MILA_public/medax_pipeline
0
0
Fork 0
Code Issues Pull Requests Actions Packages Projects Releases 1 Wiki Activity
medax_pipeline/testData/Petronila724_Rutherford999_ec8f677e-0e42-d13a-b292-ff50216121b2.json
Tom Gebhardt a9db0be88a release commit
2025-04-16 22:12:19 +02:00

73563 lines
2.4 MiB
Raw Permalink Blame History

{
"resourceType": "Bundle",
"type": "transaction",
"entry": [ {
"fullUrl": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"resource": {
"resourceType": "Patient",
"id": "ec8f677e-0e42-d13a-b292-ff50216121b2",
"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: -7750880586829590918 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": "Hedwig986 Purdy2"
}, {
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
"valueCode": "F"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
"valueAddress": {
"city": "Boston",
"state": "Massachusetts",
"country": "US"
}
}, {
"url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
"valueDecimal": 0.6345273399642718
}, {
"url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
"valueDecimal": 52.36547266003573
} ],
"identifier": [ {
"system": "https://github.com/synthetichealth/synthea",
"value": "ec8f677e-0e42-d13a-b292-ff50216121b2"
}, {
"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": "ec8f677e-0e42-d13a-b292-ff50216121b2"
}, {
"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": "999-29-5546"
}, {
"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": "S99914637"
}, {
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "PPN",
"display": "Passport Number"
} ],
"text": "Passport Number"
},
"system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
"value": "X21884630X"
} ],
"name": [ {
"use": "official",
"family": "Rutherford999",
"given": [ "Petronila724", "Kristeen693" ],
"prefix": [ "Ms." ]
} ],
"telecom": [ {
"system": "phone",
"value": "555-723-3763",
"use": "home"
} ],
"gender": "female",
"birthDate": "1969-11-27",
"address": [ {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/geolocation",
"extension": [ {
"url": "latitude",
"valueDecimal": 42.43417352303444
}, {
"url": "longitude",
"valueDecimal": -73.30041859803441
} ]
} ],
"line": [ "217 Bayer Drive Unit 35" ],
"city": "Pittsfield",
"state": "MA",
"postalCode": "01201",
"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:542f1d85-16b5-41ee-03f9-933814c47b1e",
"resource": {
"resourceType": "Encounter",
"id": "542f1d85-16b5-41ee-03f9-933814c47b1e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "542f1d85-16b5-41ee-03f9-933814c47b1e"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "1988-01-21T10:29:53+01:00",
"end": "1988-01-21T11:02:11+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "1988-01-21T10:29:53+01:00",
"end": "1988-01-21T11:02:11+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:e4163046-f4fa-093b-2bc4-3ae612dde7a6",
"resource": {
"resourceType": "Condition",
"id": "e4163046-f4fa-093b-2bc4-3ae612dde7a6",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "224295006",
"display": "Only received primary school education (finding)"
} ],
"text": "Only received primary school education (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:542f1d85-16b5-41ee-03f9-933814c47b1e"
},
"onsetDateTime": "1988-01-21T11:02:11+01:00",
"recordedDate": "1988-01-21T11:02:11+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:fcf38ece-1223-8661-7d06-6606c18de9fe",
"resource": {
"resourceType": "Condition",
"id": "fcf38ece-1223-8661-7d06-6606c18de9fe",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:542f1d85-16b5-41ee-03f9-933814c47b1e"
},
"onsetDateTime": "1988-01-21T11:02:11+01:00",
"abatementDateTime": "1995-02-02T11:05:01+01:00",
"recordedDate": "1988-01-21T11:02:11+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:ef15b4ed-b144-aad4-5b30-d9ce87ab8079",
"resource": {
"resourceType": "Condition",
"id": "ef15b4ed-b144-aad4-5b30-d9ce87ab8079",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:542f1d85-16b5-41ee-03f9-933814c47b1e"
},
"onsetDateTime": "1988-01-21T11:02:11+01:00",
"abatementDateTime": "1989-01-26T11:10:10+01:00",
"recordedDate": "1988-01-21T11:02:11+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:94a73384-2fc8-fa7a-0037-dc581a3bec00",
"resource": {
"resourceType": "DiagnosticReport",
"id": "94a73384-2fc8-fa7a-0037-dc581a3bec00",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:542f1d85-16b5-41ee-03f9-933814c47b1e"
},
"effectiveDateTime": "1988-01-21T10:29:53+01:00",
"issued": "1988-01-21T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:62c72356-127e-e055-fa53-56b297c57fa8",
"resource": {
"resourceType": "DocumentReference",
"id": "62c72356-127e-e055-fa53-56b297c57fa8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:94a73384-2fc8-fa7a-0037-dc581a3bec00"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "1988-01-21T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:542f1d85-16b5-41ee-03f9-933814c47b1e"
} ],
"period": {
"start": "1988-01-21T10:29:53+01:00",
"end": "1988-01-21T11:02:11+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:cf6498c0-cd2b-a7d8-fc16-0554c3d8a9e1",
"resource": {
"resourceType": "Claim",
"id": "cf6498c0-cd2b-a7d8-fc16-0554c3d8a9e1",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "1988-01-21T10:29:53+01:00",
"end": "1988-01-21T11:02:11+01:00"
},
"created": "1988-01-21T11:02:11+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:e4163046-f4fa-093b-2bc4-3ae612dde7a6"
}
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:fcf38ece-1223-8661-7d06-6606c18de9fe"
}
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:ef15b4ed-b144-aad4-5b30-d9ce87ab8079"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:542f1d85-16b5-41ee-03f9-933814c47b1e"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "224295006",
"display": "Only received primary school education (finding)"
} ],
"text": "Only received primary school education (finding)"
}
}, {
"sequence": 3,
"diagnosisSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
}
}, {
"sequence": 4,
"diagnosisSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
}
} ],
"total": {
"value": 1154.22,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c15aa811-6cdb-e0f2-4a83-4ea2a394eb88",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c15aa811-6cdb-e0f2-4a83-4ea2a394eb88",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "NO_INSURANCE"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "NO_INSURANCE"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "cf6498c0-cd2b-a7d8-fc16-0554c3d8a9e1"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "1988-01-21T11:02:11+01:00",
"end": "1989-01-21T11:02:11+01:00"
},
"created": "1988-01-21T11:02:11+01:00",
"insurer": {
"display": "NO_INSURANCE"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:cf6498c0-cd2b-a7d8-fc16-0554c3d8a9e1"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:e4163046-f4fa-093b-2bc4-3ae612dde7a6"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:fcf38ece-1223-8661-7d06-6606c18de9fe"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:ef15b4ed-b144-aad4-5b30-d9ce87ab8079"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "1988-01-21T10:29:53+01:00",
"end": "1988-01-21T11:02:11+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:542f1d85-16b5-41ee-03f9-933814c47b1e"
} ]
}, {
"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": "224295006",
"display": "Only received primary school education (finding)"
} ],
"text": "Only received primary school education (finding)"
},
"servicedPeriod": {
"start": "1988-01-21T10:29:53+01:00",
"end": "1988-01-21T11:02:11+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 3,
"diagnosisSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"servicedPeriod": {
"start": "1988-01-21T10:29:53+01:00",
"end": "1988-01-21T11:02:11+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 4,
"diagnosisSequence": [ 3 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"servicedPeriod": {
"start": "1988-01-21T10:29:53+01:00",
"end": "1988-01-21T11:02:11+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": 1154.22,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:6672acfc-bea6-6700-269a-a503e4efd22b",
"resource": {
"resourceType": "Encounter",
"id": "6672acfc-bea6-6700-269a-a503e4efd22b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "6672acfc-bea6-6700-269a-a503e4efd22b"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "1989-01-26T10:29:53+01:00",
"end": "1989-01-26T11:10:10+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "1989-01-26T10:29:53+01:00",
"end": "1989-01-26T11:10:10+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:23535997-219f-fe13-6709-1d63cd71f8c7",
"resource": {
"resourceType": "Condition",
"id": "23535997-219f-fe13-6709-1d63cd71f8c7",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "706893006",
"display": "Victim of intimate partner abuse (finding)"
} ],
"text": "Victim of intimate partner abuse (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:6672acfc-bea6-6700-269a-a503e4efd22b"
},
"onsetDateTime": "1989-01-26T12:18:33+01:00",
"abatementDateTime": "2021-12-09T11:06:08+01:00",
"recordedDate": "1989-01-26T12:18:33+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:d42a93cc-92ac-ecb7-a815-06be18187d60",
"resource": {
"resourceType": "DiagnosticReport",
"id": "d42a93cc-92ac-ecb7-a815-06be18187d60",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:6672acfc-bea6-6700-269a-a503e4efd22b"
},
"effectiveDateTime": "1989-01-26T10:29:53+01:00",
"issued": "1989-01-26T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ad3d7920-2bb9-57e2-09c2-bfbf7f50e416",
"resource": {
"resourceType": "DocumentReference",
"id": "ad3d7920-2bb9-57e2-09c2-bfbf7f50e416",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:d42a93cc-92ac-ecb7-a815-06be18187d60"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "1989-01-26T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:6672acfc-bea6-6700-269a-a503e4efd22b"
} ],
"period": {
"start": "1989-01-26T10:29:53+01:00",
"end": "1989-01-26T11:10:10+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:81b69655-e04a-541e-3aee-d8638ac1b933",
"resource": {
"resourceType": "Claim",
"id": "81b69655-e04a-541e-3aee-d8638ac1b933",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "1989-01-26T10:29:53+01:00",
"end": "1989-01-26T11:10:10+01:00"
},
"created": "1989-01-26T11:10:10+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:23535997-219f-fe13-6709-1d63cd71f8c7"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:6672acfc-bea6-6700-269a-a503e4efd22b"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "706893006",
"display": "Victim of intimate partner abuse (finding)"
} ],
"text": "Victim of intimate partner abuse (finding)"
}
} ],
"total": {
"value": 704.20,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:59728c07-057f-17ef-07b5-31872a060c3d",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "59728c07-057f-17ef-07b5-31872a060c3d",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "NO_INSURANCE"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "NO_INSURANCE"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "81b69655-e04a-541e-3aee-d8638ac1b933"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "1989-01-26T11:10:10+01:00",
"end": "1990-01-26T11:10:10+01:00"
},
"created": "1989-01-26T11:10:10+01:00",
"insurer": {
"display": "NO_INSURANCE"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:81b69655-e04a-541e-3aee-d8638ac1b933"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:23535997-219f-fe13-6709-1d63cd71f8c7"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "1989-01-26T10:29:53+01:00",
"end": "1989-01-26T11:10:10+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:6672acfc-bea6-6700-269a-a503e4efd22b"
} ]
}, {
"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": "706893006",
