95dd0c5c-2d9a-6e5b-ba3b-41702b567472",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"occurrenceDateTime": "2017-01-31T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:e3faf559-55ce-6538-2125-b35381a785b4",
"resource": {
"resourceType": "Immunization",
"id": "e3faf559-55ce-6538-2125-b35381a785b4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "62",
"display": "HPV, quadrivalent"
} ],
"text": "HPV, quadrivalent"
},
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"occurrenceDateTime": "2017-01-31T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:dd50ab35-f07a-5b39-c97c-f592c9493d3a",
"resource": {
"resourceType": "Immunization",
"id": "dd50ab35-f07a-5b39-c97c-f592c9493d3a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "114",
"display": "meningococcal MCV4P"
} ],
"text": "meningococcal MCV4P"
},
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"occurrenceDateTime": "2017-01-31T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:a663b3d6-3568-18d4-35f1-2b24ee6d2895",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a663b3d6-3568-18d4-35f1-2b24ee6d2895",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
} ],
"result": [ {
"reference": "urn:uuid:27fcf5d9-e996-eacd-d5e7-ec21804ce6c5",
"display": "Leukocytes [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:32e7df1e-e7fd-5e16-3957-982ecdad2d10",
"display": "Erythrocytes [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:3e1143cf-a9d3-4d8a-cc69-c9b032421fc6",
"display": "Hemoglobin [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:f2d2f15d-b88f-0b9c-45ac-b78c0e3358ff",
"display": "Hematocrit [Volume Fraction] of Blood by Automated count"
}, {
"reference": "urn:uuid:bb085731-0577-7cf4-aa19-414e1d301aae",
"display": "MCV [Entitic volume] by Automated count"
}, {
"reference": "urn:uuid:67b66b04-bb00-3857-fb7f-0b24004b2a90",
"display": "MCH [Entitic mass] by Automated count"
}, {
"reference": "urn:uuid:8a21c97b-7f70-1a7b-df61-b0e3b947f954",
"display": "MCHC [Mass/volume] by Automated count"
}, {
"reference": "urn:uuid:8bce3904-0b9b-1612-5546-9fef688563c9",
"display": "Erythrocyte distribution width [Entitic volume] by Automated count"
}, {
"reference": "urn:uuid:03e1447c-c58e-8682-fe74-6902f5daa56a",
"display": "Platelets [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:51adb804-f68b-d7f5-ba2d-9261b44b19ab",
"display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:804b35f9-598f-81ca-1fb2-6fda47df3dcb",
"display": "Platelet mean volume [Entitic volume] in Blood by Automated count"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:16f02b34-f5c2-1af8-a7c9-3e5c3dc03bc3",
"resource": {
"resourceType": "DiagnosticReport",
"id": "16f02b34-f5c2-1af8-a7c9-3e5c3dc03bc3",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
},
"effectiveDateTime": "2017-01-31T16:58:25+01:00",
"issued": "2017-01-31T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:0c342c84-cea9-0b33-fd3a-890b97424572",
"resource": {
"resourceType": "DocumentReference",
"id": "0c342c84-cea9-0b33-fd3a-890b97424572",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:16f02b34-f5c2-1af8-a7c9-3e5c3dc03bc3"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2017-01-31T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"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:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
} ],
"period": {
"start": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:7676da4c-f18e-0642-a8a1-e5591b9196db",
"resource": {
"resourceType": "Claim",
"id": "7676da4c-f18e-0642-a8a1-e5591b9196db",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+01:00"
},
"created": "2017-01-31T17:13:25+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:aae92b9e-cd64-02d6-c34a-1cd4852d1004"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:95dd0c5c-2d9a-6e5b-ba3b-41702b567472"
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:e3faf559-55ce-6538-2125-b35381a785b4"
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:dd50ab35-f07a-5b39-c97c-f592c9493d3a"
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:cd82240e-d585-88eb-eed7-9cd4ab970727"
}
} ],
"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:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "115",
"display": "Tdap"
} ],
"text": "Tdap"
},
"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": "62",
"display": "HPV, quadrivalent"
} ],
"text": "HPV, quadrivalent"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "114",
"display": "meningococcal MCV4P"
} ],
"text": "meningococcal MCV4P"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 6,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 451.49,
"currency": "USD"
}
}, {
"sequence": 7,
"informationSequence": [ 5 ],
"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": 1206.87,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:79ec5024-4865-453c-b30e-7672e33130d0",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "79ec5024-4865-453c-b30e-7672e33130d0",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "7676da4c-f18e-0642-a8a1-e5591b9196db"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2017-01-31T17:13:25+01:00",
"end": "2018-01-31T17:13:25+01:00"
},
"created": "2017-01-31T17:13:25+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"claim": {
"reference": "urn:uuid:7676da4c-f18e-0642-a8a1-e5591b9196db"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"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": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
} ]
}, {
"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": "115",
"display": "Tdap"
} ],
"text": "Tdap"
},
"servicedPeriod": {
"start": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+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": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+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": "62",
"display": "HPV, quadrivalent"
} ],
"text": "HPV, quadrivalent"
},
"servicedPeriod": {
"start": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+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": "114",
"display": "meningococcal MCV4P"
} ],
"text": "meningococcal MCV4P"
},
"servicedPeriod": {
"start": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+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,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"servicedPeriod": {
"start": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 451.49,
"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": 90.298,
"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": 361.192,
"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": 451.49,
"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": 451.49,
"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,
"informationSequence": [ 5 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "58410-2",
"display": "CBC panel - Blood by Automated count"
} ],
"text": "CBC panel - Blood by Automated count"
},
"servicedPeriod": {
"start": "2017-01-31T16:58:25+01:00",
"end": "2017-01-31T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 1206.87,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 856.056,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548",
"resource": {
"resourceType": "Encounter",
"id": "e1ce3636-88fd-a123-f612-c84e1a7ff548",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "e1ce3636-88fd-a123-f612-c84e1a7ff548"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
}
} ],
"period": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:3b43be01-ad24-fa78-61c7-e99b27b16cce",
"resource": {
"resourceType": "Condition",
"id": "3b43be01-ad24-fa78-61c7-e99b27b16cce",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"onsetDateTime": "2018-02-06T16:58:25+01:00",
"abatementDateTime": "2019-02-12T16:58:25+01:00",
"recordedDate": "2018-02-06T16:58:25+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:d36c1495-257f-0074-2317-ca3311049b73",
"resource": {
"resourceType": "Observation",
"id": "d36c1495-257f-0074-2317-ca3311049b73",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T16:58:25+01:00",
"issued": "2018-02-06T16:58:25.518+01:00",
"valueQuantity": {
"value": 136.1,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:449998b7-ceb2-299e-8854-02385c81f3a4",
"resource": {
"resourceType": "Observation",
"id": "449998b7-ceb2-299e-8854-02385c81f3a4",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T16:58:25+01:00",
"issued": "2018-02-06T16:58:25.518+01:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a23d7434-784b-c0e6-fa0b-1a26ae87c398",
"resource": {
"resourceType": "Observation",
"id": "a23d7434-784b-c0e6-fa0b-1a26ae87c398",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T16:58:25+01:00",
"issued": "2018-02-06T16:58:25.518+01:00",
"valueQuantity": {
"value": 27.4,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e964be6d-305a-fef4-a20d-ac31165403f4",
"resource": {
"resourceType": "Observation",
"id": "e964be6d-305a-fef4-a20d-ac31165403f4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T16:58:25+01:00",
"issued": "2018-02-06T16:58:25.518+01:00",
"valueQuantity": {
"value": 14.77,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a0e89cf0-4c2f-7a77-9127-38193d2beec6",
"resource": {
"resourceType": "Observation",
"id": "a0e89cf0-4c2f-7a77-9127-38193d2beec6",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T16:58:25+01:00",
"issued": "2018-02-06T16:58:25.518+01:00",
"valueQuantity": {
"value": 4.6032,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6333f402-9c5b-8a40-37c9-608fbd7ea74c",
"resource": {
"resourceType": "Observation",
"id": "6333f402-9c5b-8a40-37c9-608fbd7ea74c",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T16:58:25+01:00",
"issued": "2018-02-06T16:58:25.518+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 86,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 104,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e6ceda29-56c5-b333-3f00-01de167e3e4b",
"resource": {
"resourceType": "Observation",
"id": "e6ceda29-56c5-b333-3f00-01de167e3e4b",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T16:58:25+01:00",
"issued": "2018-02-06T16:58:25.518+01:00",
"valueQuantity": {
"value": 72,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:46b7ec3b-eaee-d6f9-285c-22d87de6561b",
"resource": {
"resourceType": "Observation",
"id": "46b7ec3b-eaee-d6f9-285c-22d87de6561b",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T16:58:25+01:00",
"issued": "2018-02-06T16:58:25.518+01:00",
"valueQuantity": {
"value": 15,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ba700f4f-bd8e-e07c-af9b-fa50cb996357",
"resource": {
"resourceType": "Observation",
"id": "ba700f4f-bd8e-e07c-af9b-fa50cb996357",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T16:58:25+01:00",
"issued": "2018-02-06T16:58:25.518+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:c28975f7-683e-3e25-caf1-f0b61160092b",
"resource": {
"resourceType": "Observation",
"id": "c28975f7-683e-3e25-caf1-f0b61160092b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "70274-6",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T17:13:53+01:00",
"issued": "2018-02-06T17:13:53.518+01:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:36397b9a-0835-2a2f-db10-cfec043e3dea",
"resource": {
"resourceType": "Observation",
"id": "36397b9a-0835-2a2f-db10-cfec043e3dea",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89204-2",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T17:44:37+01:00",
"issued": "2018-02-06T17:44:37.518+01:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5c5004c8-7d43-5742-d3bf-cb3d9774f895",
"resource": {
"resourceType": "Procedure",
"id": "5c5004c8-7d43-5742-d3bf-cb3d9774f895",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"performedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:4cc358d6-fb14-292c-61fc-c14c7f4f23c4",
"resource": {
"resourceType": "Procedure",
"id": "4cc358d6-fb14-292c-61fc-c14c7f4f23c4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"performedPeriod": {
"start": "2018-02-06T17:13:53+01:00",
"end": "2018-02-06T17:24:29+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:f3187326-ea3b-561d-6a9c-22a01c4eb0e8",
"resource": {
"resourceType": "Procedure",
"id": "f3187326-ea3b-561d-6a9c-22a01c4eb0e8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"performedPeriod": {
"start": "2018-02-06T17:24:29+01:00",
"end": "2018-02-06T17:44:37+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:d9eed616-6ae4-355c-2598-882cc7176bc8",
"resource": {
"resourceType": "Procedure",
"id": "d9eed616-6ae4-355c-2598-882cc7176bc8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"performedPeriod": {
"start": "2018-02-06T17:44:37+01:00",
"end": "2018-02-06T17:54:54+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:db6eff80-423c-ee4f-c0d6-99eabd840b87",
"resource": {
"resourceType": "Procedure",
"id": "db6eff80-423c-ee4f-c0d6-99eabd840b87",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"performedPeriod": {
"start": "2018-02-06T17:54:54+01:00",
"end": "2018-02-06T18:24:12+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:8d575b31-3bd1-67cb-3c2b-be715203d123",
"resource": {
"resourceType": "Procedure",
"id": "8d575b31-3bd1-67cb-3c2b-be715203d123",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"performedPeriod": {
"start": "2018-02-06T18:24:12+01:00",
"end": "2018-02-06T18:36:06+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:8bbebeaf-82e9-7c16-de2a-cce2ef9b5e86",
"resource": {
"resourceType": "Immunization",
"id": "8bbebeaf-82e9-7c16-de2a-cce2ef9b5e86",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"occurrenceDateTime": "2018-02-06T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:4d170a34-d59b-94ce-37a4-b44d2bd322a6",
"resource": {
"resourceType": "Immunization",
"id": "4d170a34-d59b-94ce-37a4-b44d2bd322a6",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "62",
"display": "HPV, quadrivalent"
} ],
"text": "HPV, quadrivalent"
},
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"occurrenceDateTime": "2018-02-06T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:4776d28d-38fd-fed6-b904-0aae0bf3b515",
"resource": {
"resourceType": "DiagnosticReport",
"id": "4776d28d-38fd-fed6-b904-0aae0bf3b515",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T17:13:53+01:00",
"issued": "2018-02-06T17:13:53.518+01:00",
"result": [ {
"reference": "urn:uuid:c28975f7-683e-3e25-caf1-f0b61160092b",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:40eb9f2f-5269-26d7-4162-b48186185132",
"resource": {
"resourceType": "DiagnosticReport",
"id": "40eb9f2f-5269-26d7-4162-b48186185132",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T17:44:37+01:00",
"issued": "2018-02-06T17:44:37.518+01:00",
"result": [ {
"reference": "urn:uuid:36397b9a-0835-2a2f-db10-cfec043e3dea",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:def0cc44-ee13-d89c-aa81-a558155bd6bd",
"resource": {
"resourceType": "DiagnosticReport",
"id": "def0cc44-ee13-d89c-aa81-a558155bd6bd",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
},
"effectiveDateTime": "2018-02-06T16:58:25+01:00",
"issued": "2018-02-06T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:0a404363-53cc-d6bc-4a31-49bfda956ff6",
"resource": {
"resourceType": "DocumentReference",