"display": "Victim of intimate partner abuse (finding)"
} ],
"text": "Victim of intimate partner abuse (finding)"
},
"servicedPeriod": {
"start": "1989-01-26T10:29:53+01:00",
"end": "1989-01-26T11:10:10+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 704.20,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:342af48a-cdc0-e22f-300b-9ee633531b02",
"resource": {
"resourceType": "Encounter",
"id": "342af48a-cdc0-e22f-300b-9ee633531b02",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "342af48a-cdc0-e22f-300b-9ee633531b02"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "1992-01-30T10:29:53+01:00",
"end": "1992-01-30T11:17:20+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "1992-01-30T10:29:53+01:00",
"end": "1992-01-30T11:17:20+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:50d48740-f857-33a2-c69e-c95f0f94019a",
"resource": {
"resourceType": "Condition",
"id": "50d48740-f857-33a2-c69e-c95f0f94019a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:342af48a-cdc0-e22f-300b-9ee633531b02"
},
"onsetDateTime": "1992-01-30T11:17:20+01:00",
"abatementDateTime": "1998-02-05T11:22:34+01:00",
"recordedDate": "1992-01-30T11:17:20+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:0a074369-09e8-0179-2484-91c73ab5738e",
"resource": {
"resourceType": "DiagnosticReport",
"id": "0a074369-09e8-0179-2484-91c73ab5738e",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:342af48a-cdc0-e22f-300b-9ee633531b02"
},
"effectiveDateTime": "1992-01-30T10:29:53+01:00",
"issued": "1992-01-30T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:9688e62c-14fe-a6b9-0219-8effff71983f",
"resource": {
"resourceType": "DocumentReference",
"id": "9688e62c-14fe-a6b9-0219-8effff71983f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:0a074369-09e8-0179-2484-91c73ab5738e"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "1992-01-30T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:342af48a-cdc0-e22f-300b-9ee633531b02"
} ],
"period": {
"start": "1992-01-30T10:29:53+01:00",
"end": "1992-01-30T11:17:20+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:b83a8b20-834e-6fd4-297a-94b72f1b32e2",
"resource": {
"resourceType": "Claim",
"id": "b83a8b20-834e-6fd4-297a-94b72f1b32e2",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "1992-01-30T10:29:53+01:00",
"end": "1992-01-30T11:17:20+01:00"
},
"created": "1992-01-30T11:17:20+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:50d48740-f857-33a2-c69e-c95f0f94019a"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:342af48a-cdc0-e22f-300b-9ee633531b02"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
}
} ],
"total": {
"value": 1050.78,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:42d1b265-6d05-7c91-a51e-9d76a3be8728",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "42d1b265-6d05-7c91-a51e-9d76a3be8728",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "NO_INSURANCE"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "NO_INSURANCE"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "b83a8b20-834e-6fd4-297a-94b72f1b32e2"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "1992-01-30T11:17:20+01:00",
"end": "1993-01-30T11:17:20+01:00"
},
"created": "1992-01-30T11:17:20+01:00",
"insurer": {
"display": "NO_INSURANCE"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:b83a8b20-834e-6fd4-297a-94b72f1b32e2"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:50d48740-f857-33a2-c69e-c95f0f94019a"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "1992-01-30T10:29:53+01:00",
"end": "1992-01-30T11:17:20+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:342af48a-cdc0-e22f-300b-9ee633531b02"
} ]
}, {
"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": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"servicedPeriod": {
"start": "1992-01-30T10:29:53+01:00",
"end": "1992-01-30T11:17:20+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": 1050.78,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:3ec42747-ec75-893d-4ffe-92466cb44749",
"resource": {
"resourceType": "Encounter",
"id": "3ec42747-ec75-893d-4ffe-92466cb44749",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "3ec42747-ec75-893d-4ffe-92466cb44749"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "1998-02-05T10:29:53+01:00",
"end": "1998-02-05T11:22:34+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "1998-02-05T10:29:53+01:00",
"end": "1998-02-05T11:22:34+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:2a0a3a8d-2b8d-d155-8b00-5c1b229fcef9",
"resource": {
"resourceType": "Condition",
"id": "2a0a3a8d-2b8d-d155-8b00-5c1b229fcef9",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:3ec42747-ec75-893d-4ffe-92466cb44749"
},
"onsetDateTime": "1998-02-05T11:22:34+01:00",
"abatementDateTime": "2001-02-08T11:24:46+01:00",
"recordedDate": "1998-02-05T11:22:34+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:3ae19bed-afa2-011f-6516-968a6c039c03",
"resource": {
"resourceType": "DiagnosticReport",
"id": "3ae19bed-afa2-011f-6516-968a6c039c03",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:3ec42747-ec75-893d-4ffe-92466cb44749"
},
"effectiveDateTime": "1998-02-05T10:29:53+01:00",
"issued": "1998-02-05T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:e665c00f-b095-3439-f33c-e161586a1a1c",
"resource": {
"resourceType": "DocumentReference",
"id": "e665c00f-b095-3439-f33c-e161586a1a1c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:3ae19bed-afa2-011f-6516-968a6c039c03"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "1998-02-05T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:3ec42747-ec75-893d-4ffe-92466cb44749"
} ],
"period": {
"start": "1998-02-05T10:29:53+01:00",
"end": "1998-02-05T11:22:34+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:46ec95d0-6240-1052-a0b9-021cc90edc5b",
"resource": {
"resourceType": "Claim",
"id": "46ec95d0-6240-1052-a0b9-021cc90edc5b",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "1998-02-05T10:29:53+01:00",
"end": "1998-02-05T11:22:34+01:00"
},
"created": "1998-02-05T11:22:34+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:2a0a3a8d-2b8d-d155-8b00-5c1b229fcef9"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:3ec42747-ec75-893d-4ffe-92466cb44749"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
}
} ],
"total": {
"value": 1039.00,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:ca0f3f46-fcca-4bd6-5781-547b484f5ef9",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "ca0f3f46-fcca-4bd6-5781-547b484f5ef9",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "NO_INSURANCE"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "NO_INSURANCE"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "46ec95d0-6240-1052-a0b9-021cc90edc5b"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "1998-02-05T11:22:34+01:00",
"end": "1999-02-05T11:22:34+01:00"
},
"created": "1998-02-05T11:22:34+01:00",
"insurer": {
"display": "NO_INSURANCE"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:46ec95d0-6240-1052-a0b9-021cc90edc5b"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:2a0a3a8d-2b8d-d155-8b00-5c1b229fcef9"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "1998-02-05T10:29:53+01:00",
"end": "1998-02-05T11:22:34+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:3ec42747-ec75-893d-4ffe-92466cb44749"
} ]
}, {
"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": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"servicedPeriod": {
"start": "1998-02-05T10:29:53+01:00",
"end": "1998-02-05T11:22:34+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": 1039.00,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:d21cb741-2eba-67fb-b17e-2374740e9a84",
"resource": {
"resourceType": "Encounter",
"id": "d21cb741-2eba-67fb-b17e-2374740e9a84",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "d21cb741-2eba-67fb-b17e-2374740e9a84"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2004-02-12T10:29:53+01:00",
"end": "2004-02-12T11:07:00+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "2004-02-12T10:29:53+01:00",
"end": "2004-02-12T11:07:00+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:c578a377-574d-fe04-5bf4-524d8e696909",
"resource": {
"resourceType": "Condition",
"id": "c578a377-574d-fe04-5bf4-524d8e696909",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:d21cb741-2eba-67fb-b17e-2374740e9a84"
},
"onsetDateTime": "2004-02-12T11:07:00+01:00",
"abatementDateTime": "2007-02-15T11:22:48+01:00",
"recordedDate": "2004-02-12T11:07:00+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:6b291db6-d596-b44c-7662-758cd21f6e7b",
"resource": {
"resourceType": "Condition",
"id": "6b291db6-d596-b44c-7662-758cd21f6e7b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:d21cb741-2eba-67fb-b17e-2374740e9a84"
},
"onsetDateTime": "2004-02-12T11:07:00+01:00",
"abatementDateTime": "2013-12-19T11:01:14+01:00",
"recordedDate": "2004-02-12T11:07:00+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:6d142d35-feca-9e7e-15e8-17a8f0500a0f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "6d142d35-feca-9e7e-15e8-17a8f0500a0f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:d21cb741-2eba-67fb-b17e-2374740e9a84"
},
"effectiveDateTime": "2004-02-12T10:29:53+01:00",
"issued": "2004-02-12T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:a38f0c43-e040-cae9-d6eb-918a7f946275",
"resource": {
"resourceType": "DocumentReference",
"id": "a38f0c43-e040-cae9-d6eb-918a7f946275",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:6d142d35-feca-9e7e-15e8-17a8f0500a0f"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2004-02-12T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:d21cb741-2eba-67fb-b17e-2374740e9a84"
} ],
"period": {
"start": "2004-02-12T10:29:53+01:00",
"end": "2004-02-12T11:07:00+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:bd76649c-5384-be8e-b9cc-4df5fa2443bc",
"resource": {
"resourceType": "Claim",
"id": "bd76649c-5384-be8e-b9cc-4df5fa2443bc",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2004-02-12T10:29:53+01:00",
"end": "2004-02-12T11:07:00+01:00"
},
"created": "2004-02-12T11:07:00+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:c578a377-574d-fe04-5bf4-524d8e696909"
}
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:6b291db6-d596-b44c-7662-758cd21f6e7b"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:d21cb741-2eba-67fb-b17e-2374740e9a84"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
}
}, {
"sequence": 3,
"diagnosisSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
}
} ],
"total": {
"value": 853.36,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:0ea5b47a-aac9-9ea9-b874-47fd2bdd0a39",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "0ea5b47a-aac9-9ea9-b874-47fd2bdd0a39",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "NO_INSURANCE"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "NO_INSURANCE"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "bd76649c-5384-be8e-b9cc-4df5fa2443bc"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2004-02-12T11:07:00+01:00",
"end": "2005-02-12T11:07:00+01:00"
},
"created": "2004-02-12T11:07:00+01:00",
"insurer": {
"display": "NO_INSURANCE"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:bd76649c-5384-be8e-b9cc-4df5fa2443bc"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:c578a377-574d-fe04-5bf4-524d8e696909"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:6b291db6-d596-b44c-7662-758cd21f6e7b"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2004-02-12T10:29:53+01:00",
"end": "2004-02-12T11:07:00+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:d21cb741-2eba-67fb-b17e-2374740e9a84"
} ]
}, {
"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": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"servicedPeriod": {
"start": "2004-02-12T10:29:53+01:00",
"end": "2004-02-12T11:07:00+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 3,
"diagnosisSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"servicedPeriod": {
"start": "2004-02-12T10:29:53+01:00",
"end": "2004-02-12T11:07:00+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": 853.36,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:e170bf6b-6454-c66e-81c4-faa669e7f2cd",
"resource": {
"resourceType": "Encounter",
"id": "e170bf6b-6454-c66e-81c4-faa669e7f2cd",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "e170bf6b-6454-c66e-81c4-faa669e7f2cd"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "IMP"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "305408004",
"display": "Admission to surgical department"
} ],
"text": "Admission to surgical department"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2005-05-08T12:44:14+02:00",
"end": "2005-05-09T12:44:14+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993691",
"display": "Dr. Dorcas534 Quigley282"
}
} ],
"period": {
"start": "2005-05-08T12:44:14+02:00",
"end": "2005-05-09T12:44:14+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "183996000",
"display": "Sterilization requested (situation)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|1643c041-95c7-3639-932b-2e8ea85c7d82",
"display": "BERKSHIRE MEDICAL CENTER INC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|f43f97f2-af04-3ed0-a42e-3681718cc9b2",
"display": "BERKSHIRE MEDICAL CENTER INC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:bbdc312f-4f95-abcf-f0d1-7f9a2675580e",
"resource": {
"resourceType": "Condition",
"id": "bbdc312f-4f95-abcf-f0d1-7f9a2675580e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "267020005",
"display": "History of tubal ligation (situation)"
} ],
"text": "History of tubal ligation (situation)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e170bf6b-6454-c66e-81c4-faa669e7f2cd"
},
"onsetDateTime": "2005-05-08T15:20:14+02:00",
"recordedDate": "2005-05-08T15:20:14+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:9b7eaeb6-03a9-4351-961b-6b179e8d6d86",
"resource": {
"resourceType": "DiagnosticReport",
"id": "9b7eaeb6-03a9-4351-961b-6b179e8d6d86",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e170bf6b-6454-c66e-81c4-faa669e7f2cd"
},
"effectiveDateTime": "2005-05-08T12:44:14+02:00",
"issued": "2005-05-08T12:44:14.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993691",
"display": "Dr. Dorcas534 Quigley282"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:7fc3f091-bc32-864f-a115-9866a2159326",
"resource": {
"resourceType": "DocumentReference",
"id": "7fc3f091-bc32-864f-a115-9866a2159326",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:9b7eaeb6-03a9-4351-961b-6b179e8d6d86"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2005-05-08T12:44:14.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993691",
"display": "Dr. Dorcas534 Quigley282"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|f43f97f2-af04-3ed0-a42e-3681718cc9b2",
"display": "BERKSHIRE MEDICAL CENTER INC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:e170bf6b-6454-c66e-81c4-faa669e7f2cd"
} ],
"period": {
"start": "2005-05-08T12:44:14+02:00",
"end": "2005-05-09T12:44:14+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:bae55e60-89ed-1ee3-a2d7-a6e3c933192c",
"resource": {
"resourceType": "Claim",
"id": "bae55e60-89ed-1ee3-a2d7-a6e3c933192c",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2005-05-08T12:44:14+02:00",
"end": "2005-05-09T12:44:14+02:00"
},
"created": "2005-05-09T12:44:14+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|f43f97f2-af04-3ed0-a42e-3681718cc9b2",
"display": "BERKSHIRE MEDICAL CENTER INC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|1643c041-95c7-3639-932b-2e8ea85c7d82",
"display": "BERKSHIRE MEDICAL CENTER INC"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:bbdc312f-4f95-abcf-f0d1-7f9a2675580e"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "305408004",
"display": "Admission to surgical department"
} ],
"text": "Admission to surgical department"
},
"encounter": [ {
"reference": "urn:uuid:e170bf6b-6454-c66e-81c4-faa669e7f2cd"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "267020005",
"display": "History of tubal ligation (situation)"
} ],
"text": "History of tubal ligation (situation)"
}
} ],
"total": {
"value": 8716.30,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:0f0901fe-69e7-f2d3-49fd-cd53457564e8",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "0f0901fe-69e7-f2d3-49fd-cd53457564e8",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993691"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993691"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "NO_INSURANCE"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "NO_INSURANCE"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "bae55e60-89ed-1ee3-a2d7-a6e3c933192c"
}, {
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value": "99999999999"
} ],
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2005-05-09T12:44:14+02:00",
"end": "2006-05-09T12:44:14+02:00"
},
"created": "2005-05-09T12:44:14+02:00",
"insurer": {
"display": "NO_INSURANCE"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993691"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|1643c041-95c7-3639-932b-2e8ea85c7d82",
"display": "BERKSHIRE MEDICAL CENTER INC"
},
"claim": {
"reference": "urn:uuid:bae55e60-89ed-1ee3-a2d7-a6e3c933192c"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993691"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:bbdc312f-4f95-abcf-f0d1-7f9a2675580e"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "NO_INSURANCE"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "305408004",
"display": "Admission to surgical department"
} ],
"text": "Admission to surgical department"
},
"servicedPeriod": {
"start": "2005-05-08T12:44:14+02:00",
"end": "2005-05-09T12:44:14+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:e170bf6b-6454-c66e-81c4-faa669e7f2cd"
} ]
}, {
"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": "267020005",
"display": "History of tubal ligation (situation)"
} ],
"text": "History of tubal ligation (situation)"
},
"servicedPeriod": {
"start": "2005-05-08T12:44:14+02:00",
"end": "2005-05-09T12:44:14+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": 8716.30,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:15372171-ed67-5fec-d21c-860c6a8c7d21",
"resource": {
"resourceType": "Encounter",
"id": "15372171-ed67-5fec-d21c-860c6a8c7d21",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "15372171-ed67-5fec-d21c-860c6a8c7d21"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2009-12-10T10:29:53+01:00",
"end": "2009-12-10T11:24:47+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "2009-12-10T10:29:53+01:00",
"end": "2009-12-10T11:24:47+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:4e3eb0c5-d8c9-0b33-fe38-46e5742909e8",
"resource": {
"resourceType": "Condition",
"id": "4e3eb0c5-d8c9-0b33-fe38-46e5742909e8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:15372171-ed67-5fec-d21c-860c6a8c7d21"
},
"onsetDateTime": "2009-12-10T11:24:47+01:00",
"abatementDateTime": "2015-12-24T11:29:15+01:00",
"recordedDate": "2009-12-10T11:24:47+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:c976e5ce-11dd-c67c-ff3f-3a3807173f3f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "c976e5ce-11dd-c67c-ff3f-3a3807173f3f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:15372171-ed67-5fec-d21c-860c6a8c7d21"
},
"effectiveDateTime": "2009-12-10T10:29:53+01:00",
"issued": "2009-12-10T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:7bad8fae-ab7f-0ffa-4773-a55cee225fa4",
"resource": {
"resourceType": "DocumentReference",
"id": "7bad8fae-ab7f-0ffa-4773-a55cee225fa4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:c976e5ce-11dd-c67c-ff3f-3a3807173f3f"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2009-12-10T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:15372171-ed67-5fec-d21c-860c6a8c7d21"
} ],
"period": {
"start": "2009-12-10T10:29:53+01:00",
"end": "2009-12-10T11:24:47+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:8c2e6962-f589-c7fe-401a-d936837cf2e8",
"resource": {
"resourceType": "Claim",
"id": "8c2e6962-f589-c7fe-401a-d936837cf2e8",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2009-12-10T10:29:53+01:00",
"end": "2009-12-10T11:24:47+01:00"
},
"created": "2009-12-10T11:24:47+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:4e3eb0c5-d8c9-0b33-fe38-46e5742909e8"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:15372171-ed67-5fec-d21c-860c6a8c7d21"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
}
} ],
"total": {
"value": 1303.86,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:f9e0ad85-c395-41ad-5278-7dcade796c2c",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "f9e0ad85-c395-41ad-5278-7dcade796c2c",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "8c2e6962-f589-c7fe-401a-d936837cf2e8"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2009-12-10T11:24:47+01:00",
"end": "2010-12-10T11:24:47+01:00"
},
"created": "2009-12-10T11:24:47+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:8c2e6962-f589-c7fe-401a-d936837cf2e8"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:4e3eb0c5-d8c9-0b33-fe38-46e5742909e8"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2009-12-10T10:29:53+01:00",
"end": "2009-12-10T11:24:47+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:15372171-ed67-5fec-d21c-860c6a8c7d21"
} ]
}, {
"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": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"servicedPeriod": {
"start": "2009-12-10T10:29:53+01:00",
"end": "2009-12-10T11:24:47+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": 1303.86,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c",
"resource": {
"resourceType": "Encounter",
"id": "65d3e421-112b-6657-9a1c-ab12aafb721c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "65d3e421-112b-6657-9a1c-ab12aafb721c"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2011-12-15T10:29:53+01:00",
"end": "2011-12-15T11:20:27+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "2011-12-15T10:29:53+01:00",
"end": "2011-12-15T11:20:27+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:2cd554ee-5403-3e6d-2d97-e2e4c40f815f",
"resource": {
"resourceType": "Condition",
"id": "2cd554ee-5403-3e6d-2d97-e2e4c40f815f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c"
},
"onsetDateTime": "2011-12-15T10:29:53+01:00",
"abatementDateTime": "2013-12-19T10:29:53+01:00",
"recordedDate": "2011-12-15T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:c24fe6ae-dde9-8275-6da4-22195d93d950",
"resource": {
"resourceType": "Condition",
"id": "c24fe6ae-dde9-8275-6da4-22195d93d950",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "15777000",
"display": "Prediabetes"
} ],
"text": "Prediabetes"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c"
},
"onsetDateTime": "2011-12-15T10:29:53+01:00",
"recordedDate": "2011-12-15T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:f485d323-7154-ef72-07da-8f0974b72926",
"resource": {
"resourceType": "Condition",
"id": "f485d323-7154-ef72-07da-8f0974b72926",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "271737000",
"display": "Anemia (disorder)"
} ],
"text": "Anemia (disorder)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c"
},
"onsetDateTime": "2011-12-15T10:29:53+01:00",
"recordedDate": "2011-12-15T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:0519b6e6-714b-3741-8ba8-39f91b5327fe",
"resource": {
"resourceType": "Device",
"id": "0519b6e6-714b-3741-8ba8-39f91b5327fe",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ]
},
"udiCarrier": [ {
"deviceIdentifier": "18370531670079",
"carrierHRF": "(01)18370531670079(11)111124(17)361208(10)11981207009636137(21)888322343134"
} ],
"status": "active",