"id": "0a404363-53cc-d6bc-4a31-49bfda956ff6",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:def0cc44-ee13-d89c-aa81-a558155bd6bd"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2018-02-06T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"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:e1ce3636-88fd-a123-f612-c84e1a7ff548"
} ],
"period": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:7b9b00bf-220a-bb1c-653c-d1beaaee1b04",
"resource": {
"resourceType": "Claim",
"id": "7b9b00bf-220a-bb1c-653c-d1beaaee1b04",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"created": "2018-02-06T17:13:53+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:8bbebeaf-82e9-7c16-de2a-cce2ef9b5e86"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:4d170a34-d59b-94ce-37a4-b44d2bd322a6"
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:3b43be01-ad24-fa78-61c7-e99b27b16cce"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:5c5004c8-7d43-5742-d3bf-cb3d9774f895"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:4cc358d6-fb14-292c-61fc-c14c7f4f23c4"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:f3187326-ea3b-561d-6a9c-22a01c4eb0e8"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:d9eed616-6ae4-355c-2598-882cc7176bc8"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:db6eff80-423c-ee4f-c0d6-99eabd840b87"
}
}, {
"sequence": 6,
"procedureReference": {
"reference": "urn:uuid:8d575b31-3bd1-67cb-3c2b-be715203d123"
}
} ],
"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:e1ce3636-88fd-a123-f612-c84e1a7ff548"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "62",
"display": "HPV, quadrivalent"
} ],
"text": "HPV, quadrivalent"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 4,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
}
}, {
"sequence": 5,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 6,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 7,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 8,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"net": {
"value": 26.57,
"currency": "USD"
}
}, {
"sequence": 9,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 10,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 11,
"procedureSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 12,
"procedureSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
} ],
"total": {
"value": 840.20,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:24d15bc0-f180-fe5a-46f7-aa5bf9214d33",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "24d15bc0-f180-fe5a-46f7-aa5bf9214d33",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "7b9b00bf-220a-bb1c-653c-d1beaaee1b04"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2018-02-06T17:13:53+01:00",
"end": "2019-02-06T17:13:53+01:00"
},
"created": "2018-02-06T17:13:53+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"claim": {
"reference": "urn:uuid:7b9b00bf-220a-bb1c-653c-d1beaaee1b04"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:3b43be01-ad24-fa78-61c7-e99b27b16cce"
},
"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": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+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": "62",
"display": "HPV, quadrivalent"
} ],
"text": "HPV, quadrivalent"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+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,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"informationSequence": [ 3 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 26.57,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 5.314,
"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": 21.256,
"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": 26.57,
"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": 26.57,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 9,
"informationSequence": [ 4 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 10,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 11,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 12,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"servicedPeriod": {
"start": "2018-02-06T16:58:25+01:00",
"end": "2018-02-06T17:13:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 840.20,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2083.7839999999997,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90",
"resource": {
"resourceType": "Encounter",
"id": "5523a829-0c06-5ef0-cfa7-d71de6967c90",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "5523a829-0c06-5ef0-cfa7-d71de6967c90"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
}
} ],
"period": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:eb61ae07-3b6e-c89f-0bd5-80529425472e",
"resource": {
"resourceType": "Observation",
"id": "eb61ae07-3b6e-c89f-0bd5-80529425472e",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T16:58:25+01:00",
"issued": "2019-02-12T16:58:25.518+01:00",
"valueQuantity": {
"value": 143,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:bf9b5501-d089-9126-160b-edaa7a13933f",
"resource": {
"resourceType": "Observation",
"id": "bf9b5501-d089-9126-160b-edaa7a13933f",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T16:58:25+01:00",
"issued": "2019-02-12T16:58:25.518+01:00",
"valueQuantity": {
"value": 4,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0a342922-c5ea-9ffd-d29d-5bbe15f67c5b",
"resource": {
"resourceType": "Observation",
"id": "0a342922-c5ea-9ffd-d29d-5bbe15f67c5b",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T16:58:25+01:00",
"issued": "2019-02-12T16:58:25.518+01:00",
"valueQuantity": {
"value": 32.1,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:bd30028e-5d78-9c3f-b443-4a63a9aa0728",
"resource": {
"resourceType": "Observation",
"id": "bd30028e-5d78-9c3f-b443-4a63a9aa0728",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T16:58:25+01:00",
"issued": "2019-02-12T16:58:25.518+01:00",
"valueQuantity": {
"value": 15.71,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8c8d84f5-f0c8-ad2b-2f83-69dad49d4a76",
"resource": {
"resourceType": "Observation",
"id": "8c8d84f5-f0c8-ad2b-2f83-69dad49d4a76",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T16:58:25+01:00",
"issued": "2019-02-12T16:58:25.518+01:00",
"valueQuantity": {
"value": 8.1685,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:79ea5407-486e-460f-d0a2-80cbe389bd26",
"resource": {
"resourceType": "Observation",
"id": "79ea5407-486e-460f-d0a2-80cbe389bd26",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T16:58:25+01:00",
"issued": "2019-02-12T16:58:25.518+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 78,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 101,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:77199b35-bcb1-2303-9d1e-fbc1df045cd9",
"resource": {
"resourceType": "Observation",
"id": "77199b35-bcb1-2303-9d1e-fbc1df045cd9",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T16:58:25+01:00",
"issued": "2019-02-12T16:58:25.518+01:00",
"valueQuantity": {
"value": 62,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:72b972be-e1f6-6bc6-7bf0-803932839265",
"resource": {
"resourceType": "Observation",
"id": "72b972be-e1f6-6bc6-7bf0-803932839265",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T16:58:25+01:00",
"issued": "2019-02-12T16:58:25.518+01:00",
"valueQuantity": {
"value": 13,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2d4804d1-18f1-93c0-8b1c-77a1d992019a",
"resource": {
"resourceType": "Observation",
"id": "2d4804d1-18f1-93c0-8b1c-77a1d992019a",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T16:58:25+01:00",
"issued": "2019-02-12T16:58:25.518+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:866f042a-0f14-980e-2925-d2073d1e3c1f",
"resource": {
"resourceType": "Observation",
"id": "866f042a-0f14-980e-2925-d2073d1e3c1f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89204-2",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T17:42:28+01:00",
"issued": "2019-02-12T17:42:28.518+01:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3daeda38-4676-53fd-d945-e35ed43ae947",
"resource": {
"resourceType": "Procedure",
"id": "3daeda38-4676-53fd-d945-e35ed43ae947",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"performedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:dcf4be9b-1db5-033c-a998-6707bb74e68a",
"resource": {
"resourceType": "Procedure",
"id": "dcf4be9b-1db5-033c-a998-6707bb74e68a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"performedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:05+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:3911b925-8c3f-a312-d5af-f8f41fe04ed8",
"resource": {
"resourceType": "Procedure",
"id": "3911b925-8c3f-a312-d5af-f8f41fe04ed8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"performedPeriod": {
"start": "2019-02-12T17:13:05+01:00",
"end": "2019-02-12T17:42:28+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:003471f2-97f2-5b5d-9e81-82a0ecb1872f",
"resource": {
"resourceType": "Procedure",
"id": "003471f2-97f2-5b5d-9e81-82a0ecb1872f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"performedPeriod": {
"start": "2019-02-12T17:42:28+01:00",
"end": "2019-02-12T17:52:38+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:ee8d02cc-2bae-c628-1d63-1201684acf28",
"resource": {
"resourceType": "Procedure",
"id": "ee8d02cc-2bae-c628-1d63-1201684acf28",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"performedPeriod": {
"start": "2019-02-12T17:52:38+01:00",
"end": "2019-02-12T18:03:14+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:0c00a958-a0fb-cfb4-13a6-f16ab71a95a3",
"resource": {
"resourceType": "Procedure",
"id": "0c00a958-a0fb-cfb4-13a6-f16ab71a95a3",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"performedPeriod": {
"start": "2019-02-12T18:03:14+01:00",
"end": "2019-02-12T18:16:35+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:df753891-1a2d-16b7-b4e6-93223a0cfaf9",
"resource": {
"resourceType": "Immunization",
"id": "df753891-1a2d-16b7-b4e6-93223a0cfaf9",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"occurrenceDateTime": "2019-02-12T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:053bcb34-2144-9c89-e90e-52d1cdc0bbb8",
"resource": {
"resourceType": "Immunization",
"id": "053bcb34-2144-9c89-e90e-52d1cdc0bbb8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "62",
"display": "HPV, quadrivalent"
} ],
"text": "HPV, quadrivalent"
},
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"occurrenceDateTime": "2019-02-12T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:1c434583-592f-73da-e1e0-2777c5d83da6",
"resource": {
"resourceType": "DiagnosticReport",
"id": "1c434583-592f-73da-e1e0-2777c5d83da6",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T17:42:28+01:00",
"issued": "2019-02-12T17:42:28.518+01:00",
"result": [ {
"reference": "urn:uuid:866f042a-0f14-980e-2925-d2073d1e3c1f",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:684409e4-8c57-c36a-6664-d575656aeab2",
"resource": {
"resourceType": "DiagnosticReport",
"id": "684409e4-8c57-c36a-6664-d575656aeab2",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
},
"effectiveDateTime": "2019-02-12T16:58:25+01:00",
"issued": "2019-02-12T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:e268c5dd-7cba-f1eb-7ba3-05ce831778b4",
"resource": {
"resourceType": "DocumentReference",
"id": "e268c5dd-7cba-f1eb-7ba3-05ce831778b4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:684409e4-8c57-c36a-6664-d575656aeab2"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2019-02-12T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"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:5523a829-0c06-5ef0-cfa7-d71de6967c90"
} ],
"period": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:24ee7020-e2eb-6f77-855d-bf26cd89519e",
"resource": {
"resourceType": "Claim",
"id": "24ee7020-e2eb-6f77-855d-bf26cd89519e",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"created": "2019-02-12T17:13:25+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:df753891-1a2d-16b7-b4e6-93223a0cfaf9"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:053bcb34-2144-9c89-e90e-52d1cdc0bbb8"
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:3daeda38-4676-53fd-d945-e35ed43ae947"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:dcf4be9b-1db5-033c-a998-6707bb74e68a"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:3911b925-8c3f-a312-d5af-f8f41fe04ed8"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:003471f2-97f2-5b5d-9e81-82a0ecb1872f"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:ee8d02cc-2bae-c628-1d63-1201684acf28"
}
}, {
"sequence": 6,
"procedureReference": {
"reference": "urn:uuid:0c00a958-a0fb-cfb4-13a6-f16ab71a95a3"
}
} ],
"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:5523a829-0c06-5ef0-cfa7-d71de6967c90"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "62",
"display": "HPV, quadrivalent"
} ],
"text": "HPV, quadrivalent"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 4,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 431.81,
"currency": "USD"
}
}, {
"sequence": 5,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 6,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"net": {
"value": 27.46,
"currency": "USD"
}
}, {
"sequence": 7,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 8,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 9,
"procedureSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 10,
"procedureSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
} ],
"total": {
"value": 1272.01,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:b1f48fe6-ecd8-9bbf-103d-197a93a97102",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "b1f48fe6-ecd8-9bbf-103d-197a93a97102",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "24ee7020-e2eb-6f77-855d-bf26cd89519e"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2019-02-12T17:13:25+01:00",
"end": "2020-02-12T17:13:25+01:00"
},
"created": "2019-02-12T17:13:25+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"claim": {
"reference": "urn:uuid:24ee7020-e2eb-6f77-855d-bf26cd89519e"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"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": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+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": "62",
"display": "HPV, quadrivalent"
} ],
"text": "HPV, quadrivalent"
},
"servicedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"servicedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.81,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.36200000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.44800000000004,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.81,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.81,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"servicedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 27.46,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 5.492000000000001,
"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": 21.968000000000004,
"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": 27.46,
"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": 27.46,
"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,
"informationSequence": [ 3 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"servicedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 9,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"servicedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 10,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"servicedPeriod": {
"start": "2019-02-12T16:58:25+01:00",
"end": "2019-02-12T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 1272.01,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2025.1599999999999,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09",
"resource": {
"resourceType": "Encounter",
"id": "20729876-69e4-6cb9-4fa7-6c2d9d268c09",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "20729876-69e4-6cb9-4fa7-6c2d9d268c09"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
}
} ],
"period": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:fbff5e6b-97b9-a2c8-7305-fee8f93f9587",
"resource": {
"resourceType": "Condition",
"id": "fbff5e6b-97b9-a2c8-7305-fee8f93f9587",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"onsetDateTime": "2020-02-18T16:58:25+01:00",
"abatementDateTime": "2020-02-18T16:58:25+01:00",
"recordedDate": "2020-02-18T16:58:25+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:9767382e-8701-c44c-0d06-54800cdb6f4d",
"resource": {
"resourceType": "Observation",
"id": "9767382e-8701-c44c-0d06-54800cdb6f4d",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T16:58:25+01:00",
"issued": "2020-02-18T16:58:25.518+01:00",
"valueQuantity": {
"value": 147.2,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2ac27c13-1068-a347-7586-6023e6b9d546",
"resource": {
"resourceType": "Observation",
"id": "2ac27c13-1068-a347-7586-6023e6b9d546",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T16:58:25+01:00",
"issued": "2020-02-18T16:58:25.518+01:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9d33681e-c809-65af-9605-3c2b85f0239d",
"resource": {
"resourceType": "Observation",
"id": "9d33681e-c809-65af-9605-3c2b85f0239d",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T16:58:25+01:00",
"issued": "2020-02-18T16:58:25.518+01:00",
"valueQuantity": {
"value": 36.9,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e87a2047-5301-0af4-1cbf-e6bc279cbb60",
"resource": {
"resourceType": "Observation",
"id": "e87a2047-5301-0af4-1cbf-e6bc279cbb60",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T16:58:25+01:00",
"issued": "2020-02-18T16:58:25.518+01:00",
"valueQuantity": {
"value": 17.05,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e3e891a1-246f-583f-21ba-f575d34c8a20",
"resource": {
"resourceType": "Observation",
"id": "e3e891a1-246f-583f-21ba-f575d34c8a20",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T16:58:25+01:00",
"issued": "2020-02-18T16:58:25.518+01:00",
"valueQuantity": {
"value": 16.559,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:59a8b87d-1dea-a0ee-a33e-5fef50c35783",
"resource": {
"resourceType": "Observation",
"id": "59a8b87d-1dea-a0ee-a33e-5fef50c35783",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T16:58:25+01:00",
"issued": "2020-02-18T16:58:25.518+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 84,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 106,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5a51109b-0ed2-ea55-cce6-7236a4e831d2",
"resource": {
"resourceType": "Observation",
"id": "5a51109b-0ed2-ea55-cce6-7236a4e831d2",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T16:58:25+01:00",
"issued": "2020-02-18T16:58:25.518+01:00",
"valueQuantity": {
"value": 62,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:90b0c885-99f9-574e-8a6f-68f91b79db29",
"resource": {
"resourceType": "Observation",
"id": "90b0c885-99f9-574e-8a6f-68f91b79db29",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T16:58:25+01:00",
"issued": "2020-02-18T16:58:25.518+01:00",
"valueQuantity": {
"value": 12,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d57f7cad-55d4-0e5b-ee46-277bfd054ac7",
"resource": {
"resourceType": "Observation",
"id": "d57f7cad-55d4-0e5b-ee46-277bfd054ac7",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T16:58:25+01:00",
"issued": "2020-02-18T16:58:25.518+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:028da976-c374-f779-17df-1d19c326732b",
"resource": {
"resourceType": "Observation",
"id": "028da976-c374-f779-17df-1d19c326732b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "70274-6",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T17:15:21+01:00",
"issued": "2020-02-18T17:15:21.518+01:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a1a10bde-9f6a-a10f-c577-36aa415621c2",
"resource": {
"resourceType": "Observation",
"id": "a1a10bde-9f6a-a10f-c577-36aa415621c2",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89204-2",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T17:48:56+01:00",
"issued": "2020-02-18T17:48:56.518+01:00",
"valueQuantity": {
"value": 4,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3cc2592e-d511-4c90-9431-e69db486e704",
"resource": {
"resourceType": "Procedure",
"id": "3cc2592e-d511-4c90-9431-e69db486e704",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"performedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:13:25+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:c5265a4a-cd5a-6be1-eec5-1654a0a2dfb6",
"resource": {
"resourceType": "Procedure",
"id": "c5265a4a-cd5a-6be1-eec5-1654a0a2dfb6",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"performedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:05ffc406-4e86-06be-49ab-0aac5b324809",
"resource": {
"resourceType": "Procedure",
"id": "05ffc406-4e86-06be-49ab-0aac5b324809",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"performedPeriod": {
"start": "2020-02-18T17:15:21+01:00",
"end": "2020-02-18T17:28:48+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:ae58cc86-5cc3-b819-1bfb-2914194fd9eb",
"resource": {
"resourceType": "Procedure",
"id": "ae58cc86-5cc3-b819-1bfb-2914194fd9eb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"performedPeriod": {
"start": "2020-02-18T17:28:48+01:00",
"end": "2020-02-18T17:48:56+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:605393dc-c29a-4a1f-729e-a68759edfe1a",
"resource": {
"resourceType": "Procedure",
"id": "605393dc-c29a-4a1f-729e-a68759edfe1a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"performedPeriod": {
"start": "2020-02-18T17:48:56+01:00",
"end": "2020-02-18T18:03:38+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:77e94359-0393-b48d-1163-7f9d3c70efcc",
"resource": {
"resourceType": "Procedure",
"id": "77e94359-0393-b48d-1163-7f9d3c70efcc",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"performedPeriod": {
"start": "2020-02-18T18:03:38+01:00",
"end": "2020-02-18T18:23:47+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:1f2459e2-589c-b9e7-8a14-c79ee37523b6",
"resource": {
"resourceType": "Procedure",
"id": "1f2459e2-589c-b9e7-8a14-c79ee37523b6",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"performedPeriod": {
"start": "2020-02-18T18:23:47+01:00",
"end": "2020-02-18T18:33:16+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:03b3250a-aead-fdbf-f1ff-a63774654ad8",
"resource": {
"resourceType": "Immunization",
"id": "03b3250a-aead-fdbf-f1ff-a63774654ad8",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"occurrenceDateTime": "2020-02-18T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:f865b71a-b937-cda9-05b3-658a0fdf9ea4",
"resource": {
"resourceType": "DiagnosticReport",
"id": "f865b71a-b937-cda9-05b3-658a0fdf9ea4",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T17:15:21+01:00",
"issued": "2020-02-18T17:15:21.518+01:00",
"result": [ {
"reference": "urn:uuid:028da976-c374-f779-17df-1d19c326732b",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:f37f6348-3d73-cb38-f8d7-08a5d6577736",
"resource": {
"resourceType": "DiagnosticReport",
"id": "f37f6348-3d73-cb38-f8d7-08a5d6577736",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T17:48:56+01:00",
"issued": "2020-02-18T17:48:56.518+01:00",
"result": [ {
"reference": "urn:uuid:a1a10bde-9f6a-a10f-c577-36aa415621c2",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:5d5e295d-0a78-bee4-7fc3-125cce9230ff",
"resource": {
"resourceType": "DiagnosticReport",
"id": "5d5e295d-0a78-bee4-7fc3-125cce9230ff",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
},
"effectiveDateTime": "2020-02-18T16:58:25+01:00",
"issued": "2020-02-18T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMjAtMDItMTgKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCk1hcmxhbmE0MDIKIGlzIGEgMTQgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgZmVtYWxlLiBQYXRpZW50IGhhcyBhIGhpc3Rvcnkgb2YgYWN1dGUgYnJvbmNoaXRpcyAoZGlzb3JkZXIpLCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbikuCgojIFNvY2lhbCBIaXN0b3J5CiBQYXRpZW50IGhhcyBuZXZlciBzbW9rZWQuCgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KClBhdGllbnQgY3VycmVudGx5IGhhcyBNZWRpY2FpZC4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKYWNldGFtaW5vcGhlbiAzMjUgbWcgb3JhbCB0YWJsZXQKCiMgQXNzZXNzbWVudCBhbmQgUGxhbgpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbikuIAoKIyMgUGxhbgpQYXRpZW50IHdhcyBnaXZlbiB0aGUgZm9sbG93aW5nIGltbXVuaXphdGlvbnM6IGluZmx1ZW56YSwgc2Vhc29uYWwsIGluamVjdGFibGUsIHByZXNlcnZhdGl2ZSBmcmVlLiAKVGhlIGZvbGxvd2luZyBwcm9jZWR1cmVzIHdlcmUgY29uZHVjdGVkOgotIG1lZGljYXRpb24gcmVjb25jaWxpYXRpb24gKHByb2NlZHVyZSkKLSBhc3Nlc3NtZW50IG9mIGFueGlldHkgKHByb2NlZHVyZSkKLSBkZXByZXNzaW9uIHNjcmVlbmluZyAocHJvY2VkdXJlKQotIGRlcHJlc3Npb24gc2NyZWVuaW5nIHVzaW5nIHBhdGllbnQgaGVhbHRoIHF1ZXN0aW9ubmFpcmUgbmluZSBpdGVtIHNjb3JlIChwcm9jZWR1cmUpCi0gYXNzZXNzbWVudCBvZiBzdWJzdGFuY2UgdXNlIChwcm9jZWR1cmUpCi0gYXNzZXNzbWVudCB1c2luZyBjYXIsIHJlbGF4LCBhbG9uZSwgZm9yZ2V0LCBmcmllbmRzLCB0cm91YmxlIHNjcmVlbmluZyB0ZXN0IChwcm9jZWR1cmUpCi0gYW50aWNpcGF0b3J5IGd1aWRhbmNlIChwcm9jZWR1cmUpCg=="
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:5370d044-e838-7bbf-1f01-a9580f8079e0",
"resource": {
"resourceType": "DocumentReference",
"id": "5370d044-e838-7bbf-1f01-a9580f8079e0",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:5d5e295d-0a78-bee4-7fc3-125cce9230ff"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2020-02-18T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"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:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
} ],
"period": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:306fabfc-b2a4-c4dd-12ec-52f8d1b0c4f8",
"resource": {
"resourceType": "Claim",
"id": "306fabfc-b2a4-c4dd-12ec-52f8d1b0c4f8",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"created": "2020-02-18T17:15:21+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:03b3250a-aead-fdbf-f1ff-a63774654ad8"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:fbff5e6b-97b9-a2c8-7305-fee8f93f9587"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:3cc2592e-d511-4c90-9431-e69db486e704"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:c5265a4a-cd5a-6be1-eec5-1654a0a2dfb6"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:05ffc406-4e86-06be-49ab-0aac5b324809"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:ae58cc86-5cc3-b819-1bfb-2914194fd9eb"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:605393dc-c29a-4a1f-729e-a68759edfe1a"
}
}, {
"sequence": 6,
"procedureReference": {
"reference": "urn:uuid:77e94359-0393-b48d-1163-7f9d3c70efcc"
}
}, {
"sequence": 7,
"procedureReference": {
"reference": "urn:uuid:1f2459e2-589c-b9e7-8a14-c79ee37523b6"
}
} ],
"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:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
}
}, {
"sequence": 4,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 471.39,
"currency": "USD"
}
}, {
"sequence": 5,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 6,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 7,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 8,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"net": {
"value": 28.22,
"currency": "USD"
}
}, {
"sequence": 9,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 10,
"procedureSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 11,
"procedureSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 12,
"procedureSequence": [ 7 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
} ],
"total": {
"value": 1175.59,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c2e590fb-4aec-2743-5e64-9abf640e4d92",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c2e590fb-4aec-2743-5e64-9abf640e4d92",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "306fabfc-b2a4-c4dd-12ec-52f8d1b0c4f8"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2020-02-18T17:15:21+01:00",
"end": "2021-02-18T17:15:21+01:00"
},
"created": "2020-02-18T17:15:21+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"claim": {
"reference": "urn:uuid:306fabfc-b2a4-c4dd-12ec-52f8d1b0c4f8"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:fbff5e6b-97b9-a2c8-7305-fee8f93f9587"
},
"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": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 471.39,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 94.278,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 377.112,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 471.39,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 471.39,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"informationSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 28.22,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 5.644,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 22.576,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 28.22,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 28.22,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 9,
"informationSequence": [ 3 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 10,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 11,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 12,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"servicedPeriod": {
"start": "2020-02-18T16:58:25+01:00",
"end": "2020-02-18T17:15:21+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 1175.59,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2353.4159999999997,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f",
"resource": {
"resourceType": "Encounter",
"id": "970a9c48-4805-f742-cefd-469ab856ad3f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "970a9c48-4805-f742-cefd-469ab856ad3f"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
}
} ],
"period": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:a903dcf9-713f-8ae6-d8bc-4a683a51e16d",
"resource": {
"resourceType": "Condition",
"id": "a903dcf9-713f-8ae6-d8bc-4a683a51e16d",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"onsetDateTime": "2021-02-23T16:58:25+01:00",
"abatementDateTime": "2022-03-01T16:58:25+01:00",
"recordedDate": "2021-02-23T16:58:25+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:57e2f3fd-5138-0d79-af8e-445a736aa159",
"resource": {
"resourceType": "Observation",
"id": "57e2f3fd-5138-0d79-af8e-445a736aa159",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T16:58:25+01:00",
"issued": "2021-02-23T16:58:25.518+01:00",
"valueQuantity": {
"value": 148.7,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:51dbf4fb-42a2-6c08-1bfd-13014580efbc",
"resource": {
"resourceType": "Observation",
"id": "51dbf4fb-42a2-6c08-1bfd-13014580efbc",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T16:58:25+01:00",
"issued": "2021-02-23T16:58:25.518+01:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c2536051-7cd2-da52-5a1f-230618c26554",
"resource": {
"resourceType": "Observation",