"distinctIdentifier": "18370531670079",
"manufactureDate": "2011-11-24T10:29:53+01:00",
"expirationDate": "2036-12-08T10:29:53+01:00",
"lotNumber": "11981207009636137",
"serialNumber": "888322343134",
"deviceName": [ {
"name": "Blood glucose meter (physical object)",
"type": "user-friendly-name"
} ],
"type": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337414009",
"display": "Blood glucose meter (physical object)"
} ],
"text": "Blood glucose meter (physical object)"
},
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
}
},
"request": {
"method": "POST",
"url": "Device"
}
}, {
"fullUrl": "urn:uuid:69c1e663-0b0a-a95a-2474-d42783a6ee7f",
"resource": {
"resourceType": "SupplyDelivery",
"id": "69c1e663-0b0a-a95a-2474-d42783a6ee7f",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2011-12-15T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:4eca683a-e9e7-7746-543a-94dd77598c87",
"resource": {
"resourceType": "CareTeam",
"id": "4eca683a-e9e7-7746-543a-94dd77598c87",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ]
},
"status": "active",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c"
},
"period": {
"start": "2011-12-15T10:29:53+01:00"
},
"participant": [ {
"role": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "116154003",
"display": "Patient"
} ],
"text": "Patient"
} ],
"member": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
}
}, {
"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|9999960690",
"display": "Dr. Mao115 Bednar518"
}
}, {
"role": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "224891009",
"display": "Healthcare services (qualifier value)"
} ],
"text": "Healthcare services (qualifier value)"
} ],
"member": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "15777000",
"display": "Prediabetes"
} ],
"text": "Prediabetes"
} ],
"managingOrganization": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ]
},
"request": {
"method": "POST",
"url": "CareTeam"
}
}, {
"fullUrl": "urn:uuid:002aebf5-cb8c-89c6-aeea-cfefa23f01e7",
"resource": {
"resourceType": "CarePlan",
"id": "002aebf5-cb8c-89c6-aeea-cfefa23f01e7",
"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 Diabetes self management plan.<br/>Care plan is meant to treat Prediabetes.<br/>Activities: <ul><li>Diabetes self management plan</li><li>Diabetes self management plan</li></ul></div>"
},
"status": "active",
"intent": "order",
"category": [ {
"coding": [ {
"system": "http://hl7.org/fhir/us/core/CodeSystem/careplan-category",
"code": "assess-plan"
} ]
}, {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "698360004",
"display": "Diabetes self management plan"
} ],
"text": "Diabetes self management plan"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c"
},
"period": {
"start": "2011-12-15T10:29:53+01:00"
},
"careTeam": [ {
"reference": "urn:uuid:4eca683a-e9e7-7746-543a-94dd77598c87"
} ],
"addresses": [ {
"reference": "urn:uuid:c24fe6ae-dde9-8275-6da4-22195d93d950"
} ],
"activity": [ {
"detail": {
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160670007",
"display": "Diabetic diet"
} ],
"text": "Diabetic diet"
},
"reasonReference": [ {
"reference": "urn:uuid:c24fe6ae-dde9-8275-6da4-22195d93d950"
} ],
"status": "in-progress",
"location": {
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
}
}, {
"detail": {
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "229065009",
"display": "Exercise therapy"
} ],
"text": "Exercise therapy"
},
"reasonReference": [ {
"reference": "urn:uuid:c24fe6ae-dde9-8275-6da4-22195d93d950"
} ],
"status": "in-progress",
"location": {
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
}
} ]
},
"request": {
"method": "POST",
"url": "CarePlan"
}
}, {
"fullUrl": "urn:uuid:a14877ea-ab7f-36c7-409c-0f76dedbbc0e",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a14877ea-ab7f-36c7-409c-0f76dedbbc0e",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c"
},
"effectiveDateTime": "2011-12-15T10:29:53+01:00",
"issued": "2011-12-15T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMTEtMTItMTUKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzClBldHJvbmlsYTcyNAogaXMgYSA0MiB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIHZpY3RpbSBvZiBpbnRpbWF0ZSBwYXJ0bmVyIGFidXNlIChmaW5kaW5nKSwgc3RyZXNzIChmaW5kaW5nKS4KCiMgU29jaWFsIEhpc3RvcnkKUGF0aWVudCBpcyBzaW5nbGUuIFBhdGllbnQgcXVpdCBzbW9raW5nIGF0IGFnZSAxNy4KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuCgpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgogUGF0aWVudCBkaWQgbm90IGZpbmlzaCBoaWdoIHNjaG9vbC4KUGF0aWVudCBjdXJyZW50bHkgaGFzIFVuaXRlZEhlYWx0aGNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCk5vIEFjdGl2ZSBNZWRpY2F0aW9ucy4KCiMgQXNzZXNzbWVudCBhbmQgUGxhbgpQYXRpZW50IGlzIHByZXNlbnRpbmcgd2l0aCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIHByZWRpYWJldGVzLCBhbmVtaWEgKGRpc29yZGVyKS4gCgojIyBQbGFuCgpUaGUgcGF0aWVudCB3YXMgcGxhY2VkIG9uIGEgY2FyZXBsYW46Ci0gZGlhYmV0ZXMgc2VsZiBtYW5hZ2VtZW50IHBsYW4K"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:c87f6900-fc96-effd-aca9-9dfb99535158",
"resource": {
"resourceType": "DocumentReference",
"id": "c87f6900-fc96-effd-aca9-9dfb99535158",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:a14877ea-ab7f-36c7-409c-0f76dedbbc0e"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2011-12-15T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c"
} ],
"period": {
"start": "2011-12-15T10:29:53+01:00",
"end": "2011-12-15T11:20:27+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:6edf1f66-bff5-c81a-4661-76890a0bfb64",
"resource": {
"resourceType": "Claim",
"id": "6edf1f66-bff5-c81a-4661-76890a0bfb64",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2011-12-15T10:29:53+01:00",
"end": "2011-12-15T11:20:27+01:00"
},
"created": "2011-12-15T11:20:27+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:2cd554ee-5403-3e6d-2d97-e2e4c40f815f"
}
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:c24fe6ae-dde9-8275-6da4-22195d93d950"
}
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:f485d323-7154-ef72-07da-8f0974b72926"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
}
}, {
"sequence": 3,
"diagnosisSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "15777000",
"display": "Prediabetes"
} ],
"text": "Prediabetes"
}
}, {
"sequence": 4,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337414009",
"display": "Blood glucose meter (physical object)"
} ],
"text": "Blood glucose meter (physical object)"
},
"net": {
"value": 63.64,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
}, {
"sequence": 6,
"diagnosisSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "271737000",
"display": "Anemia (disorder)"
} ],
"text": "Anemia (disorder)"
}
} ],
"total": {
"value": 1195.80,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c2e5d1eb-9e1d-c8e5-7afc-232257286968",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c2e5d1eb-9e1d-c8e5-7afc-232257286968",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "6edf1f66-bff5-c81a-4661-76890a0bfb64"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2011-12-15T11:20:27+01:00",
"end": "2012-12-15T11:20:27+01:00"
},
"created": "2011-12-15T11:20:27+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:6edf1f66-bff5-c81a-4661-76890a0bfb64"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:2cd554ee-5403-3e6d-2d97-e2e4c40f815f"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:c24fe6ae-dde9-8275-6da4-22195d93d950"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:f485d323-7154-ef72-07da-8f0974b72926"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2011-12-15T10:29:53+01:00",
"end": "2011-12-15T11:20:27+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"servicedPeriod": {
"start": "2011-12-15T10:29:53+01:00",
"end": "2011-12-15T11:20:27+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 3,
"diagnosisSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "15777000",
"display": "Prediabetes"
} ],
"text": "Prediabetes"
},
"servicedPeriod": {
"start": "2011-12-15T10:29:53+01:00",
"end": "2011-12-15T11:20:27+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 4,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337414009",
"display": "Blood glucose meter (physical object)"
} ],
"text": "Blood glucose meter (physical object)"
},
"servicedPeriod": {
"start": "2011-12-15T10:29:53+01:00",
"end": "2011-12-15T11:20:27+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 63.64,
"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": 12.728000000000002,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 50.912000000000006,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 63.64,
"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": 63.64,
"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,
"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://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2011-12-15T10:29:53+01:00",
"end": "2011-12-15T11:20:27+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"diagnosisSequence": [ 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": "271737000",
"display": "Anemia (disorder)"
} ],
"text": "Anemia (disorder)"
},
"servicedPeriod": {
"start": "2011-12-15T10:29:53+01:00",
"end": "2011-12-15T11:20:27+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": 1195.80,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 56.352000000000004,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:f6ad31a4-b371-dcc2-d0c0-062e5dfd5a84",
"resource": {
"resourceType": "Encounter",
"id": "f6ad31a4-b371-dcc2-d0c0-062e5dfd5a84",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "f6ad31a4-b371-dcc2-d0c0-062e5dfd5a84"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2013-11-21T10:29:53+01:00",
"end": "2013-11-21T10:46:01+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2013-11-21T10:29:53+01:00",
"end": "2013-11-21T10:46:01+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:87ff4f1e-9a8d-12fa-5798-461ddad17ec0",
"resource": {
"resourceType": "Procedure",
"id": "87ff4f1e-9a8d-12fa-5798-461ddad17ec0",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:f6ad31a4-b371-dcc2-d0c0-062e5dfd5a84"
},
"performedPeriod": {
"start": "2013-11-21T10:29:53+01:00",
"end": "2013-11-21T10:46:01+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:71b3d37b-87ef-b135-f71f-64245bda2426",
"resource": {
"resourceType": "DiagnosticReport",
"id": "71b3d37b-87ef-b135-f71f-64245bda2426",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:f6ad31a4-b371-dcc2-d0c0-062e5dfd5a84"
},
"effectiveDateTime": "2013-11-21T10:29:53+01:00",
"issued": "2013-11-21T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:54a49ee2-d889-bece-a83c-2b16350f056d",
"resource": {
"resourceType": "DocumentReference",
"id": "54a49ee2-d889-bece-a83c-2b16350f056d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:71b3d37b-87ef-b135-f71f-64245bda2426"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2013-11-21T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:f6ad31a4-b371-dcc2-d0c0-062e5dfd5a84"
} ],
"period": {
"start": "2013-11-21T10:29:53+01:00",
"end": "2013-11-21T10:46:01+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:2de81fdc-7bdb-2df9-2105-cc4713c411aa",
"resource": {
"resourceType": "Claim",
"id": "2de81fdc-7bdb-2df9-2105-cc4713c411aa",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2013-11-21T10:29:53+01:00",
"end": "2013-11-21T10:46:01+01:00"
},
"created": "2013-11-21T10:46:01+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:87ff4f1e-9a8d-12fa-5798-461ddad17ec0"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:f6ad31a4-b371-dcc2-d0c0-062e5dfd5a84"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2913.27,
"currency": "USD"
}
} ],
"total": {
"value": 3055.85,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:6b6b1f41-52e1-12c1-340e-7bc6a394364d",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "6b6b1f41-52e1-12c1-340e-7bc6a394364d",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "2de81fdc-7bdb-2df9-2105-cc4713c411aa"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2013-11-21T10:46:01+01:00",