"id": "c2536051-7cd2-da52-5a1f-230618c26554",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T16:58:25+01:00",
"issued": "2021-02-23T16:58:25.518+01:00",
"valueQuantity": {
"value": 38.6,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2238d57f-1831-7218-bb48-9fa5122546d2",
"resource": {
"resourceType": "Observation",
"id": "2238d57f-1831-7218-bb48-9fa5122546d2",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T16:58:25+01:00",
"issued": "2021-02-23T16:58:25.518+01:00",
"valueQuantity": {
"value": 17.46,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:efcf936f-81f5-a168-0bbb-0610d653d3bb",
"resource": {
"resourceType": "Observation",
"id": "efcf936f-81f5-a168-0bbb-0610d653d3bb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T16:58:25+01:00",
"issued": "2021-02-23T16:58:25.518+01:00",
"valueQuantity": {
"value": 15.142,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1e0c0e6e-b26e-83dc-4902-881362d0d67d",
"resource": {
"resourceType": "Observation",
"id": "1e0c0e6e-b26e-83dc-4902-881362d0d67d",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T16:58:25+01:00",
"issued": "2021-02-23T16:58:25.518+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 85,
"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": 98,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d811130d-ef3e-c3c4-7a67-99b0d11b7900",
"resource": {
"resourceType": "Observation",
"id": "d811130d-ef3e-c3c4-7a67-99b0d11b7900",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T16:58:25+01:00",
"issued": "2021-02-23T16:58:25.518+01:00",
"valueQuantity": {
"value": 99,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:fdcc04d0-f396-0646-1138-eeb4c4194c9f",
"resource": {
"resourceType": "Observation",
"id": "fdcc04d0-f396-0646-1138-eeb4c4194c9f",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T16:58:25+01:00",
"issued": "2021-02-23T16:58:25.518+01:00",
"valueQuantity": {
"value": 16,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5b3b430e-344a-f047-26a2-a5e58888a5ed",
"resource": {
"resourceType": "Observation",
"id": "5b3b430e-344a-f047-26a2-a5e58888a5ed",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T16:58:25+01:00",
"issued": "2021-02-23T16:58:25.518+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:431d7e64-8120-824a-8afc-75ccad0f80c7",
"resource": {
"resourceType": "Observation",
"id": "431d7e64-8120-824a-8afc-75ccad0f80c7",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "70274-6",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T17:18:00+01:00",
"issued": "2021-02-23T17:18:00.518+01:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a682f249-4a0e-5bd5-30b5-6aea15b18b99",
"resource": {
"resourceType": "Observation",
"id": "a682f249-4a0e-5bd5-30b5-6aea15b18b99",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89204-2",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T17:50:54+01:00",
"issued": "2021-02-23T17:50:54.518+01:00",
"valueQuantity": {
"value": 23,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a0529fbf-1097-6f7e-6439-b21b0e0f360d",
"resource": {
"resourceType": "Procedure",
"id": "a0529fbf-1097-6f7e-6439-b21b0e0f360d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"performedPeriod": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:7060bb0e-a115-6ead-6411-39d243287cd5",
"resource": {
"resourceType": "Procedure",
"id": "7060bb0e-a115-6ead-6411-39d243287cd5",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"performedPeriod": {
"start": "2021-02-23T17:18:00+01:00",
"end": "2021-02-23T17:30:02+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:335f9d34-e91a-bbc9-4a2e-244145a26f6f",
"resource": {
"resourceType": "Procedure",
"id": "335f9d34-e91a-bbc9-4a2e-244145a26f6f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"performedPeriod": {
"start": "2021-02-23T17:30:02+01:00",
"end": "2021-02-23T17:50:54+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:5a10c65c-cd84-753e-9e06-14c9503e8028",
"resource": {
"resourceType": "Immunization",
"id": "5a10c65c-cd84-753e-9e06-14c9503e8028",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"occurrenceDateTime": "2021-02-23T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:4b792f0c-365a-bb7f-9467-fdbfa6f26b3a",
"resource": {
"resourceType": "DiagnosticReport",
"id": "4b792f0c-365a-bb7f-9467-fdbfa6f26b3a",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T17:18:00+01:00",
"issued": "2021-02-23T17:18:00.518+01:00",
"result": [ {
"reference": "urn:uuid:431d7e64-8120-824a-8afc-75ccad0f80c7",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:c45c2ca4-29f0-2fdf-660c-6bcc171b30ed",
"resource": {
"resourceType": "DiagnosticReport",
"id": "c45c2ca4-29f0-2fdf-660c-6bcc171b30ed",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T17:50:54+01:00",
"issued": "2021-02-23T17:50:54.518+01:00",
"result": [ {
"reference": "urn:uuid:a682f249-4a0e-5bd5-30b5-6aea15b18b99",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:4009facb-7fbd-f312-4d9b-2d3fff9fffcb",
"resource": {
"resourceType": "DiagnosticReport",
"id": "4009facb-7fbd-f312-4d9b-2d3fff9fffcb",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
},
"effectiveDateTime": "2021-02-23T16:58:25+01:00",
"issued": "2021-02-23T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:a55f4ed6-820e-eab5-b5c5-17430ba28eb4",
"resource": {
"resourceType": "DocumentReference",
"id": "a55f4ed6-820e-eab5-b5c5-17430ba28eb4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:4009facb-7fbd-f312-4d9b-2d3fff9fffcb"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2021-02-23T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"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:970a9c48-4805-f742-cefd-469ab856ad3f"
} ],
"period": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:53cf233e-7e1f-58cb-f5bf-23ef0281bbac",
"resource": {
"resourceType": "Claim",
"id": "53cf233e-7e1f-58cb-f5bf-23ef0281bbac",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"created": "2021-02-23T17:18:00+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:5a10c65c-cd84-753e-9e06-14c9503e8028"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:a903dcf9-713f-8ae6-d8bc-4a683a51e16d"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:a0529fbf-1097-6f7e-6439-b21b0e0f360d"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:7060bb0e-a115-6ead-6411-39d243287cd5"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:335f9d34-e91a-bbc9-4a2e-244145a26f6f"
}
} ],
"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:970a9c48-4805-f742-cefd-469ab856ad3f"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
}
}, {
"sequence": 4,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 6,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 7,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"net": {
"value": 29.67,
"currency": "USD"
}
}, {
"sequence": 8,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
} ],
"total": {
"value": 704.20,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:0410443f-bb5e-ac5a-52ab-fefe3a17ce80",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "0410443f-bb5e-ac5a-52ab-fefe3a17ce80",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "53cf233e-7e1f-58cb-f5bf-23ef0281bbac"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2021-02-23T17:18:00+01:00",
"end": "2022-02-23T17:18:00+01:00"
},
"created": "2021-02-23T17:18:00+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"claim": {
"reference": "urn:uuid:53cf233e-7e1f-58cb-f5bf-23ef0281bbac"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:a903dcf9-713f-8ae6-d8bc-4a683a51e16d"
},
"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": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
} ]
}, {
"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": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"servicedPeriod": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"servicedPeriod": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 5,
"informationSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"servicedPeriod": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"servicedPeriod": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 29.67,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 5.934000000000001,
"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": 23.736000000000004,
"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": 29.67,
"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": 29.67,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"informationSequence": [ 3 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"servicedPeriod": {
"start": "2021-02-23T16:58:25+01:00",
"end": "2021-02-23T17:18:00+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 704.20,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 942.104,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:b3036739-45eb-3752-216f-18e716d4b5b4",
"resource": {
"resourceType": "Encounter",
"id": "b3036739-45eb-3752-216f-18e716d4b5b4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "b3036739-45eb-3752-216f-18e716d4b5b4"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "33879002",
"display": "Administration of vaccine to produce active immunity (procedure)"
} ],
"text": "Administration of vaccine to produce active immunity (procedure)"
} ],
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-09-07T17:58:25+02:00",
"end": "2021-09-07T18:13:25+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
}
} ],
"period": {
"start": "2021-09-07T17:58:25+02:00",
"end": "2021-09-07T18:13:25+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:edcaa4da-2ead-9ed2-f2f5-18e664165402",
"resource": {
"resourceType": "Immunization",
"id": "edcaa4da-2ead-9ed2-f2f5-18e664165402",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "207",
"display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
} ],
"text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
},
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:b3036739-45eb-3752-216f-18e716d4b5b4"
},
"occurrenceDateTime": "2021-09-07T17:58:25+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:1f92dbda-0d40-2b18-019f-94e79e729f98",
"resource": {
"resourceType": "DiagnosticReport",
"id": "1f92dbda-0d40-2b18-019f-94e79e729f98",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:b3036739-45eb-3752-216f-18e716d4b5b4"
},
"effectiveDateTime": "2021-09-07T17:58:25+02:00",
"issued": "2021-09-07T17:58:25.518+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:076910b2-5d9b-a497-9b0d-0fc2c3641120",
"resource": {
"resourceType": "DocumentReference",
"id": "076910b2-5d9b-a497-9b0d-0fc2c3641120",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:1f92dbda-0d40-2b18-019f-94e79e729f98"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2021-09-07T17:58:25.518+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"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:b3036739-45eb-3752-216f-18e716d4b5b4"
} ],
"period": {
"start": "2021-09-07T17:58:25+02:00",
"end": "2021-09-07T18:13:25+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:312451f8-388b-3f5c-8286-2af5344c8d74",
"resource": {
"resourceType": "Claim",
"id": "312451f8-388b-3f5c-8286-2af5344c8d74",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2021-09-07T17:58:25+02:00",
"end": "2021-09-07T18:13:25+02:00"
},
"created": "2021-09-07T18:13:25+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:edcaa4da-2ead-9ed2-f2f5-18e664165402"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "33879002",
"display": "Administration of vaccine to produce active immunity (procedure)"
} ],
"text": "Administration of vaccine to produce active immunity (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:b3036739-45eb-3752-216f-18e716d4b5b4"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "207",
"display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
} ],
"text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
},
"net": {
"value": 136.00,
"currency": "USD"
}
} ],
"total": {
"value": 278.58,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:3e64834a-3530-a46c-8d00-5d93a769c692",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "3e64834a-3530-a46c-8d00-5d93a769c692",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "312451f8-388b-3f5c-8286-2af5344c8d74"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2021-09-07T18:13:25+02:00",
"end": "2022-09-07T18:13:25+02:00"
},
"created": "2021-09-07T18:13:25+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"claim": {
"reference": "urn:uuid:312451f8-388b-3f5c-8286-2af5344c8d74"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"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": "33879002",
"display": "Administration of vaccine to produce active immunity (procedure)"
} ],
"text": "Administration of vaccine to produce active immunity (procedure)"
},
"servicedPeriod": {
"start": "2021-09-07T17:58:25+02:00",
"end": "2021-09-07T18:13:25+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:b3036739-45eb-3752-216f-18e716d4b5b4"
} ]
}, {
"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": "207",
"display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
} ],
"text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
},
"servicedPeriod": {
"start": "2021-09-07T17:58:25+02:00",
"end": "2021-09-07T18:13:25+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 278.58,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:c57d1234-91d0-d9a0-2eb5-cd51c3a6bed4",
"resource": {
"resourceType": "Encounter",
"id": "c57d1234-91d0-d9a0-2eb5-cd51c3a6bed4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "c57d1234-91d0-d9a0-2eb5-cd51c3a6bed4"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "33879002",
"display": "Administration of vaccine to produce active immunity (procedure)"
} ],
"text": "Administration of vaccine to produce active immunity (procedure)"
} ],
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-10-05T17:58:25+02:00",
"end": "2021-10-05T18:13:25+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
}
} ],
"period": {
"start": "2021-10-05T17:58:25+02:00",
"end": "2021-10-05T18:13:25+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:9a26a8b1-0a90-6b5e-2529-75ee64a29709",
"resource": {
"resourceType": "Immunization",
"id": "9a26a8b1-0a90-6b5e-2529-75ee64a29709",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "207",
"display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
} ],
"text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
},
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:c57d1234-91d0-d9a0-2eb5-cd51c3a6bed4"
},
"occurrenceDateTime": "2021-10-05T17:58:25+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:cca76f0a-c208-8891-faea-c3575f288114",
"resource": {
"resourceType": "DiagnosticReport",
"id": "cca76f0a-c208-8891-faea-c3575f288114",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:c57d1234-91d0-d9a0-2eb5-cd51c3a6bed4"
},
"effectiveDateTime": "2021-10-05T17:58:25+02:00",
"issued": "2021-10-05T17:58:25.518+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:1c320014-7051-f37d-1bf6-19868b745866",
"resource": {
"resourceType": "DocumentReference",
"id": "1c320014-7051-f37d-1bf6-19868b745866",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:cca76f0a-c208-8891-faea-c3575f288114"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2021-10-05T17:58:25.518+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"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:c57d1234-91d0-d9a0-2eb5-cd51c3a6bed4"
} ],
"period": {
"start": "2021-10-05T17:58:25+02:00",
"end": "2021-10-05T18:13:25+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:c4657b58-e73a-0ee1-b59c-37a27eec7213",
"resource": {
"resourceType": "Claim",
"id": "c4657b58-e73a-0ee1-b59c-37a27eec7213",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2021-10-05T17:58:25+02:00",
"end": "2021-10-05T18:13:25+02:00"
},
"created": "2021-10-05T18:13:25+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:9a26a8b1-0a90-6b5e-2529-75ee64a29709"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "33879002",
"display": "Administration of vaccine to produce active immunity (procedure)"
} ],
"text": "Administration of vaccine to produce active immunity (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:c57d1234-91d0-d9a0-2eb5-cd51c3a6bed4"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "207",
"display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
} ],
"text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
},
"net": {
"value": 136.00,
"currency": "USD"
}
} ],
"total": {
"value": 278.58,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:21675f09-557f-6276-26d9-9355f2b7200c",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "21675f09-557f-6276-26d9-9355f2b7200c",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "c4657b58-e73a-0ee1-b59c-37a27eec7213"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2021-10-05T18:13:25+02:00",
"end": "2022-10-05T18:13:25+02:00"
},
"created": "2021-10-05T18:13:25+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"claim": {
"reference": "urn:uuid:c4657b58-e73a-0ee1-b59c-37a27eec7213"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"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": "33879002",
"display": "Administration of vaccine to produce active immunity (procedure)"
} ],
"text": "Administration of vaccine to produce active immunity (procedure)"
},
"servicedPeriod": {
"start": "2021-10-05T17:58:25+02:00",
"end": "2021-10-05T18:13:25+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:c57d1234-91d0-d9a0-2eb5-cd51c3a6bed4"
} ]
}, {
"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": "207",
"display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
} ],
"text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose"
},
"servicedPeriod": {
"start": "2021-10-05T17:58:25+02:00",
"end": "2021-10-05T18:13:25+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 278.58,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:fe2166df-26f8-1a0a-61de-01d27976fb66",
"resource": {
"resourceType": "Encounter",
"id": "fe2166df-26f8-1a0a-61de-01d27976fb66",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "fe2166df-26f8-1a0a-61de-01d27976fb66"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "698314001",
"display": "Consultation for treatment"
} ],
"text": "Consultation for treatment"
} ],
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-01-06T16:58:25+01:00",
"end": "2022-01-06T17:13:25+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
}
} ],
"period": {
"start": "2022-01-06T16:58:25+01:00",
"end": "2022-01-06T17:13:25+01:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:36cd9114-2b07-53e5-d7f2-e606835bd592",
"resource": {
"resourceType": "MedicationRequest",
"id": "36cd9114-2b07-53e5-d7f2-e606835bd592",
"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": "978950",
"display": "Natazia 28 Day Pack"
} ],
"text": "Natazia 28 Day Pack"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:fe2166df-26f8-1a0a-61de-01d27976fb66"
},
"authoredOn": "2022-01-06T16:58:25+01:00",
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
}
},
"request": {
"method": "POST",
"url": "MedicationRequest"
}
}, {
"fullUrl": "urn:uuid:cad19709-ce3d-cbc8-2e93-f231fc0e8095",
"resource": {
"resourceType": "Claim",
"id": "cad19709-ce3d-cbc8-2e93-f231fc0e8095",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2022-01-06T16:58:25+01:00",
"end": "2022-01-06T17:13:25+01:00"
},
"created": "2022-01-06T17:13:25+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"prescription": {
"reference": "urn:uuid:36cd9114-2b07-53e5-d7f2-e606835bd592"
},
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "978950",
"display": "Natazia 28 Day Pack"
} ],
"text": "Natazia 28 Day Pack"
},
"encounter": [ {
"reference": "urn:uuid:fe2166df-26f8-1a0a-61de-01d27976fb66"
} ]
} ],
"total": {
"value": 392.66,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:f3fcbfc2-1d36-bd33-0724-0db8fe75c9c1",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "f3fcbfc2-1d36-bd33-0724-0db8fe75c9c1",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "cad19709-ce3d-cbc8-2e93-f231fc0e8095"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2022-01-06T17:13:25+01:00",
"end": "2023-01-06T17:13:25+01:00"
},
"created": "2022-01-06T17:13:25+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"claim": {
"reference": "urn:uuid:cad19709-ce3d-cbc8-2e93-f231fc0e8095"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"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": "978950",
"display": "Natazia 28 Day Pack"
} ],
"text": "Natazia 28 Day Pack"
},
"servicedPeriod": {
"start": "2022-01-06T16:58:25+01:00",
"end": "2022-01-06T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:fe2166df-26f8-1a0a-61de-01d27976fb66"
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 392.66,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:a84150d1-d0d3-8bac-a805-6a43ebf5f095",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a84150d1-d0d3-8bac-a805-6a43ebf5f095",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:fe2166df-26f8-1a0a-61de-01d27976fb66"
},
"effectiveDateTime": "2022-01-06T16:58:25+01:00",
"issued": "2022-01-06T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMjItMDEtMDYKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCk1hcmxhbmE0MDIKIGlzIGEgMTUgeWVhci1vbGQgbm9uaGlzcGFuaWMgd2hpdGUgZmVtYWxlLiBQYXRpZW50IGhhcyBhIGhpc3Rvcnkgb2YgYWN1dGUgYnJvbmNoaXRpcyAoZGlzb3JkZXIpLCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbikuCgojIFNvY2lhbCBIaXN0b3J5CiBQYXRpZW50IGhhcyBuZXZlciBzbW9rZWQuCgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KClBhdGllbnQgY3VycmVudGx5IGhhcyBNZWRpY2FpZC4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKYWNldGFtaW5vcGhlbiAzMjUgbWcgb3JhbCB0YWJsZXQKCiMgQXNzZXNzbWVudCBhbmQgUGxhbgoKCiMjIFBsYW4KClRoZSBwYXRpZW50IHdhcyBwcmVzY3JpYmVkIHRoZSBmb2xsb3dpbmcgbWVkaWNhdGlvbnM6Ci0gbmF0YXppYSAyOCBkYXkgcGFjawo="
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:f6786ea1-7614-082f-099f-b69f96df9905",
"resource": {
"resourceType": "DocumentReference",
"id": "f6786ea1-7614-082f-099f-b69f96df9905",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:a84150d1-d0d3-8bac-a805-6a43ebf5f095"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2022-01-06T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"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:fe2166df-26f8-1a0a-61de-01d27976fb66"
} ],
"period": {
"start": "2022-01-06T16:58:25+01:00",
"end": "2022-01-06T17:13:25+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:8d54e1b7-ff8a-47ab-8abc-a7fc421039d2",
"resource": {
"resourceType": "Claim",
"id": "8d54e1b7-ff8a-47ab-8abc-a7fc421039d2",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2022-01-06T16:58:25+01:00",
"end": "2022-01-06T17:13:25+01:00"
},
"created": "2022-01-06T17:13:25+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "Medicaid"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "698314001",
"display": "Consultation for treatment"
} ],
"text": "Consultation for treatment"
},
"encounter": [ {
"reference": "urn:uuid:fe2166df-26f8-1a0a-61de-01d27976fb66"
} ]
} ],
"total": {
"value": 142.58,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:d5d6ee4f-f69d-95e5-ce3b-76e9310d4cef",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "d5d6ee4f-f69d-95e5-ce3b-76e9310d4cef",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "8d54e1b7-ff8a-47ab-8abc-a7fc421039d2"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2022-01-06T17:13:25+01:00",
"end": "2023-01-06T17:13:25+01:00"
},
"created": "2022-01-06T17:13:25+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"claim": {
"reference": "urn:uuid:8d54e1b7-ff8a-47ab-8abc-a7fc421039d2"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"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": "698314001",
"display": "Consultation for treatment"
} ],
"text": "Consultation for treatment"
},
"servicedPeriod": {
"start": "2022-01-06T16:58:25+01:00",
"end": "2022-01-06T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:fe2166df-26f8-1a0a-61de-01d27976fb66"
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 142.58,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e",
"resource": {
"resourceType": "Encounter",
"id": "5e969ab6-9dfb-d670-3d87-17050f0a915e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "5e969ab6-9dfb-d670-3d87-17050f0a915e"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
}
} ],
"period": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:ebb09079-b7a8-b48e-4dc2-31c7cbc56218",
"resource": {
"resourceType": "Observation",
"id": "ebb09079-b7a8-b48e-4dc2-31c7cbc56218",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 149.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d6c58720-56f4-db3c-33ac-8536db3e9a73",
"resource": {
"resourceType": "Observation",
"id": "d6c58720-56f4-db3c-33ac-8536db3e9a73",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d48a3482-80f0-d891-8ef3-668170291d0f",
"resource": {
"resourceType": "Observation",
"id": "d48a3482-80f0-d891-8ef3-668170291d0f",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 39.1,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:925a15e6-dec8-0b11-e89d-e483c67ef02c",
"resource": {
"resourceType": "Observation",
"id": "925a15e6-dec8-0b11-e89d-e483c67ef02c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 17.53,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ec667303-10ae-d7a3-2bab-099ca8c40098",
"resource": {
"resourceType": "Observation",
"id": "ec667303-10ae-d7a3-2bab-099ca8c40098",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 10.639,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:35df3781-0643-1af8-b57b-6f61e7a6647b",
"resource": {
"resourceType": "Observation",
"id": "35df3781-0643-1af8-b57b-6f61e7a6647b",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"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": 101,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:18ad046a-9880-fd25-d9eb-5992d4c3be38",
"resource": {
"resourceType": "Observation",
"id": "18ad046a-9880-fd25-d9eb-5992d4c3be38",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 90,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3d09137f-80c9-ea5a-48eb-f97be429c94d",
"resource": {
"resourceType": "Observation",
"id": "3d09137f-80c9-ea5a-48eb-f97be429c94d",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 13,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:16d1a081-9bce-70e5-2fc5-dbb4a0440eb0",
"resource": {
"resourceType": "Observation",
"id": "16d1a081-9bce-70e5-2fc5-dbb4a0440eb0",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 10.168,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6ce6a5ac-2935-563b-5938-fc1ca22ff71e",
"resource": {
"resourceType": "Observation",
"id": "6ce6a5ac-2935-563b-5938-fc1ca22ff71e",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 5.2033,
"unit": "10*6/uL",
"system": "http://unitsofmeasure.org",
"code": "10*6/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7d2c2563-d532-225c-f1be-eb0ea2a99cb2",
"resource": {
"resourceType": "Observation",
"id": "7d2c2563-d532-225c-f1be-eb0ea2a99cb2",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 13.151,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:70cdc5d6-4f3b-6e93-3234-9b6999d198ec",
"resource": {
"resourceType": "Observation",
"id": "70cdc5d6-4f3b-6e93-3234-9b6999d198ec",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 40.715,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:90b55ae8-18fd-b0c1-1500-838f67076805",
"resource": {
"resourceType": "Observation",
"id": "90b55ae8-18fd-b0c1-1500-838f67076805",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 83.013,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1824df8c-d02d-ff46-70fb-0d7d6bb6bced",
"resource": {
"resourceType": "Observation",
"id": "1824df8c-d02d-ff46-70fb-0d7d6bb6bced",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 27.429,
"unit": "pg",
"system": "http://unitsofmeasure.org",
"code": "pg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:b1f26b84-da02-70b4-5484-24f10d87e813",
"resource": {
"resourceType": "Observation",
"id": "b1f26b84-da02-70b4-5484-24f10d87e813",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 35.563,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:b96009fb-66fd-60d2-232f-fb98fee52319",
"resource": {
"resourceType": "Observation",
"id": "b96009fb-66fd-60d2-232f-fb98fee52319",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 39.121,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:92abf271-83bd-589c-8bcc-1ab1e124c1e9",
"resource": {
"resourceType": "Observation",
"id": "92abf271-83bd-589c-8bcc-1ab1e124c1e9",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 314.79,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1ff55901-8bee-293d-05de-deaca3af05fa",
"resource": {
"resourceType": "Observation",
"id": "1ff55901-8bee-293d-05de-deaca3af05fa",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 421.27,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2e7623df-bfc6-0a38-3ece-54af2d112aa1",
"resource": {
"resourceType": "Observation",
"id": "2e7623df-bfc6-0a38-3ece-54af2d112aa1",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"valueQuantity": {
"value": 10.97,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:34b1730b-532d-49b8-8a8e-92f871ca0351",
"resource": {
"resourceType": "Observation",
"id": "34b1730b-532d-49b8-8a8e-92f871ca0351",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+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:fc94e4fc-e54c-60e2-22fa-5c434f52abb5",
"resource": {
"resourceType": "Observation",
"id": "fc94e4fc-e54c-60e2-22fa-5c434f52abb5",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89204-2",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T17:32:00+01:00",
"issued": "2022-03-01T17:32:00.518+01:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:746918f2-b648-0bef-bbdf-32cf4e3749b7",
"resource": {
"resourceType": "Procedure",
"id": "746918f2-b648-0bef-bbdf-32cf4e3749b7",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"performedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:62849f6a-067c-3d60-8b87-1ba6954166b0",
"resource": {
"resourceType": "Procedure",
"id": "62849f6a-067c-3d60-8b87-1ba6954166b0",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"performedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:10:37+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:b30fc1c2-b2d3-d196-1254-43eb4e82421d",
"resource": {
"resourceType": "Procedure",
"id": "b30fc1c2-b2d3-d196-1254-43eb4e82421d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"performedPeriod": {
"start": "2022-03-01T17:10:37+01:00",