"end": "2014-11-21T10:46:01+01:00"
},
"created": "2013-11-21T10:46:01+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:2de81fdc-7bdb-2df9-2105-cc4713c411aa"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2013-11-21T10:29:53+01:00",
"end": "2013-11-21T10:46:01+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:f6ad31a4-b371-dcc2-d0c0-062e5dfd5a84"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2013-11-21T10:29:53+01:00",
"end": "2013-11-21T10:46:01+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2913.27,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 582.654,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2330.616,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2913.27,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2913.27,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 3055.85,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2330.616,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c",
"resource": {
"resourceType": "Encounter",
"id": "12669957-dd6f-68ac-804e-6efb4f49ca5c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "12669957-dd6f-68ac-804e-6efb4f49ca5c"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:9e82bf06-a43c-05bc-7913-027fe3f10ab8",
"resource": {
"resourceType": "Condition",
"id": "9e82bf06-a43c-05bc-7913-027fe3f10ab8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162864005",
"display": "Body mass index 30+ - obesity (finding)"
} ],
"text": "Body mass index 30+ - obesity (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"onsetDateTime": "2013-12-19T10:29:53+01:00",
"recordedDate": "2013-12-19T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:5908382d-903a-735e-bad1-966eadddd5c4",
"resource": {
"resourceType": "Observation",
"id": "5908382d-903a-735e-bad1-966eadddd5c4",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
} ],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 6.36,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:4a5229f8-c191-2d50-89e6-3b9c2e39e96b",
"resource": {
"resourceType": "Observation",
"id": "4a5229f8-c191-2d50-89e6-3b9c2e39e96b",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 170.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d36c6e33-1749-9db9-a03f-332c22ca7d51",
"resource": {
"resourceType": "Observation",
"id": "d36c6e33-1749-9db9-a03f-332c22ca7d51",
"status": "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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9b8d3ba8-3cd4-42f5-984e-8f66f9e42138",
"resource": {
"resourceType": "Observation",
"id": "9b8d3ba8-3cd4-42f5-984e-8f66f9e42138",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 88.1,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:b7bfc038-5a0a-ba54-a718-32df0fe99123",
"resource": {
"resourceType": "Observation",
"id": "b7bfc038-5a0a-ba54-a718-32df0fe99123",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 30.38,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:70dc93b9-4b7e-e1e9-0639-7373a4fee1b2",
"resource": {
"resourceType": "Observation",
"id": "70dc93b9-4b7e-e1e9-0639-7373a4fee1b2",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 90,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 122,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:cf4605db-8a43-c12d-33d9-e70733080cfa",
"resource": {
"resourceType": "Observation",
"id": "cf4605db-8a43-c12d-33d9-e70733080cfa",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 70,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d2be5b61-73cd-a70c-1ea3-7ba886855224",
"resource": {
"resourceType": "Observation",
"id": "d2be5b61-73cd-a70c-1ea3-7ba886855224",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 14,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c4a6cae0-619f-a1f4-ae26-877a9e9ed62a",
"resource": {
"resourceType": "Observation",
"id": "c4a6cae0-619f-a1f4-ae26-877a9e9ed62a",
"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": "2339-0",
"display": "Glucose [Mass/volume] in Blood"
} ],
"text": "Glucose [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 71.54,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:eff5d42b-e3a3-f797-4c15-4868a87f888b",
"resource": {
"resourceType": "Observation",
"id": "eff5d42b-e3a3-f797-4c15-4868a87f888b",
"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": "6299-2",
"display": "Urea nitrogen [Mass/volume] in Blood"
} ],
"text": "Urea nitrogen [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 15.43,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:94279922-7d59-54a5-755d-c4426f6eb99b",
"resource": {
"resourceType": "Observation",
"id": "94279922-7d59-54a5-755d-c4426f6eb99b",
"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": "38483-4",
"display": "Creatinine [Mass/volume] in Blood"
} ],
"text": "Creatinine [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 1,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:33e40deb-e8a2-71ca-63b6-3c9b4bec4a97",
"resource": {
"resourceType": "Observation",
"id": "33e40deb-e8a2-71ca-63b6-3c9b4bec4a97",
"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": "49765-1",
"display": "Calcium [Mass/volume] in Blood"
} ],
"text": "Calcium [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 9.5,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:61a16984-59b6-93db-5622-7cf309d74af8",
"resource": {
"resourceType": "Observation",
"id": "61a16984-59b6-93db-5622-7cf309d74af8",
"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": "2947-0",
"display": "Sodium [Moles/volume] in Blood"
} ],
"text": "Sodium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 136.69,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:50de9a77-769d-5b4b-03fd-67169bd0970b",
"resource": {
"resourceType": "Observation",
"id": "50de9a77-769d-5b4b-03fd-67169bd0970b",
"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": "6298-4",
"display": "Potassium [Moles/volume] in Blood"
} ],
"text": "Potassium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 4.83,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5a09c3eb-4c53-96e3-68e4-61c7ab104bc1",
"resource": {
"resourceType": "Observation",
"id": "5a09c3eb-4c53-96e3-68e4-61c7ab104bc1",
"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": "2069-3",
"display": "Chloride [Moles/volume] in Blood"
} ],
"text": "Chloride [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 102.53,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9de306e3-235e-0db2-ed98-8d99cefe23c3",
"resource": {
"resourceType": "Observation",
"id": "9de306e3-235e-0db2-ed98-8d99cefe23c3",
"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": "20565-8",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ],
"text": "Carbon dioxide, total [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 24.37,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8d79800a-0aee-010b-50ce-a542a943ac2c",
"resource": {
"resourceType": "Observation",
"id": "8d79800a-0aee-010b-50ce-a542a943ac2c",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Ex-smoker (finding)"
} ],
"text": "Ex-smoker (finding)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1598fa50-fd5e-30c4-bda9-5c451878a60b",
"resource": {
"resourceType": "Observation",
"id": "1598fa50-fd5e-30c4-bda9-5c451878a60b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93025-5",
"display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T11:01:14+01:00",
"issued": "2013-12-19T11:01:14.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76501-6",
"display": "Within the last year, have you been afraid of your partner or ex-partner?"
} ],
"text": "Within the last year, have you been afraid of your partner or ex-partner?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93026-3",
"display": "Do you feel physically and emotionally safe where you currently live?"
} ],
"text": "Do you feel physically and emotionally safe where you currently live?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA33-6",
"display": "Yes"
} ],
"text": "Yes"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93027-1",
"display": "Are you a refugee?"
} ],
"text": "Are you a refugee?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93028-9",
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93038-8",
"display": "Stress level"
} ],
"text": "Stress level"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6568-5",
"display": "Not at all"
} ],
"text": "Not at all"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93029-7",
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30131-9",
"display": "3 to 5 times a week"
} ],
"text": "3 to 5 times a week"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93030-5",
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
} ],
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93031-3",
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30122-8",
"display": "I choose not to answer this question"
} ],
"text": "I choose not to answer this question"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63586-2",
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
},
"valueQuantity": {
"value": 90472,
"unit": "/a",
"system": "http://unitsofmeasure.org",
"code": "/a"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76437-3",
"display": "Primary insurance"
} ],
"text": "Primary insurance"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6350-8",
"display": "Private insurance"
} ],
"text": "Private insurance"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "67875-5",
"display": "Employment status - current"
} ],
"text": "Employment status - current"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30136-8",
"display": "Full-time work"
} ],
"text": "Full-time work"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82589-3",
"display": "Highest level of education"
} ],
"text": "Highest level of education"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30191-3",
"display": "Less than high school degree"
} ],
"text": "Less than high school degree"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56799-0",
"display": "Address"
} ],
"text": "Address"
},
"valueString": "217 Bayer Drive Unit 35"
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93033-9",
"display": "Are you worried about losing your housing?"
} ],
"text": "Are you worried about losing your housing?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "71802-3",
"display": "Housing status"
} ],
"text": "Housing status"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30189-7",
"display": "I have housing"
} ],
"text": "I have housing"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63512-8",
"display": "How many people are living or staying at this address?"
} ],
"text": "How many people are living or staying at this address?"
},
"valueQuantity": {
"value": 5,
"unit": "{#}",
"system": "http://unitsofmeasure.org",
"code": "{#}"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "54899-0",
"display": "Preferred language"
} ],
"text": "Preferred language"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA43-5",
"display": "English"
} ],
"text": "English"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93034-7",
"display": "Have you been discharged from the armed forces of the United States?"
} ],
"text": "Have you been discharged from the armed forces of the United States?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93035-4",
"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "32624-9",
"display": "Race"
} ],
"text": "Race"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA4457-3",
"display": "White"
} ],
"text": "White"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56051-6",
"display": "Do you consider yourself Hispanic/Latino?"
} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:deb2b64d-401f-ab33-4f8e-62eb4c8f93fb",
"resource": {
"resourceType": "Observation",
"id": "deb2b64d-401f-ab33-4f8e-62eb4c8f93fb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76504-0",
"display": "Total score [HARK]"
} ],
"text": "Total score [HARK]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T11:37:43+01:00",
"issued": "2013-12-19T11:37:43.294+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:87f9599c-2114-b085-c276-bb9206689582",
"resource": {
"resourceType": "Observation",
"id": "87f9599c-2114-b085-c276-bb9206689582",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55758-7",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T12:15:18+01:00",
"issued": "2013-12-19T12:15:18.294+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:dab95344-2278-f6f9-bcb5-f701cdec055f",
"resource": {
"resourceType": "Observation",
"id": "dab95344-2278-f6f9-bcb5-f701cdec055f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82667-7",
"display": "Total score [DAST-10]"
} ],
"text": "Total score [DAST-10]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T12:55:42+01:00",
"issued": "2013-12-19T12:55:42.294+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3445ae02-f504-8918-f00d-f02988410b5f",
"resource": {
"resourceType": "Procedure",
"id": "3445ae02-f504-8918-f00d-f02988410b5f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"performedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T10:44:53+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:9b023c6f-deb4-542b-63d3-b6f80a043db9",
"resource": {
"resourceType": "Procedure",
"id": "9b023c6f-deb4-542b-63d3-b6f80a043db9",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"performedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:df9871ec-b18a-87fc-e433-f71f21b7f8e2",
"resource": {
"resourceType": "Procedure",
"id": "df9871ec-b18a-87fc-e433-f71f21b7f8e2",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "866148006",
"display": "Screening for domestic abuse (procedure)"
} ],
"text": "Screening for domestic abuse (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"performedPeriod": {
"start": "2013-12-19T11:01:14+01:00",
"end": "2013-12-19T11:37:43+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:e2ecd6e7-c7ae-b2dd-c8a2-0dc0ff8c6c44",
"resource": {
"resourceType": "Procedure",
"id": "e2ecd6e7-c7ae-b2dd-c8a2-0dc0ff8c6c44",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"performedPeriod": {
"start": "2013-12-19T11:37:43+01:00",
"end": "2013-12-19T11:51:50+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:1b03f71a-3947-170d-c2f0-52268f67ec25",
"resource": {
"resourceType": "Procedure",
"id": "1b03f71a-3947-170d-c2f0-52268f67ec25",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"performedPeriod": {
"start": "2013-12-19T11:51:50+01:00",
"end": "2013-12-19T12:15:18+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:337040a4-f598-e894-1bcc-2bd538ab9300",
"resource": {
"resourceType": "Procedure",
"id": "337040a4-f598-e894-1bcc-2bd538ab9300",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"performedPeriod": {
"start": "2013-12-19T12:15:18+01:00",
"end": "2013-12-19T12:27:16+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:5bcaa08a-7b27-318f-2043-9e096db0a4ef",
"resource": {
"resourceType": "Procedure",
"id": "5bcaa08a-7b27-318f-2043-9e096db0a4ef",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "713106006",
"display": "Screening for drug abuse (procedure)"
} ],
"text": "Screening for drug abuse (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"performedPeriod": {
"start": "2013-12-19T12:27:16+01:00",
"end": "2013-12-19T12:55:42+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:468e1e02-3ea3-9f37-3d2c-1f4289a8544c",
"resource": {
"resourceType": "SupplyDelivery",
"id": "468e1e02-3ea3-9f37-3d2c-1f4289a8544c",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2013-12-19T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:3e7452e8-9f7a-dd90-8f43-6525eeef8b2f",
"resource": {
"resourceType": "Immunization",
"id": "3e7452e8-9f7a-dd90-8f43-6525eeef8b2f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"occurrenceDateTime": "2013-12-19T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:bb6c1bc0-386a-7441-c4c3-e41e144a11c9",
"resource": {
"resourceType": "DiagnosticReport",
"id": "bb6c1bc0-386a-7441-c4c3-e41e144a11c9",
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:c4a6cae0-619f-a1f4-ae26-877a9e9ed62a",
"display": "Glucose [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:eff5d42b-e3a3-f797-4c15-4868a87f888b",
"display": "Urea nitrogen [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:94279922-7d59-54a5-755d-c4426f6eb99b",
"display": "Creatinine [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:33e40deb-e8a2-71ca-63b6-3c9b4bec4a97",
"display": "Calcium [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:61a16984-59b6-93db-5622-7cf309d74af8",
"display": "Sodium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:50de9a77-769d-5b4b-03fd-67169bd0970b",
"display": "Potassium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:5a09c3eb-4c53-96e3-68e4-61c7ab104bc1",
"display": "Chloride [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:9de306e3-235e-0db2-ed98-8d99cefe23c3",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:4ae7a33d-4176-772f-c518-a0c7a97ca8a6",
"resource": {
"resourceType": "DiagnosticReport",
"id": "4ae7a33d-4176-772f-c518-a0c7a97ca8a6",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76499-3",
"display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
} ],
"text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T11:37:43+01:00",
"issued": "2013-12-19T11:37:43.294+01:00",
"result": [ {
"reference": "urn:uuid:deb2b64d-401f-ab33-4f8e-62eb4c8f93fb",
"display": "Total score [HARK]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:e2c90d27-75ca-5e05-7f64-2b15c8a1884c",
"resource": {
"resourceType": "DiagnosticReport",
"id": "e2c90d27-75ca-5e05-7f64-2b15c8a1884c",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T12:15:18+01:00",
"issued": "2013-12-19T12:15:18.294+01:00",
"result": [ {
"reference": "urn:uuid:87f9599c-2114-b085-c276-bb9206689582",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:7c11becc-0db2-bb90-b224-a50185052452",
"resource": {
"resourceType": "DiagnosticReport",
"id": "7c11becc-0db2-bb90-b224-a50185052452",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82666-9",
"display": "Drug Abuse Screening Test-10 [DAST-10]"
} ],
"text": "Drug Abuse Screening Test-10 [DAST-10]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T12:55:42+01:00",
"issued": "2013-12-19T12:55:42.294+01:00",
"result": [ {
"reference": "urn:uuid:dab95344-2278-f6f9-bcb5-f701cdec055f",
"display": "Total score [DAST-10]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:f1b34493-59c9-c9b9-771e-d53c2db43cab",
"resource": {
"resourceType": "DiagnosticReport",
"id": "f1b34493-59c9-c9b9-771e-d53c2db43cab",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
},
"effectiveDateTime": "2013-12-19T10:29:53+01:00",
"issued": "2013-12-19T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:2568c2e2-dffa-e0ed-7900-4f163c80278c",
"resource": {
"resourceType": "DocumentReference",
"id": "2568c2e2-dffa-e0ed-7900-4f163c80278c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:f1b34493-59c9-c9b9-771e-d53c2db43cab"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2013-12-19T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
} ],
"period": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:2cc07577-be07-1f67-9d47-479777d02fc8",
"resource": {
"resourceType": "Claim",
"id": "2cc07577-be07-1f67-9d47-479777d02fc8",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"created": "2013-12-19T11:01:14+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:3e7452e8-9f7a-dd90-8f43-6525eeef8b2f"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:9e82bf06-a43c-05bc-7913-027fe3f10ab8"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:3445ae02-f504-8918-f00d-f02988410b5f"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:9b023c6f-deb4-542b-63d3-b6f80a043db9"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:df9871ec-b18a-87fc-e433-f71f21b7f8e2"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:e2ecd6e7-c7ae-b2dd-c8a2-0dc0ff8c6c44"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:1b03f71a-3947-170d-c2f0-52268f67ec25"
}
}, {
"sequence": 6,
"procedureReference": {
"reference": "urn:uuid:337040a4-f598-e894-1bcc-2bd538ab9300"
}
}, {
"sequence": 7,
"procedureReference": {
"reference": "urn:uuid:5bcaa08a-7b27-318f-2043-9e096db0a4ef"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 660.67,
"currency": "USD"
}
}, {
"sequence": 4,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
}, {
"sequence": 5,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162864005",
"display": "Body mass index 30+ - obesity (finding)"
} ],
"text": "Body mass index 30+ - obesity (finding)"
}
}, {
"sequence": 6,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 7,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 8,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "866148006",
"display": "Screening for domestic abuse (procedure)"
} ],
"text": "Screening for domestic abuse (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 9,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "76499-3",
"display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
} ],
"text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 10,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 11,
"procedureSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 12,
"informationSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 13,
"procedureSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 14,
"procedureSequence": [ 7 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "713106006",
"display": "Screening for drug abuse (procedure)"
} ],
"text": "Screening for drug abuse (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 15,
"informationSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "82666-9",
"display": "Drug Abuse Screening Test-10 [DAST-10]"
} ],
"text": "Drug Abuse Screening Test-10 [DAST-10]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
} ],
"total": {
"value": 1446.25,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:5d2363a1-da4d-4723-93dc-6e4349977fb4",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "5d2363a1-da4d-4723-93dc-6e4349977fb4",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "2cc07577-be07-1f67-9d47-479777d02fc8"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2013-12-19T11:01:14+01:00",
"end": "2014-12-19T11:01:14+01:00"
},
"created": "2013-12-19T11:01:14+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:2cc07577-be07-1f67-9d47-479777d02fc8"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:9e82bf06-a43c-05bc-7913-027fe3f10ab8"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
} ]
}, {
"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": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 660.67,
"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": 132.134,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 528.536,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 660.67,
"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": 660.67,
"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": 4,
"informationSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 5,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162864005",
"display": "Body mass index 30+ - obesity (finding)"
} ],
"text": "Body mass index 30+ - obesity (finding)"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+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": "866148006",
"display": "Screening for domestic abuse (procedure)"
} ],
"text": "Screening for domestic abuse (procedure)"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 9,
"informationSequence": [ 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": "76499-3",
"display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
} ],
"text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+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": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+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": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 12,