"end": "2022-03-01T17:32:00+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:07763287-a464-614f-6ae8-9ba990020c2b",
"resource": {
"resourceType": "Procedure",
"id": "07763287-a464-614f-6ae8-9ba990020c2b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"performedPeriod": {
"start": "2022-03-01T17:32:00+01:00",
"end": "2022-03-01T17:43:18+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a3413336-731b-0a19-21a5-ef62c61d9fb8",
"resource": {
"resourceType": "Procedure",
"id": "a3413336-731b-0a19-21a5-ef62c61d9fb8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"performedPeriod": {
"start": "2022-03-01T17:43:18+01:00",
"end": "2022-03-01T17:54:56+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:517ecd28-0a45-35bb-cfa4-6e471ebb9f37",
"resource": {
"resourceType": "Procedure",
"id": "517ecd28-0a45-35bb-cfa4-6e471ebb9f37",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"performedPeriod": {
"start": "2022-03-01T17:54:56+01:00",
"end": "2022-03-01T18:09:22+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a894c75d-e74d-4a5b-0c6a-89f68a7bd70b",
"resource": {
"resourceType": "Immunization",
"id": "a894c75d-e74d-4a5b-0c6a-89f68a7bd70b",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"occurrenceDateTime": "2022-03-01T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:3f0619ee-1988-6274-2511-a7209e449a88",
"resource": {
"resourceType": "Immunization",
"id": "3f0619ee-1988-6274-2511-a7209e449a88",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "114",
"display": "meningococcal MCV4P"
} ],
"text": "meningococcal MCV4P"
},
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"occurrenceDateTime": "2022-03-01T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:f47c6fdb-a264-648a-7827-239739bfc93e",
"resource": {
"resourceType": "DiagnosticReport",
"id": "f47c6fdb-a264-648a-7827-239739bfc93e",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
} ],
"result": [ {
"reference": "urn:uuid:16d1a081-9bce-70e5-2fc5-dbb4a0440eb0",
"display": "Leukocytes [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:6ce6a5ac-2935-563b-5938-fc1ca22ff71e",
"display": "Erythrocytes [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:7d2c2563-d532-225c-f1be-eb0ea2a99cb2",
"display": "Hemoglobin [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:70cdc5d6-4f3b-6e93-3234-9b6999d198ec",
"display": "Hematocrit [Volume Fraction] of Blood by Automated count"
}, {
"reference": "urn:uuid:90b55ae8-18fd-b0c1-1500-838f67076805",
"display": "MCV [Entitic volume] by Automated count"
}, {
"reference": "urn:uuid:1824df8c-d02d-ff46-70fb-0d7d6bb6bced",
"display": "MCH [Entitic mass] by Automated count"
}, {
"reference": "urn:uuid:b1f26b84-da02-70b4-5484-24f10d87e813",
"display": "MCHC [Mass/volume] by Automated count"
}, {
"reference": "urn:uuid:b96009fb-66fd-60d2-232f-fb98fee52319",
"display": "Erythrocyte distribution width [Entitic volume] by Automated count"
}, {
"reference": "urn:uuid:92abf271-83bd-589c-8bcc-1ab1e124c1e9",
"display": "Platelets [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:1ff55901-8bee-293d-05de-deaca3af05fa",
"display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:2e7623df-bfc6-0a38-3ece-54af2d112aa1",
"display": "Platelet mean volume [Entitic volume] in Blood by Automated count"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:8780c87a-da58-56af-8076-15cc4cf617ae",
"resource": {
"resourceType": "DiagnosticReport",
"id": "8780c87a-da58-56af-8076-15cc4cf617ae",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T17:32:00+01:00",
"issued": "2022-03-01T17:32:00.518+01:00",
"result": [ {
"reference": "urn:uuid:fc94e4fc-e54c-60e2-22fa-5c434f52abb5",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:7c654aa2-86ec-1f18-0c61-8c39a89e4567",
"resource": {
"resourceType": "DiagnosticReport",
"id": "7c654aa2-86ec-1f18-0c61-8c39a89e4567",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
},
"effectiveDateTime": "2022-03-01T16:58:25+01:00",
"issued": "2022-03-01T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:0e7fe10c-210d-ebd2-9fb2-558c031aa4df",
"resource": {
"resourceType": "DocumentReference",
"id": "0e7fe10c-210d-ebd2-9fb2-558c031aa4df",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:7c654aa2-86ec-1f18-0c61-8c39a89e4567"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2022-03-01T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"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:5e969ab6-9dfb-d670-3d87-17050f0a915e"
} ],
"period": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:4a8ae07a-6101-f7e5-2e26-959164490a3e",
"resource": {
"resourceType": "Claim",
"id": "4a8ae07a-6101-f7e5-2e26-959164490a3e",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"created": "2022-03-01T17:13:25+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:a894c75d-e74d-4a5b-0c6a-89f68a7bd70b"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:3f0619ee-1988-6274-2511-a7209e449a88"
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:746918f2-b648-0bef-bbdf-32cf4e3749b7"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:62849f6a-067c-3d60-8b87-1ba6954166b0"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:b30fc1c2-b2d3-d196-1254-43eb4e82421d"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:07763287-a464-614f-6ae8-9ba990020c2b"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:a3413336-731b-0a19-21a5-ef62c61d9fb8"
}
}, {
"sequence": 6,
"procedureReference": {
"reference": "urn:uuid:517ecd28-0a45-35bb-cfa4-6e471ebb9f37"
}
} ],
"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:5e969ab6-9dfb-d670-3d87-17050f0a915e"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "114",
"display": "meningococcal MCV4P"
} ],
"text": "meningococcal MCV4P"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 4,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 421.70,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "58410-2",
"display": "CBC panel - Blood by Automated count"
} ],
"text": "CBC panel - Blood by Automated count"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 6,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 7,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"net": {
"value": 26.23,
"currency": "USD"
}
}, {
"sequence": 8,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 9,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 10,
"procedureSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 11,
"procedureSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
} ],
"total": {
"value": 1336.48,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:302f2a14-5aa9-5b8c-9762-bfa67d0e454b",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "302f2a14-5aa9-5b8c-9762-bfa67d0e454b",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "4a8ae07a-6101-f7e5-2e26-959164490a3e"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2022-03-01T17:13:25+01:00",
"end": "2023-03-01T17:13:25+01:00"
},
"created": "2022-03-01T17:13:25+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"claim": {
"reference": "urn:uuid:4a8ae07a-6101-f7e5-2e26-959164490a3e"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"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": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+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": "114",
"display": "meningococcal MCV4P"
} ],
"text": "meningococcal MCV4P"
},
"servicedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"servicedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 421.70,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 84.34,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 337.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 421.70,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 421.70,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 5,
"informationSequence": [ 3 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "58410-2",
"display": "CBC panel - Blood by Automated count"
} ],
"text": "CBC panel - Blood by Automated count"
},
"servicedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"servicedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 26.23,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 5.246,
"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": 20.984,
"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": 26.23,
"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": 26.23,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"informationSequence": [ 4 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"servicedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 9,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 10,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"servicedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 11,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"servicedPeriod": {
"start": "2022-03-01T16:58:25+01:00",
"end": "2022-03-01T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 1336.48,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2075.752,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c",
"resource": {
"resourceType": "Encounter",
"id": "9d70acd3-0229-1a99-bf92-9f5ea266054c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "9d70acd3-0229-1a99-bf92-9f5ea266054c"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
}
} ],
"period": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:26345211-0023-7203-c533-4873f07a227d",
"resource": {
"resourceType": "Condition",
"id": "26345211-0023-7203-c533-4873f07a227d",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"onsetDateTime": "2023-03-07T16:58:25+01:00",
"abatementDateTime": "2023-03-07T16:58:25+01:00",
"recordedDate": "2023-03-07T16:58:25+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:f589c2f9-25ad-0aa6-c1d4-3df83799c31d",
"resource": {
"resourceType": "Observation",
"id": "f589c2f9-25ad-0aa6-c1d4-3df83799c31d",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T16:58:25+01:00",
"issued": "2023-03-07T16:58:25.518+01:00",
"valueQuantity": {
"value": 149.6,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:37a579c7-3e9b-3870-a479-ad5fc19def5a",
"resource": {
"resourceType": "Observation",
"id": "37a579c7-3e9b-3870-a479-ad5fc19def5a",
"status": "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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T16:58:25+01:00",
"issued": "2023-03-07T16:58:25.518+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3b87f30d-3d2e-1a8a-0d17-b33be4fb15a2",
"resource": {
"resourceType": "Observation",
"id": "3b87f30d-3d2e-1a8a-0d17-b33be4fb15a2",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T16:58:25+01:00",
"issued": "2023-03-07T16:58:25.518+01:00",
"valueQuantity": {
"value": 40.8,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3f042a8f-c9f3-4087-5dd0-555e44ddc7d6",
"resource": {
"resourceType": "Observation",
"id": "3f042a8f-c9f3-4087-5dd0-555e44ddc7d6",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "39156-5",
"display": "Body mass index (BMI) [Ratio]"
} ],
"text": "Body mass index (BMI) [Ratio]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T16:58:25+01:00",
"issued": "2023-03-07T16:58:25.518+01:00",
"valueQuantity": {
"value": 18.23,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:74312ac4-aefe-94a1-0a1a-f479eeccdfd0",
"resource": {
"resourceType": "Observation",
"id": "74312ac4-aefe-94a1-0a1a-f479eeccdfd0",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "59576-9",
"display": "Body mass index (BMI) [Percentile] Per age and sex"
} ],
"text": "Body mass index (BMI) [Percentile] Per age and sex"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T16:58:25+01:00",
"issued": "2023-03-07T16:58:25.518+01:00",
"valueQuantity": {
"value": 13.546,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:506d2dee-45e6-fee0-d701-9d8f6ccdb6e3",
"resource": {
"resourceType": "Observation",
"id": "506d2dee-45e6-fee0-d701-9d8f6ccdb6e3",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T16:58:25+01:00",
"issued": "2023-03-07T16:58:25.518+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 80,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 102,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0de385cc-4d47-c4d2-e2d7-454dea061f3e",
"resource": {
"resourceType": "Observation",
"id": "0de385cc-4d47-c4d2-e2d7-454dea061f3e",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T16:58:25+01:00",
"issued": "2023-03-07T16:58:25.518+01:00",
"valueQuantity": {
"value": 75,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9c2e4c50-98ba-87f9-812f-b6b89d18d7f5",
"resource": {
"resourceType": "Observation",
"id": "9c2e4c50-98ba-87f9-812f-b6b89d18d7f5",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T16:58:25+01:00",
"issued": "2023-03-07T16:58:25.518+01:00",
"valueQuantity": {
"value": 15,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5c2a0848-59c4-9449-747e-af69692c54f5",
"resource": {
"resourceType": "Observation",
"id": "5c2a0848-59c4-9449-747e-af69692c54f5",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T16:58:25+01:00",
"issued": "2023-03-07T16:58:25.518+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:04f5d9cc-46a5-2abe-b537-4b0cd5e49352",
"resource": {
"resourceType": "Observation",
"id": "04f5d9cc-46a5-2abe-b537-4b0cd5e49352",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89204-2",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T17:36:25+01:00",
"issued": "2023-03-07T17:36:25.518+01:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f54726da-140f-463c-7e7e-b8129a073d2e",
"resource": {
"resourceType": "Procedure",
"id": "f54726da-140f-463c-7e7e-b8129a073d2e",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"performedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:cab6e320-36dd-5dd5-d58d-e14a66ef8776",
"resource": {
"resourceType": "Procedure",
"id": "cab6e320-36dd-5dd5-d58d-e14a66ef8776",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"performedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:12:17+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:c1ffa90e-8613-9133-6801-cf27aea20360",
"resource": {
"resourceType": "Procedure",
"id": "c1ffa90e-8613-9133-6801-cf27aea20360",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"performedPeriod": {
"start": "2023-03-07T17:12:17+01:00",
"end": "2023-03-07T17:36:25+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a87b0f45-60f3-7d05-9d35-6073142b7580",
"resource": {
"resourceType": "Procedure",
"id": "a87b0f45-60f3-7d05-9d35-6073142b7580",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"performedPeriod": {
"start": "2023-03-07T17:36:25+01:00",
"end": "2023-03-07T17:48:33+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:8c98197e-72f5-094f-b62f-4a8800e7d683",
"resource": {
"resourceType": "Procedure",
"id": "8c98197e-72f5-094f-b62f-4a8800e7d683",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"performedPeriod": {
"start": "2023-03-07T17:48:33+01:00",
"end": "2023-03-07T17:59:31+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:c7fa2b47-1a45-f7bb-fbac-b7f6d97c1c71",
"resource": {
"resourceType": "Procedure",
"id": "c7fa2b47-1a45-f7bb-fbac-b7f6d97c1c71",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"performedPeriod": {
"start": "2023-03-07T17:59:31+01:00",
"end": "2023-03-07T18:10:53+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:b178923a-23b5-157d-efe3-e021e7b3fa8a",
"resource": {
"resourceType": "Immunization",
"id": "b178923a-23b5-157d-efe3-e021e7b3fa8a",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"occurrenceDateTime": "2023-03-07T16:58:25+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:b7905aae-b967-2ac1-9cd5-cd848d069ef8",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b7905aae-b967-2ac1-9cd5-cd848d069ef8",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T17:36:25+01:00",
"issued": "2023-03-07T17:36:25.518+01:00",
"result": [ {
"reference": "urn:uuid:04f5d9cc-46a5-2abe-b537-4b0cd5e49352",
"display": "Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:cf14d4b7-c6b7-6550-97ae-0ef7b7bdc1d7",
"resource": {
"resourceType": "DiagnosticReport",
"id": "cf14d4b7-c6b7-6550-97ae-0ef7b7bdc1d7",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
},
"effectiveDateTime": "2023-03-07T16:58:25+01:00",
"issued": "2023-03-07T16:58:25.518+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:9e88f1cf-ecb9-1a10-d16d-2714b68b1998",
"resource": {
"resourceType": "DocumentReference",
"id": "9e88f1cf-ecb9-1a10-d16d-2714b68b1998",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:cf14d4b7-c6b7-6550-97ae-0ef7b7bdc1d7"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2023-03-07T16:58:25.518+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894",
"display": "Dr. King743 Predovic534"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"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:9d70acd3-0229-1a99-bf92-9f5ea266054c"
} ],
"period": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:b95f460a-ea93-2dc6-980c-61766bf30b99",
"resource": {
"resourceType": "Claim",
"id": "b95f460a-ea93-2dc6-980c-61766bf30b99",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"created": "2023-03-07T17:13:25+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|a3327df4-d092-350b-b551-e60c82076c9a",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:b178923a-23b5-157d-efe3-e021e7b3fa8a"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:26345211-0023-7203-c533-4873f07a227d"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:f54726da-140f-463c-7e7e-b8129a073d2e"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:cab6e320-36dd-5dd5-d58d-e14a66ef8776"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:c1ffa90e-8613-9133-6801-cf27aea20360"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:a87b0f45-60f3-7d05-9d35-6073142b7580"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:8c98197e-72f5-094f-b62f-4a8800e7d683"
}
}, {
"sequence": 6,
"procedureReference": {
"reference": "urn:uuid:c7fa2b47-1a45-f7bb-fbac-b7f6d97c1c71"
}
} ],
"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:9d70acd3-0229-1a99-bf92-9f5ea266054c"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
}
}, {
"sequence": 4,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 368.64,
"currency": "USD"
}
}, {
"sequence": 5,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 6,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"net": {
"value": 32.88,
"currency": "USD"
}
}, {
"sequence": 7,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 8,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 9,
"procedureSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 10,
"procedureSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
} ],
"total": {
"value": 1072.84,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:76ce5958-d37b-269d-0a75-65e2d0796f27",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "76ce5958-d37b-269d-0a75-65e2d0796f27",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "b95f460a-ea93-2dc6-980c-61766bf30b99"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2023-03-07T17:13:25+01:00",
"end": "2024-03-07T17:13:25+01:00"
},
"created": "2023-03-07T17:13:25+01:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|3a17518b-e99e-3a41-b432-912fda4fe8c6",
"display": "WEST BROOKFIELD FAMILY PRACTICE"
},
"claim": {
"reference": "urn:uuid:b95f460a-ea93-2dc6-980c-61766bf30b99"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999957894"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:26345211-0023-7203-c533-4873f07a227d"
},
"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": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"servicedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"servicedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"servicedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 368.64,
"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": 73.728,
"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": 294.912,
"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": 368.64,
"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": 368.64,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "715252007",
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
},
"servicedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 32.88,
"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": 6.5760000000000005,
"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": 26.304000000000002,
"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": 32.88,
"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": 32.88,
"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,
"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": "89206-7",
"display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
} ],
"text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
},
"servicedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 9,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "868187001",
"display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
} ],
"text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
},
"servicedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 10,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386516004",
"display": "Anticipatory guidance (procedure)"
} ],
"text": "Anticipatory guidance (procedure)"
},
"servicedPeriod": {
"start": "2023-03-07T16:58:25+01:00",
"end": "2023-03-07T17:13:25+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 1072.84,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1870.1599999999999,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:ad06f3c5-d5cd-3310-8364-85a5d8efebd8",
"resource": {
"resourceType": "Encounter",
"id": "ad06f3c5-d5cd-3310-8364-85a5d8efebd8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "ad06f3c5-d5cd-3310-8364-85a5d8efebd8"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Tiera511 Hansen121"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2023-06-18T06:58:25+02:00",
"end": "2023-06-18T07:13:25+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
}
} ],
"period": {
"start": "2023-06-18T06:58:25+02:00",
"end": "2023-06-18T07:13:25+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "444814009",
"display": "Viral sinusitis (disorder)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:30cfb131-a37a-099f-41a1-fbe73302fafe",
"resource": {
"resourceType": "Condition",
"id": "30cfb131-a37a-099f-41a1-fbe73302fafe",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:ad06f3c5-d5cd-3310-8364-85a5d8efebd8"
},
"onsetDateTime": "2023-06-18T06:58:25+02:00",
"abatementDateTime": "2023-07-02T06:58:25+02:00",
"recordedDate": "2023-06-18T06:58:25+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:50d626cd-bf8c-56fe-39d5-eae731a77963",
"resource": {
"resourceType": "DiagnosticReport",
"id": "50d626cd-bf8c-56fe-39d5-eae731a77963",
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"encounter": {
"reference": "urn:uuid:ad06f3c5-d5cd-3310-8364-85a5d8efebd8"
},
"effectiveDateTime": "2023-06-18T06:58:25+02:00",
"issued": "2023-06-18T06:58:25.518+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:0c62e6ec-38a1-fb76-e576-0e3436c2c706",
"resource": {
"resourceType": "DocumentReference",
"id": "0c62e6ec-38a1-fb76-e576-0e3436c2c706",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:50d626cd-bf8c-56fe-39d5-eae731a77963"
} ],
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"date": "2023-06-18T06:58:25.518+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195",
"display": "Dr. Logan497 Fisher429"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"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:ad06f3c5-d5cd-3310-8364-85a5d8efebd8"
} ],
"period": {
"start": "2023-06-18T06:58:25+02:00",
"end": "2023-06-18T07:13:25+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:a201d92b-946c-3f0e-11bf-1b3cf2995a9d",
"resource": {
"resourceType": "Claim",
"id": "a201d92b-946c-3f0e-11bf-1b3cf2995a9d",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76",
"display": "Marlana402 Hansen121"
},
"billablePeriod": {
"start": "2023-06-18T06:58:25+02:00",
"end": "2023-06-18T07:13:25+02:00"
},
"created": "2023-06-18T07:13:25+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:30cfb131-a37a-099f-41a1-fbe73302fafe"
}
} ],
"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:ad06f3c5-d5cd-3310-8364-85a5d8efebd8"
} ]
}, {
"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:dd79e763-fdd3-ae21-8604-048624224a64",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "dd79e763-fdd3-ae21-8604-048624224a64",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "Medicaid"
},
"beneficiary": {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"payor": [ {
"display": "Medicaid"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "a201d92b-946c-3f0e-11bf-1b3cf2995a9d"
}, {
"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:8c570871-8d00-8c04-5da3-1ef43ed00f76"
},
"billablePeriod": {
"start": "2023-06-18T07:13:25+02:00",
"end": "2024-06-18T07:13:25+02:00"
},
"created": "2023-06-18T07:13:25+02:00",
"insurer": {
"display": "Medicaid"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|50f0f829-0cb0-35cf-9e3f-c2f2e54827c3",
"display": "BAYSTATE MEDICAL CENTER"
},
"claim": {
"reference": "urn:uuid:a201d92b-946c-3f0e-11bf-1b3cf2995a9d"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998195"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:30cfb131-a37a-099f-41a1-fbe73302fafe"
},
"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": "2023-06-18T06:58:25+02:00",
"end": "2023-06-18T07:13:25+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:ad06f3c5-d5cd-3310-8364-85a5d8efebd8"
} ]
}, {
"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": "2023-06-18T06:58:25+02:00",
"end": "2023-06-18T07:13:25+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
}
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 85.55,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:7b63e27d-e921-f416-04f7-888eabb5025f",
"resource": {
"resourceType": "Provenance",
"id": "7b63e27d-e921-f416-04f7-888eabb5025f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance" ]
},
"target": [ {
"reference": "urn:uuid:8c570871-8d00-8c04-5da3-1ef43ed00f76"
}, {
"reference": "urn:uuid:d6914177-7f04-f8a7-10b9-ee21bdc2a5ce"
}, {
"reference": "urn:uuid:c28907fa-84e7-e9e4-c5ef-7b1c4cd1993b"
}, {
"reference": "urn:uuid:2bfb3718-ae46-4f6c-8529-8eee0fe05d34"
}, {
"reference": "urn:uuid:80fddf18-f2e3-89a7-9393-a286e1ff01a4"
}, {
"reference": "urn:uuid:0f1744b1-d41e-c595-1004-65b6c48bc0d3"
}, {
"reference": "urn:uuid:c9beac79-c1cf-1258-dd21-f9ea66d6eee7"
}, {
"reference": "urn:uuid:9e83c0ae-7b98-c0b1-bde9-0c7f4258b48c"
}, {
"reference": "urn:uuid:86113400-714d-a9d8-0af6-7cefc2028cf6"
}, {
"reference": "urn:uuid:c2f95e3b-623c-d27e-e883-47369ab4624b"
}, {
"reference": "urn:uuid:f7f1916e-b91c-30c5-06cf-6d330c614d08"
}, {
"reference": "urn:uuid:c02ba134-6658-c0d9-221a-884c76e505a5"
}, {
"reference": "urn:uuid:82f46ccd-6906-985d-95a2-5783d7e4a7c4"
}, {
"reference": "urn:uuid:d859f2cf-b2fe-c07a-0b3e-28147cd0c003"
}, {
"reference": "urn:uuid:2de2addd-c2e4-237d-bdde-ef74e49649cb"
}, {
"reference": "urn:uuid:5248f014-a50f-5872-80de-5b792dcb7743"
}, {
"reference": "urn:uuid:1cacb987-71ee-6110-50de-54502422adad"
}, {
"reference": "urn:uuid:33e2ca73-c062-f81a-7805-433e14c328ec"
}, {
"reference": "urn:uuid:0eec6a84-d883-3448-24d7-8a1ae6386c85"
}, {
"reference": "urn:uuid:080f9c61-e2d5-3ae5-1826-374a73d8c493"
}, {
"reference": "urn:uuid:7ec2a827-e9da-d219-5d17-0c7081e2d4ae"
}, {
"reference": "urn:uuid:61f5a871-732e-5ffa-2954-b74a4980f04f"
}, {
"reference": "urn:uuid:6bca7dcb-21f6-b707-a459-6be7cb31e11b"
}, {
"reference": "urn:uuid:3d825904-ed09-71df-f618-790ccf53af42"
}, {
"reference": "urn:uuid:a73dcec2-aff5-eb31-af43-bbf4d04ec547"
}, {
"reference": "urn:uuid:5f4cc762-e5e6-2ef8-0f17-00e7dbd25039"
}, {
"reference": "urn:uuid:8d8fd4a5-4ce7-0845-891d-78f1d9a553e1"
}, {
"reference": "urn:uuid:410552d1-8d61-b531-2ce1-eb297be4d546"
}, {
"reference": "urn:uuid:b1c1846a-0db9-52bc-93ce-3d779eebc73c"
}, {
"reference": "urn:uuid:c0cca943-d2e0-269a-5470-a85438a89324"
}, {
"reference": "urn:uuid:0deb9114-3c2d-7240-2475-7bc0420f2b56"
}, {
"reference": "urn:uuid:9e38cc46-121c-1861-adb5-5d59396942a2"
}, {
"reference": "urn:uuid:6987fe87-9179-7d41-d6c0-9debc99b16bb"
}, {
"reference": "urn:uuid:878b2645-4c2f-20b7-d801-c0e0228bde02"
}, {
"reference": "urn:uuid:8940ff77-9645-94c7-f67d-eb8de3597fc3"
}, {
"reference": "urn:uuid:4fab8d2e-aea3-6590-fc89-0312f4f0c90e"
}, {
"reference": "urn:uuid:5d596c1b-5938-ee97-92ec-a032ab32c57d"
}, {
"reference": "urn:uuid:b9a632d1-8765-22bc-3b00-4e1651386d8d"
}, {
"reference": "urn:uuid:6879c868-cf66-1e52-c295-0d32a2b0eed3"
}, {
"reference": "urn:uuid:1616a49f-884c-bb5d-e02d-966007b866b4"
}, {
"reference": "urn:uuid:5418b0d1-c4a7-d1fe-5329-169a313165a2"
}, {
"reference": "urn:uuid:d0ba4f6e-73bc-74ed-1d57-6f66f6eab842"
}, {
"reference": "urn:uuid:5bf1fd3d-e58e-d43d-3fda-f60b94c926dc"
}, {
"reference": "urn:uuid:ceef7e92-4026-17c0-5788-b8fb9a33a595"
}, {
"reference": "urn:uuid:6271dff0-ad6e-4041-e035-7258ce93e962"
}, {
"reference": "urn:uuid:f714ad82-8a20-7dae-3276-4e24137505b2"
}, {
"reference": "urn:uuid:2e1b3e0e-0463-8652-cf38-9d976c4996b2"
}, {
"reference": "urn:uuid:677ec8b7-246d-d89a-ed41-fbf640840392"
}, {
"reference": "urn:uuid:d7208010-3146-1823-a9a5-433b8a29a356"
}, {
"reference": "urn:uuid:abe1401b-b3d7-3639-a328-55f5cab1e26c"
}, {
"reference": "urn:uuid:1312c37e-c26e-58a2-4514-dfb13bab4aa5"
}, {
"reference": "urn:uuid:d0b8d09a-e870-a238-3443-09a0b0efc5d3"
}, {
"reference": "urn:uuid:2665fce9-a277-dc3a-1408-baa01f4dfd15"
}, {
"reference": "urn:uuid:7dce3e24-ad20-664f-833b-59883f3e3f23"
}, {
"reference": "urn:uuid:f977589e-2e44-3eeb-19e6-a267d6ce162e"
}, {
"reference": "urn:uuid:c9e751ac-014d-8d81-eab2-e2851474d57f"
}, {
"reference": "urn:uuid:c6f589ab-a65a-cd83-0135-7ab202e1961d"
}, {
"reference": "urn:uuid:47f69879-da9f-144e-3248-dc525be236ca"
}, {
"reference": "urn:uuid:ba5b9d1a-0d14-2ce3-7975-f7e31e46a1b6"
}, {
"reference": "urn:uuid:15373422-0753-f927-5cab-dae3023e8f62"
}, {
"reference": "urn:uuid:1f6c8a59-f03f-57d5-02ea-f4cab9e1fed6"
}, {
"reference": "urn:uuid:a6ab080a-f048-bf79-bd30-f9067ff2d6b1"
}, {
"reference": "urn:uuid:5d194f04-5d28-5061-b5b7-c9baf2629029"
}, {
"reference": "urn:uuid:ac2a74af-7df3-e7d1-dc45-bf59cf7c8002"
}, {
"reference": "urn:uuid:32d56de6-561a-fbd2-a371-368a3e7c0aba"
}, {
"reference": "urn:uuid:c2832e74-1f2c-d42c-3fb7-863f6b38f033"
}, {
"reference": "urn:uuid:6f181e8d-5fd8-db41-5532-ace4eb00a571"
}, {
"reference": "urn:uuid:90cbd992-9396-3f87-fbd5-2eb3febc65b9"
}, {
"reference": "urn:uuid:d7a1ed4f-d79e-4e72-3089-45eaec36ef83"
}, {
"reference": "urn:uuid:fbda66bd-7b5e-ae6d-0050-292877c32927"
}, {