"informationSequence": [ 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": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 13,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 14,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "713106006",
"display": "Screening for drug abuse (procedure)"
} ],
"text": "Screening for drug abuse (procedure)"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 15,
"informationSequence": [ 6 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "82666-9",
"display": "Drug Abuse Screening Test-10 [DAST-10]"
} ],
"text": "Drug Abuse Screening Test-10 [DAST-10]"
},
"servicedPeriod": {
"start": "2013-12-19T10:29:53+01:00",
"end": "2013-12-19T11:01:14+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": 1446.25,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2952.152,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:84374611-b7be-90f0-0d74-4f1e42725364",
"resource": {
"resourceType": "Encounter",
"id": "84374611-b7be-90f0-0d74-4f1e42725364",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "84374611-b7be-90f0-0d74-4f1e42725364"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2014-02-20T10:29:53+01:00",
"end": "2014-02-20T10:45:28+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2014-02-20T10:29:53+01:00",
"end": "2014-02-20T10:45:28+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:a1d06ac2-b01f-3b4a-ad9d-cca7e69b900a",
"resource": {
"resourceType": "Procedure",
"id": "a1d06ac2-b01f-3b4a-ad9d-cca7e69b900a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:84374611-b7be-90f0-0d74-4f1e42725364"
},
"performedPeriod": {
"start": "2014-02-20T10:29:53+01:00",
"end": "2014-02-20T10:45:28+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:2856441e-d58c-deaa-0b63-1b402734b390",
"resource": {
"resourceType": "DiagnosticReport",
"id": "2856441e-d58c-deaa-0b63-1b402734b390",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:84374611-b7be-90f0-0d74-4f1e42725364"
},
"effectiveDateTime": "2014-02-20T10:29:53+01:00",
"issued": "2014-02-20T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:84a38729-6cc9-62c5-c34a-b641c3826d52",
"resource": {
"resourceType": "DocumentReference",
"id": "84a38729-6cc9-62c5-c34a-b641c3826d52",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:2856441e-d58c-deaa-0b63-1b402734b390"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2014-02-20T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:84374611-b7be-90f0-0d74-4f1e42725364"
} ],
"period": {
"start": "2014-02-20T10:29:53+01:00",
"end": "2014-02-20T10:45:28+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:69bc9db8-afda-a1a0-16ae-6a3f697f7c4b",
"resource": {
"resourceType": "Claim",
"id": "69bc9db8-afda-a1a0-16ae-6a3f697f7c4b",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2014-02-20T10:29:53+01:00",
"end": "2014-02-20T10:45:28+01:00"
},
"created": "2014-02-20T10:45:28+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:a1d06ac2-b01f-3b4a-ad9d-cca7e69b900a"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:84374611-b7be-90f0-0d74-4f1e42725364"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 3492.10,
"currency": "USD"
}
} ],
"total": {
"value": 3634.68,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:19d4c489-f501-406b-305e-fa524a0d5cf5",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "19d4c489-f501-406b-305e-fa524a0d5cf5",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "69bc9db8-afda-a1a0-16ae-6a3f697f7c4b"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2014-02-20T10:45:28+01:00",
"end": "2015-02-20T10:45:28+01:00"
},
"created": "2014-02-20T10:45:28+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:69bc9db8-afda-a1a0-16ae-6a3f697f7c4b"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2014-02-20T10:29:53+01:00",
"end": "2014-02-20T10:45:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:84374611-b7be-90f0-0d74-4f1e42725364"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2014-02-20T10:29:53+01:00",
"end": "2014-02-20T10:45:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 3492.10,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 698.4200000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2793.6800000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 3492.10,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 3492.10,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 3634.68,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2793.6800000000003,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:cbb7ba6e-d6a0-c447-62db-5dc10b24c13b",
"resource": {
"resourceType": "Encounter",
"id": "cbb7ba6e-d6a0-c447-62db-5dc10b24c13b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "cbb7ba6e-d6a0-c447-62db-5dc10b24c13b"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2014-05-22T11:29:53+02:00",
"end": "2014-05-22T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2014-05-22T11:29:53+02:00",
"end": "2014-05-22T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:49734b9c-b61d-6637-7efd-aedc9bf4da40",
"resource": {
"resourceType": "Procedure",
"id": "49734b9c-b61d-6637-7efd-aedc9bf4da40",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cbb7ba6e-d6a0-c447-62db-5dc10b24c13b"
},
"performedPeriod": {
"start": "2014-05-22T11:29:53+02:00",
"end": "2014-05-22T11:39:58+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:b35753cc-8a7c-5fe6-256c-6e49d8da90b4",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b35753cc-8a7c-5fe6-256c-6e49d8da90b4",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cbb7ba6e-d6a0-c447-62db-5dc10b24c13b"
},
"effectiveDateTime": "2014-05-22T11:29:53+02:00",
"issued": "2014-05-22T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:416aa3bb-acc0-3f37-32f0-0f4c559429aa",
"resource": {
"resourceType": "DocumentReference",
"id": "416aa3bb-acc0-3f37-32f0-0f4c559429aa",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:b35753cc-8a7c-5fe6-256c-6e49d8da90b4"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2014-05-22T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:cbb7ba6e-d6a0-c447-62db-5dc10b24c13b"
} ],
"period": {
"start": "2014-05-22T11:29:53+02:00",
"end": "2014-05-22T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:3772ade0-c028-4e25-4c65-9230bdc9d6f4",
"resource": {
"resourceType": "Claim",
"id": "3772ade0-c028-4e25-4c65-9230bdc9d6f4",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2014-05-22T11:29:53+02:00",
"end": "2014-05-22T11:44:53+02:00"
},
"created": "2014-05-22T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:49734b9c-b61d-6637-7efd-aedc9bf4da40"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:cbb7ba6e-d6a0-c447-62db-5dc10b24c13b"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 3054.90,
"currency": "USD"
}
} ],
"total": {
"value": 3197.48,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:cfcdf8d7-5fac-21fd-1d7c-3b7fc7e2fd82",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "cfcdf8d7-5fac-21fd-1d7c-3b7fc7e2fd82",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "3772ade0-c028-4e25-4c65-9230bdc9d6f4"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2014-05-22T11:44:53+02:00",
"end": "2015-05-22T11:44:53+02:00"
},
"created": "2014-05-22T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:3772ade0-c028-4e25-4c65-9230bdc9d6f4"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2014-05-22T11:29:53+02:00",
"end": "2014-05-22T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:cbb7ba6e-d6a0-c447-62db-5dc10b24c13b"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2014-05-22T11:29:53+02:00",
"end": "2014-05-22T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 3054.90,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 610.98,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2443.92,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 3054.90,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 3054.90,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 3197.48,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2443.92,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:bf6a228f-ea45-982c-c0e7-d2e77a6fa149",
"resource": {
"resourceType": "Encounter",
"id": "bf6a228f-ea45-982c-c0e7-d2e77a6fa149",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "bf6a228f-ea45-982c-c0e7-d2e77a6fa149"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2014-07-07T15:29:53+02:00",
"end": "2014-07-07T15:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2014-07-07T15:29:53+02:00",
"end": "2014-07-07T15:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "75498004",
"display": "Acute bacterial sinusitis (disorder)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:07c3a5e3-06bb-c5e0-04fb-813eb1577931",
"resource": {
"resourceType": "Condition",
"id": "07c3a5e3-06bb-c5e0-04fb-813eb1577931",
"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": "75498004",
"display": "Acute bacterial sinusitis (disorder)"
} ],
"text": "Acute bacterial sinusitis (disorder)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:bf6a228f-ea45-982c-c0e7-d2e77a6fa149"
},
"onsetDateTime": "2014-07-07T15:29:53+02:00",
"abatementDateTime": "2014-09-14T15:29:53+02:00",
"recordedDate": "2014-07-07T15:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:6d0bcc2a-a946-3c0b-c3c4-d6b7e7ed6b23",
"resource": {
"resourceType": "DiagnosticReport",
"id": "6d0bcc2a-a946-3c0b-c3c4-d6b7e7ed6b23",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:bf6a228f-ea45-982c-c0e7-d2e77a6fa149"
},
"effectiveDateTime": "2014-07-07T15:29:53+02:00",
"issued": "2014-07-07T15:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:a38f90bc-bbda-6337-dd08-53f2842ecd2c",
"resource": {
"resourceType": "DocumentReference",
"id": "a38f90bc-bbda-6337-dd08-53f2842ecd2c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:6d0bcc2a-a946-3c0b-c3c4-d6b7e7ed6b23"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2014-07-07T15:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMTQtMDctMDcKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzClBldHJvbmlsYTcyNAogaXMgYSA0NCB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIGZ1bGwtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgdmljdGltIG9mIGludGltYXRlIHBhcnRuZXIgYWJ1c2UgKGZpbmRpbmcpLCBzdHJlc3MgKGZpbmRpbmcpLgoKIyBTb2NpYWwgSGlzdG9yeQpQYXRpZW50IGlzIHNpbmdsZS4gUGF0aWVudCBxdWl0IHNtb2tpbmcgYXQgYWdlIDE3LgogUGF0aWVudCBpZGVudGlmaWVzIGFzIGhldGVyb3NleHVhbC4KClBhdGllbnQgY29tZXMgZnJvbSBhIG1pZGRsZSBzb2Npb2Vjb25vbWljIGJhY2tncm91bmQuCiBQYXRpZW50IGRpZCBub3QgZmluaXNoIGhpZ2ggc2Nob29sLgpQYXRpZW50IGN1cnJlbnRseSBoYXMgVW5pdGVkSGVhbHRoY2FyZS4KCiMgQWxsZXJnaWVzCk5vIEtub3duIEFsbGVyZ2llcy4KCiMgTWVkaWNhdGlvbnMKTm8gQWN0aXZlIE1lZGljYXRpb25zLgoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuClBhdGllbnQgaXMgcHJlc2VudGluZyB3aXRoIGFjdXRlIGJhY3RlcmlhbCBzaW51c2l0aXMgKGRpc29yZGVyKS4gCgojIyBQbGFuCgo="
},
"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:bf6a228f-ea45-982c-c0e7-d2e77a6fa149"
} ],
"period": {
"start": "2014-07-07T15:29:53+02:00",
"end": "2014-07-07T15:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:5960e88d-cbd2-e56d-e7fb-470c54648db3",
"resource": {
"resourceType": "Claim",
"id": "5960e88d-cbd2-e56d-e7fb-470c54648db3",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2014-07-07T15:29:53+02:00",
"end": "2014-07-07T15:44:53+02:00"
},
"created": "2014-07-07T15:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:07c3a5e3-06bb-c5e0-04fb-813eb1577931"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:bf6a228f-ea45-982c-c0e7-d2e77a6fa149"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "75498004",
"display": "Acute bacterial sinusitis (disorder)"
} ],
"text": "Acute bacterial sinusitis (disorder)"
}
} ],
"total": {
"value": 85.55,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:66d0cd91-6cdc-3561-1688-3fc2a3954003",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "66d0cd91-6cdc-3561-1688-3fc2a3954003",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "5960e88d-cbd2-e56d-e7fb-470c54648db3"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2014-07-07T15:44:53+02:00",
"end": "2015-07-07T15:44:53+02:00"
},