"reference": "urn:uuid:27e3df1f-8619-d2d9-b506-03a65e21f83e"
}, {
"reference": "urn:uuid:5cec2851-d118-68be-edc5-3b7919168989"
}, {
"reference": "urn:uuid:dea25eb4-eeda-3a17-cfa8-bb3bb7737457"
}, {
"reference": "urn:uuid:3353ce82-c876-dc0c-ede4-5d977897c5ae"
}, {
"reference": "urn:uuid:c6dacfc8-a2d6-6b6e-18e1-aafbc61b3542"
}, {
"reference": "urn:uuid:82aa4225-4f9a-215b-3d1c-fbcc5249894a"
}, {
"reference": "urn:uuid:7623df23-0439-d3c0-8e14-c23de358a9e4"
}, {
"reference": "urn:uuid:01efcaa8-8576-689c-6e76-89ec046aa68f"
}, {
"reference": "urn:uuid:c4319bab-81a2-f6fd-167f-ea45146426ba"
}, {
"reference": "urn:uuid:a6dcdcf9-5152-5cfa-6f83-a9a17def3987"
}, {
"reference": "urn:uuid:9fe878ac-6ade-1286-eafc-7350e0072202"
}, {
"reference": "urn:uuid:75b03d9b-34ed-1e6b-4493-279a35a571df"
}, {
"reference": "urn:uuid:eb7b1a11-73f9-0be6-9320-01c01c350119"
}, {
"reference": "urn:uuid:db2ae796-3250-3f93-97dc-bdb294d1950b"
}, {
"reference": "urn:uuid:27fcf5d9-e996-eacd-d5e7-ec21804ce6c5"
}, {
"reference": "urn:uuid:32e7df1e-e7fd-5e16-3957-982ecdad2d10"
}, {
"reference": "urn:uuid:3e1143cf-a9d3-4d8a-cc69-c9b032421fc6"
}, {
"reference": "urn:uuid:f2d2f15d-b88f-0b9c-45ac-b78c0e3358ff"
}, {
"reference": "urn:uuid:bb085731-0577-7cf4-aa19-414e1d301aae"
}, {
"reference": "urn:uuid:67b66b04-bb00-3857-fb7f-0b24004b2a90"
}, {
"reference": "urn:uuid:8a21c97b-7f70-1a7b-df61-b0e3b947f954"
}, {
"reference": "urn:uuid:8bce3904-0b9b-1612-5546-9fef688563c9"
}, {
"reference": "urn:uuid:03e1447c-c58e-8682-fe74-6902f5daa56a"
}, {
"reference": "urn:uuid:51adb804-f68b-d7f5-ba2d-9261b44b19ab"
}, {
"reference": "urn:uuid:804b35f9-598f-81ca-1fb2-6fda47df3dcb"
}, {
"reference": "urn:uuid:64fd1989-4a96-971d-9679-934ab9d33d8d"
}, {
"reference": "urn:uuid:cd82240e-d585-88eb-eed7-9cd4ab970727"
}, {
"reference": "urn:uuid:aae92b9e-cd64-02d6-c34a-1cd4852d1004"
}, {
"reference": "urn:uuid:95dd0c5c-2d9a-6e5b-ba3b-41702b567472"
}, {
"reference": "urn:uuid:e3faf559-55ce-6538-2125-b35381a785b4"
}, {
"reference": "urn:uuid:dd50ab35-f07a-5b39-c97c-f592c9493d3a"
}, {
"reference": "urn:uuid:a663b3d6-3568-18d4-35f1-2b24ee6d2895"
}, {
"reference": "urn:uuid:16f02b34-f5c2-1af8-a7c9-3e5c3dc03bc3"
}, {
"reference": "urn:uuid:0c342c84-cea9-0b33-fd3a-890b97424572"
}, {
"reference": "urn:uuid:7676da4c-f18e-0642-a8a1-e5591b9196db"
}, {
"reference": "urn:uuid:79ec5024-4865-453c-b30e-7672e33130d0"
}, {
"reference": "urn:uuid:e1ce3636-88fd-a123-f612-c84e1a7ff548"
}, {
"reference": "urn:uuid:3b43be01-ad24-fa78-61c7-e99b27b16cce"
}, {
"reference": "urn:uuid:d36c1495-257f-0074-2317-ca3311049b73"
}, {
"reference": "urn:uuid:449998b7-ceb2-299e-8854-02385c81f3a4"
}, {
"reference": "urn:uuid:a23d7434-784b-c0e6-fa0b-1a26ae87c398"
}, {
"reference": "urn:uuid:e964be6d-305a-fef4-a20d-ac31165403f4"
}, {
"reference": "urn:uuid:a0e89cf0-4c2f-7a77-9127-38193d2beec6"
}, {
"reference": "urn:uuid:6333f402-9c5b-8a40-37c9-608fbd7ea74c"
}, {
"reference": "urn:uuid:e6ceda29-56c5-b333-3f00-01de167e3e4b"
}, {
"reference": "urn:uuid:46b7ec3b-eaee-d6f9-285c-22d87de6561b"
}, {
"reference": "urn:uuid:ba700f4f-bd8e-e07c-af9b-fa50cb996357"
}, {
"reference": "urn:uuid:c28975f7-683e-3e25-caf1-f0b61160092b"
}, {
"reference": "urn:uuid:36397b9a-0835-2a2f-db10-cfec043e3dea"
}, {
"reference": "urn:uuid:5c5004c8-7d43-5742-d3bf-cb3d9774f895"
}, {
"reference": "urn:uuid:4cc358d6-fb14-292c-61fc-c14c7f4f23c4"
}, {
"reference": "urn:uuid:f3187326-ea3b-561d-6a9c-22a01c4eb0e8"
}, {
"reference": "urn:uuid:d9eed616-6ae4-355c-2598-882cc7176bc8"
}, {
"reference": "urn:uuid:db6eff80-423c-ee4f-c0d6-99eabd840b87"
}, {
"reference": "urn:uuid:8d575b31-3bd1-67cb-3c2b-be715203d123"
}, {
"reference": "urn:uuid:8bbebeaf-82e9-7c16-de2a-cce2ef9b5e86"
}, {
"reference": "urn:uuid:4d170a34-d59b-94ce-37a4-b44d2bd322a6"
}, {
"reference": "urn:uuid:4776d28d-38fd-fed6-b904-0aae0bf3b515"
}, {
"reference": "urn:uuid:40eb9f2f-5269-26d7-4162-b48186185132"
}, {
"reference": "urn:uuid:def0cc44-ee13-d89c-aa81-a558155bd6bd"
}, {
"reference": "urn:uuid:0a404363-53cc-d6bc-4a31-49bfda956ff6"
}, {
"reference": "urn:uuid:7b9b00bf-220a-bb1c-653c-d1beaaee1b04"
}, {
"reference": "urn:uuid:24d15bc0-f180-fe5a-46f7-aa5bf9214d33"
}, {
"reference": "urn:uuid:5523a829-0c06-5ef0-cfa7-d71de6967c90"
}, {
"reference": "urn:uuid:eb61ae07-3b6e-c89f-0bd5-80529425472e"
}, {
"reference": "urn:uuid:bf9b5501-d089-9126-160b-edaa7a13933f"
}, {
"reference": "urn:uuid:0a342922-c5ea-9ffd-d29d-5bbe15f67c5b"
}, {
"reference": "urn:uuid:bd30028e-5d78-9c3f-b443-4a63a9aa0728"
}, {
"reference": "urn:uuid:8c8d84f5-f0c8-ad2b-2f83-69dad49d4a76"
}, {
"reference": "urn:uuid:79ea5407-486e-460f-d0a2-80cbe389bd26"
}, {
"reference": "urn:uuid:77199b35-bcb1-2303-9d1e-fbc1df045cd9"
}, {
"reference": "urn:uuid:72b972be-e1f6-6bc6-7bf0-803932839265"
}, {
"reference": "urn:uuid:2d4804d1-18f1-93c0-8b1c-77a1d992019a"
}, {
"reference": "urn:uuid:866f042a-0f14-980e-2925-d2073d1e3c1f"
}, {
"reference": "urn:uuid:3daeda38-4676-53fd-d945-e35ed43ae947"
}, {
"reference": "urn:uuid:dcf4be9b-1db5-033c-a998-6707bb74e68a"
}, {
"reference": "urn:uuid:3911b925-8c3f-a312-d5af-f8f41fe04ed8"
}, {
"reference": "urn:uuid:003471f2-97f2-5b5d-9e81-82a0ecb1872f"
}, {
"reference": "urn:uuid:ee8d02cc-2bae-c628-1d63-1201684acf28"
}, {
"reference": "urn:uuid:0c00a958-a0fb-cfb4-13a6-f16ab71a95a3"
}, {
"reference": "urn:uuid:df753891-1a2d-16b7-b4e6-93223a0cfaf9"
}, {
"reference": "urn:uuid:053bcb34-2144-9c89-e90e-52d1cdc0bbb8"
}, {
"reference": "urn:uuid:1c434583-592f-73da-e1e0-2777c5d83da6"
}, {
"reference": "urn:uuid:684409e4-8c57-c36a-6664-d575656aeab2"
}, {
"reference": "urn:uuid:e268c5dd-7cba-f1eb-7ba3-05ce831778b4"
}, {
"reference": "urn:uuid:24ee7020-e2eb-6f77-855d-bf26cd89519e"
}, {
"reference": "urn:uuid:b1f48fe6-ecd8-9bbf-103d-197a93a97102"
}, {
"reference": "urn:uuid:20729876-69e4-6cb9-4fa7-6c2d9d268c09"
}, {
"reference": "urn:uuid:fbff5e6b-97b9-a2c8-7305-fee8f93f9587"
}, {
"reference": "urn:uuid:9767382e-8701-c44c-0d06-54800cdb6f4d"
}, {
"reference": "urn:uuid:2ac27c13-1068-a347-7586-6023e6b9d546"
}, {
"reference": "urn:uuid:9d33681e-c809-65af-9605-3c2b85f0239d"
}, {
"reference": "urn:uuid:e87a2047-5301-0af4-1cbf-e6bc279cbb60"
}, {
"reference": "urn:uuid:e3e891a1-246f-583f-21ba-f575d34c8a20"
}, {
"reference": "urn:uuid:59a8b87d-1dea-a0ee-a33e-5fef50c35783"
}, {
"reference": "urn:uuid:5a51109b-0ed2-ea55-cce6-7236a4e831d2"
}, {
"reference": "urn:uuid:90b0c885-99f9-574e-8a6f-68f91b79db29"
}, {
"reference": "urn:uuid:d57f7cad-55d4-0e5b-ee46-277bfd054ac7"
}, {
"reference": "urn:uuid:028da976-c374-f779-17df-1d19c326732b"
}, {
"reference": "urn:uuid:a1a10bde-9f6a-a10f-c577-36aa415621c2"
}, {
"reference": "urn:uuid:3cc2592e-d511-4c90-9431-e69db486e704"
}, {
"reference": "urn:uuid:c5265a4a-cd5a-6be1-eec5-1654a0a2dfb6"
}, {
"reference": "urn:uuid:05ffc406-4e86-06be-49ab-0aac5b324809"
}, {
"reference": "urn:uuid:ae58cc86-5cc3-b819-1bfb-2914194fd9eb"
}, {
"reference": "urn:uuid:605393dc-c29a-4a1f-729e-a68759edfe1a"
}, {
"reference": "urn:uuid:77e94359-0393-b48d-1163-7f9d3c70efcc"
}, {
"reference": "urn:uuid:1f2459e2-589c-b9e7-8a14-c79ee37523b6"
}, {
"reference": "urn:uuid:03b3250a-aead-fdbf-f1ff-a63774654ad8"
}, {
"reference": "urn:uuid:f865b71a-b937-cda9-05b3-658a0fdf9ea4"
}, {
"reference": "urn:uuid:f37f6348-3d73-cb38-f8d7-08a5d6577736"
}, {
"reference": "urn:uuid:5d5e295d-0a78-bee4-7fc3-125cce9230ff"
}, {
"reference": "urn:uuid:5370d044-e838-7bbf-1f01-a9580f8079e0"
}, {
"reference": "urn:uuid:306fabfc-b2a4-c4dd-12ec-52f8d1b0c4f8"
}, {
"reference": "urn:uuid:c2e590fb-4aec-2743-5e64-9abf640e4d92"
}, {
"reference": "urn:uuid:970a9c48-4805-f742-cefd-469ab856ad3f"
}, {
"reference": "urn:uuid:a903dcf9-713f-8ae6-d8bc-4a683a51e16d"
}, {
"reference": "urn:uuid:57e2f3fd-5138-0d79-af8e-445a736aa159"
}, {
"reference": "urn:uuid:51dbf4fb-42a2-6c08-1bfd-13014580efbc"
}, {
"reference": "urn:uuid:c2536051-7cd2-da52-5a1f-230618c26554"
}, {
"reference": "urn:uuid:2238d57f-1831-7218-bb48-9fa5122546d2"
}, {
"reference": "urn:uuid:efcf936f-81f5-a168-0bbb-0610d653d3bb"
}, {
"reference": "urn:uuid:1e0c0e6e-b26e-83dc-4902-881362d0d67d"
}, {
"reference": "urn:uuid:d811130d-ef3e-c3c4-7a67-99b0d11b7900"
}, {
"reference": "urn:uuid:fdcc04d0-f396-0646-1138-eeb4c4194c9f"
}, {
"reference": "urn:uuid:5b3b430e-344a-f047-26a2-a5e58888a5ed"
}, {
"reference": "urn:uuid:431d7e64-8120-824a-8afc-75ccad0f80c7"
}, {
"reference": "urn:uuid:a682f249-4a0e-5bd5-30b5-6aea15b18b99"
}, {
"reference": "urn:uuid:a0529fbf-1097-6f7e-6439-b21b0e0f360d"
}, {
"reference": "urn:uuid:7060bb0e-a115-6ead-6411-39d243287cd5"
}, {
"reference": "urn:uuid:335f9d34-e91a-bbc9-4a2e-244145a26f6f"
}, {
"reference": "urn:uuid:5a10c65c-cd84-753e-9e06-14c9503e8028"
}, {
"reference": "urn:uuid:4b792f0c-365a-bb7f-9467-fdbfa6f26b3a"
}, {
"reference": "urn:uuid:c45c2ca4-29f0-2fdf-660c-6bcc171b30ed"
}, {
"reference": "urn:uuid:4009facb-7fbd-f312-4d9b-2d3fff9fffcb"
}, {
"reference": "urn:uuid:a55f4ed6-820e-eab5-b5c5-17430ba28eb4"
}, {
"reference": "urn:uuid:53cf233e-7e1f-58cb-f5bf-23ef0281bbac"
}, {
"reference": "urn:uuid:0410443f-bb5e-ac5a-52ab-fefe3a17ce80"
}, {
"reference": "urn:uuid:b3036739-45eb-3752-216f-18e716d4b5b4"
}, {
"reference": "urn:uuid:edcaa4da-2ead-9ed2-f2f5-18e664165402"
}, {
"reference": "urn:uuid:1f92dbda-0d40-2b18-019f-94e79e729f98"
}, {
"reference": "urn:uuid:076910b2-5d9b-a497-9b0d-0fc2c3641120"
}, {
"reference": "urn:uuid:312451f8-388b-3f5c-8286-2af5344c8d74"
}, {
"reference": "urn:uuid:3e64834a-3530-a46c-8d00-5d93a769c692"
}, {
"reference": "urn:uuid:c57d1234-91d0-d9a0-2eb5-cd51c3a6bed4"
}, {
"reference": "urn:uuid:9a26a8b1-0a90-6b5e-2529-75ee64a29709"
}, {
"reference": "urn:uuid:cca76f0a-c208-8891-faea-c3575f288114"
}, {
"reference": "urn:uuid:1c320014-7051-f37d-1bf6-19868b745866"
}, {
"reference": "urn:uuid:c4657b58-e73a-0ee1-b59c-37a27eec7213"
}, {
"reference": "urn:uuid:21675f09-557f-6276-26d9-9355f2b7200c"
}, {
"reference": "urn:uuid:fe2166df-26f8-1a0a-61de-01d27976fb66"
}, {
"reference": "urn:uuid:36cd9114-2b07-53e5-d7f2-e606835bd592"
}, {
"reference": "urn:uuid:cad19709-ce3d-cbc8-2e93-f231fc0e8095"
}, {
"reference": "urn:uuid:f3fcbfc2-1d36-bd33-0724-0db8fe75c9c1"
}, {
"reference": "urn:uuid:a84150d1-d0d3-8bac-a805-6a43ebf5f095"
}, {
"reference": "urn:uuid:f6786ea1-7614-082f-099f-b69f96df9905"
}, {
"reference": "urn:uuid:8d54e1b7-ff8a-47ab-8abc-a7fc421039d2"
}, {
"reference": "urn:uuid:d5d6ee4f-f69d-95e5-ce3b-76e9310d4cef"
}, {
"reference": "urn:uuid:5e969ab6-9dfb-d670-3d87-17050f0a915e"
}, {
"reference": "urn:uuid:ebb09079-b7a8-b48e-4dc2-31c7cbc56218"
}, {
"reference": "urn:uuid:d6c58720-56f4-db3c-33ac-8536db3e9a73"
}, {
"reference": "urn:uuid:d48a3482-80f0-d891-8ef3-668170291d0f"
}, {
"reference": "urn:uuid:925a15e6-dec8-0b11-e89d-e483c67ef02c"
}, {
"reference": "urn:uuid:ec667303-10ae-d7a3-2bab-099ca8c40098"
}, {
"reference": "urn:uuid:35df3781-0643-1af8-b57b-6f61e7a6647b"
}, {
"reference": "urn:uuid:18ad046a-9880-fd25-d9eb-5992d4c3be38"
}, {
"reference": "urn:uuid:3d09137f-80c9-ea5a-48eb-f97be429c94d"
}, {
"reference": "urn:uuid:16d1a081-9bce-70e5-2fc5-dbb4a0440eb0"
}, {
"reference": "urn:uuid:6ce6a5ac-2935-563b-5938-fc1ca22ff71e"
}, {
"reference": "urn:uuid:7d2c2563-d532-225c-f1be-eb0ea2a99cb2"
}, {
"reference": "urn:uuid:70cdc5d6-4f3b-6e93-3234-9b6999d198ec"
}, {
"reference": "urn:uuid:90b55ae8-18fd-b0c1-1500-838f67076805"
}, {
"reference": "urn:uuid:1824df8c-d02d-ff46-70fb-0d7d6bb6bced"
}, {
"reference": "urn:uuid:b1f26b84-da02-70b4-5484-24f10d87e813"
}, {
"reference": "urn:uuid:b96009fb-66fd-60d2-232f-fb98fee52319"
}, {
"reference": "urn:uuid:92abf271-83bd-589c-8bcc-1ab1e124c1e9"
}, {
"reference": "urn:uuid:1ff55901-8bee-293d-05de-deaca3af05fa"
}, {
"reference": "urn:uuid:2e7623df-bfc6-0a38-3ece-54af2d112aa1"
}, {
"reference": "urn:uuid:34b1730b-532d-49b8-8a8e-92f871ca0351"
}, {
"reference": "urn:uuid:fc94e4fc-e54c-60e2-22fa-5c434f52abb5"
}, {
"reference": "urn:uuid:746918f2-b648-0bef-bbdf-32cf4e3749b7"
}, {
"reference": "urn:uuid:62849f6a-067c-3d60-8b87-1ba6954166b0"
}, {
"reference": "urn:uuid:b30fc1c2-b2d3-d196-1254-43eb4e82421d"
}, {
"reference": "urn:uuid:07763287-a464-614f-6ae8-9ba990020c2b"
}, {
"reference": "urn:uuid:a3413336-731b-0a19-21a5-ef62c61d9fb8"
}, {
"reference": "urn:uuid:517ecd28-0a45-35bb-cfa4-6e471ebb9f37"
}, {
"reference": "urn:uuid:a894c75d-e74d-4a5b-0c6a-89f68a7bd70b"
}, {
"reference": "urn:uuid:3f0619ee-1988-6274-2511-a7209e449a88"
}, {
"reference": "urn:uuid:f47c6fdb-a264-648a-7827-239739bfc93e"
}, {
"reference": "urn:uuid:8780c87a-da58-56af-8076-15cc4cf617ae"
}, {
"reference": "urn:uuid:7c654aa2-86ec-1f18-0c61-8c39a89e4567"
}, {
"reference": "urn:uuid:0e7fe10c-210d-ebd2-9fb2-558c031aa4df"
}, {
"reference": "urn:uuid:4a8ae07a-6101-f7e5-2e26-959164490a3e"
}, {
"reference": "urn:uuid:302f2a14-5aa9-5b8c-9762-bfa67d0e454b"
}, {
"reference": "urn:uuid:9d70acd3-0229-1a99-bf92-9f5ea266054c"
}, {
"reference": "urn:uuid:26345211-0023-7203-c533-4873f07a227d"
}, {
"reference": "urn:uuid:f589c2f9-25ad-0aa6-c1d4-3df83799c31d"
}, {
"reference": "urn:uuid:37a579c7-3e9b-3870-a479-ad5fc19def5a"
}, {
"reference": "urn:uuid:3b87f30d-3d2e-1a8a-0d17-b33be4fb15a2"
}, {
"reference": "urn:uuid:3f042a8f-c9f3-4087-5dd0-555e44ddc7d6"
}, {
"reference": "urn:uuid:74312ac4-aefe-94a1-0a1a-f479eeccdfd0"
}, {
"reference": "urn:uuid:506d2dee-45e6-fee0-d701-9d8f6ccdb6e3"
}, {
"reference": "urn:uuid:0de385cc-4d47-c4d2-e2d7-454dea061f3e"
}, {
"reference": "urn:uuid:9c2e4c50-98ba-87f9-812f-b6b89d18d7f5"
}, {
"reference": "urn:uuid:5c2a0848-59c4-9449-747e-af69692c54f5"
}, {
"reference": "urn:uuid:04f5d9cc-46a5-2abe-b537-4b0cd5e49352"
}, {
"reference": "urn:uuid:f54726da-140f-463c-7e7e-b8129a073d2e"
}, {
"reference": "urn:uuid:cab6e320-36dd-5dd5-d58d-e14a66ef8776"
}, {
"reference": "urn:uuid:c1ffa90e-8613-9133-6801-cf27aea20360"
}, {
"reference": "urn:uuid:a87b0f45-60f3-7d05-9d35-6073142b7580"
}, {
"reference": "urn:uuid:8c98197e-72f5-094f-b62f-4a8800e7d683"
}, {
"reference": "urn:uuid:c7fa2b47-1a45-f7bb-fbac-b7f6d97c1c71"
}, {
"reference": "urn:uuid:b178923a-23b5-157d-efe3-e021e7b3fa8a"
}, {
"reference": "urn:uuid:b7905aae-b967-2ac1-9cd5-cd848d069ef8"
}, {
"reference": "urn:uuid:cf14d4b7-c6b7-6550-97ae-0ef7b7bdc1d7"
}, {
"reference": "urn:uuid:9e88f1cf-ecb9-1a10-d16d-2714b68b1998"
}, {
"reference": "urn:uuid:b95f460a-ea93-2dc6-980c-61766bf30b99"
}, {
"reference": "urn:uuid:76ce5958-d37b-269d-0a75-65e2d0796f27"
}, {
"reference": "urn:uuid:ad06f3c5-d5cd-3310-8364-85a5d8efebd8"
}, {
"reference": "urn:uuid:30cfb131-a37a-099f-41a1-fbe73302fafe"
}, {
"reference": "urn:uuid:50d626cd-bf8c-56fe-39d5-eae731a77963"
}, {
"reference": "urn:uuid:0c62e6ec-38a1-fb76-e576-0e3436c2c706"
}, {
"reference": "urn:uuid:a201d92b-946c-3f0e-11bf-1b3cf2995a9d"
}, {
"reference": "urn:uuid:dd79e763-fdd3-ae21-8604-048624224a64"
} ],
"recorded": "2023-09-05T17:58:25.518+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|9999998195",
"display": "Dr. Logan497 Fisher429"
},
"onBehalfOf": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
}
}, {
"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|9999998195",
"display": "Dr. Logan497 Fisher429"
},
"onBehalfOf": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|e59fb2d5-508c-38c6-af2e-21d8216dd2b0",
"display": "BAYSTATE MEDICAL CENTER"
}
} ]
},
"request": {
"method": "POST",
"url": "Provenance"
}
} ]
}
Reference in New Issue View Git Blame Copy Permalink