"created": "2014-07-07T15:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:5960e88d-cbd2-e56d-e7fb-470c54648db3"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:07c3a5e3-06bb-c5e0-04fb-813eb1577931"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2014-07-07T15:29:53+02:00",
"end": "2014-07-07T15:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:bf6a228f-ea45-982c-c0e7-d2e77a6fa149"
} ]
}, {
"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": "75498004",
"display": "Acute bacterial sinusitis (disorder)"
} ],
"text": "Acute bacterial sinusitis (disorder)"
},
"servicedPeriod": {
"start": "2014-07-07T15:29:53+02:00",
"end": "2014-07-07T15:44:53+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:819d6f7f-74cf-f5f6-10b1-28c4fe260256",
"resource": {
"resourceType": "Encounter",
"id": "819d6f7f-74cf-f5f6-10b1-28c4fe260256",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "819d6f7f-74cf-f5f6-10b1-28c4fe260256"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2014-08-10T15:29:53+02:00",
"end": "2014-08-10T15:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2014-08-10T15:29:53+02:00",
"end": "2014-08-10T15:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "75498004",
"display": "Acute bacterial sinusitis (disorder)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:9dbab15b-7a41-e722-9b2b-e0db1b1ffe74",
"resource": {
"resourceType": "Condition",
"id": "9dbab15b-7a41-e722-9b2b-e0db1b1ffe74",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "40055000",
"display": "Chronic sinusitis (disorder)"
} ],
"text": "Chronic sinusitis (disorder)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:819d6f7f-74cf-f5f6-10b1-28c4fe260256"
},
"onsetDateTime": "2014-08-10T15:29:53+02:00",
"recordedDate": "2014-08-10T15:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:c0784213-1307-60f7-196a-6a4a1a92828c",
"resource": {
"resourceType": "Device",
"id": "c0784213-1307-60f7-196a-6a4a1a92828c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device" ]
},
"udiCarrier": [ {
"deviceIdentifier": "96610210118978",
"carrierHRF": "(01)96610210118978(11)140720(17)390804(10)842986(21)654133048243048928"
} ],
"status": "active",
"distinctIdentifier": "96610210118978",
"manufactureDate": "2014-07-20T15:29:53+02:00",
"expirationDate": "2039-08-04T15:29:53+02:00",
"lotNumber": "842986",
"serialNumber": "654133048243048928",
"deviceName": [ {
"name": "Home nebulizer (physical object)",
"type": "user-friendly-name"
} ],
"type": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "170615005",
"display": "Home nebulizer (physical object)"
} ],
"text": "Home nebulizer (physical object)"
},
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
}
},
"request": {
"method": "POST",
"url": "Device"
}
}, {
"fullUrl": "urn:uuid:5e64e932-e20e-8505-bc95-b6a4f7290253",
"resource": {
"resourceType": "DiagnosticReport",
"id": "5e64e932-e20e-8505-bc95-b6a4f7290253",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:819d6f7f-74cf-f5f6-10b1-28c4fe260256"
},
"effectiveDateTime": "2014-08-10T15:29:53+02:00",
"issued": "2014-08-10T15:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:e4030e51-91ad-31d8-b7ed-81431718c281",
"resource": {
"resourceType": "DocumentReference",
"id": "e4030e51-91ad-31d8-b7ed-81431718c281",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:5e64e932-e20e-8505-bc95-b6a4f7290253"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2014-08-10T15:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:819d6f7f-74cf-f5f6-10b1-28c4fe260256"
} ],
"period": {
"start": "2014-08-10T15:29:53+02:00",
"end": "2014-08-10T15:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:efa27ded-d610-3bfe-b8a1-fe8f62cbe038",
"resource": {
"resourceType": "Claim",
"id": "efa27ded-d610-3bfe-b8a1-fe8f62cbe038",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2014-08-10T15:29:53+02:00",
"end": "2014-08-10T15:44:53+02:00"
},
"created": "2014-08-10T15:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:9dbab15b-7a41-e722-9b2b-e0db1b1ffe74"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:819d6f7f-74cf-f5f6-10b1-28c4fe260256"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "40055000",
"display": "Chronic sinusitis (disorder)"
} ],
"text": "Chronic sinusitis (disorder)"
}
}, {
"sequence": 3,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "170615005",
"display": "Home nebulizer (physical object)"
} ],
"text": "Home nebulizer (physical object)"
},
"net": {
"value": 7.38,
"currency": "USD"
}
} ],
"total": {
"value": 92.93,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:e6679a6b-cce6-1192-0f3e-bbc0043b3049",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "e6679a6b-cce6-1192-0f3e-bbc0043b3049",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "efa27ded-d610-3bfe-b8a1-fe8f62cbe038"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2014-08-10T15:44:53+02:00",
"end": "2015-08-10T15:44:53+02:00"
},
"created": "2014-08-10T15:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:efa27ded-d610-3bfe-b8a1-fe8f62cbe038"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:9dbab15b-7a41-e722-9b2b-e0db1b1ffe74"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2014-08-10T15:29:53+02:00",
"end": "2014-08-10T15:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:819d6f7f-74cf-f5f6-10b1-28c4fe260256"
} ]
}, {
"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": "40055000",
"display": "Chronic sinusitis (disorder)"
} ],
"text": "Chronic sinusitis (disorder)"
},
"servicedPeriod": {
"start": "2014-08-10T15:29:53+02:00",
"end": "2014-08-10T15:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
}
}, {
"sequence": 3,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "170615005",
"display": "Home nebulizer (physical object)"
} ],
"text": "Home nebulizer (physical object)"
},
"servicedPeriod": {
"start": "2014-08-10T15:29:53+02:00",
"end": "2014-08-10T15:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 7.38,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.476,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.904,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 7.38,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 7.38,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 92.93,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 5.904,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:c4be8af1-7a2d-7ca2-60cc-fba57e403277",
"resource": {
"resourceType": "Encounter",
"id": "c4be8af1-7a2d-7ca2-60cc-fba57e403277",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "c4be8af1-7a2d-7ca2-60cc-fba57e403277"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2014-08-21T11:29:53+02:00",
"end": "2014-08-21T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2014-08-21T11:29:53+02:00",
"end": "2014-08-21T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:01e7cb29-e006-b9f5-3344-1652329b53d2",
"resource": {
"resourceType": "Procedure",
"id": "01e7cb29-e006-b9f5-3344-1652329b53d2",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c4be8af1-7a2d-7ca2-60cc-fba57e403277"
},
"performedPeriod": {
"start": "2014-08-21T11:29:53+02:00",
"end": "2014-08-21T11:42:35+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:bd75b9db-921a-997e-64a4-d2324b2526bd",
"resource": {
"resourceType": "DiagnosticReport",
"id": "bd75b9db-921a-997e-64a4-d2324b2526bd",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c4be8af1-7a2d-7ca2-60cc-fba57e403277"
},
"effectiveDateTime": "2014-08-21T11:29:53+02:00",
"issued": "2014-08-21T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:85dce35d-5d04-4322-da46-d896d5c778ea",
"resource": {
"resourceType": "DocumentReference",
"id": "85dce35d-5d04-4322-da46-d896d5c778ea",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:bd75b9db-921a-997e-64a4-d2324b2526bd"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2014-08-21T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:c4be8af1-7a2d-7ca2-60cc-fba57e403277"
} ],
"period": {
"start": "2014-08-21T11:29:53+02:00",
"end": "2014-08-21T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:3c4614f9-2294-2edb-df0b-67dada65f888",
"resource": {
"resourceType": "Claim",
"id": "3c4614f9-2294-2edb-df0b-67dada65f888",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2014-08-21T11:29:53+02:00",
"end": "2014-08-21T11:44:53+02:00"
},
"created": "2014-08-21T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:01e7cb29-e006-b9f5-3344-1652329b53d2"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:c4be8af1-7a2d-7ca2-60cc-fba57e403277"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 1737.64,
"currency": "USD"
}
} ],
"total": {
"value": 1880.22,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:5edc60f0-7843-c4f3-0d1f-096001aa1941",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "5edc60f0-7843-c4f3-0d1f-096001aa1941",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "3c4614f9-2294-2edb-df0b-67dada65f888"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2014-08-21T11:44:53+02:00",
"end": "2015-08-21T11:44:53+02:00"
},
"created": "2014-08-21T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:3c4614f9-2294-2edb-df0b-67dada65f888"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2014-08-21T11:29:53+02:00",
"end": "2014-08-21T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:c4be8af1-7a2d-7ca2-60cc-fba57e403277"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2014-08-21T11:29:53+02:00",
"end": "2014-08-21T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1737.64,
"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": 347.528,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1390.112,
"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": 1737.64,
"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": 1737.64,
"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"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 1880.22,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1390.112,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:05eb8859-8bcf-4b5f-813b-eefe3351c6ef",
"resource": {
"resourceType": "Encounter",
"id": "05eb8859-8bcf-4b5f-813b-eefe3351c6ef",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "05eb8859-8bcf-4b5f-813b-eefe3351c6ef"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2014-08-24T15:29:53+02:00",
"end": "2014-08-24T15:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2014-08-24T15:29:53+02:00",
"end": "2014-08-24T15:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "75498004",
"display": "Acute bacterial sinusitis (disorder)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:216d41d4-ab65-217a-c0c0-d960dec1a6c0",
"resource": {
"resourceType": "DiagnosticReport",
"id": "216d41d4-ab65-217a-c0c0-d960dec1a6c0",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:05eb8859-8bcf-4b5f-813b-eefe3351c6ef"
},
"effectiveDateTime": "2014-08-24T15:29:53+02:00",
"issued": "2014-08-24T15:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:70359f02-22e6-3ffd-545f-d3fcbfa2a158",
"resource": {
"resourceType": "DocumentReference",
"id": "70359f02-22e6-3ffd-545f-d3fcbfa2a158",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:216d41d4-ab65-217a-c0c0-d960dec1a6c0"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2014-08-24T15:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMTQtMDgtMjQKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzClBldHJvbmlsYTcyNAogaXMgYSA0NCB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBhY3V0ZSBiYWN0ZXJpYWwgc2ludXNpdGlzIChkaXNvcmRlciksIG1lZGljYXRpb24gcmV2aWV3IGR1ZSAoc2l0dWF0aW9uKSwgZnVsbC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCB2aWN0aW0gb2YgaW50aW1hdGUgcGFydG5lciBhYnVzZSAoZmluZGluZyksIHN0cmVzcyAoZmluZGluZykuCgojIFNvY2lhbCBIaXN0b3J5ClBhdGllbnQgaXMgc2luZ2xlLiBQYXRpZW50IHF1aXQgc21va2luZyBhdCBhZ2UgMTcuCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KIFBhdGllbnQgZGlkIG5vdCBmaW5pc2ggaGlnaCBzY2hvb2wuClBhdGllbnQgY3VycmVudGx5IGhhcyBVbml0ZWRIZWFsdGhjYXJlLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwpObyBBY3RpdmUgTWVkaWNhdGlvbnMuCgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KCgojIyBQbGFuCgo="
},
"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:05eb8859-8bcf-4b5f-813b-eefe3351c6ef"
} ],
"period": {
"start": "2014-08-24T15:29:53+02:00",
"end": "2014-08-24T15:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:67f5a8e9-df6a-eb11-6325-11493e56c590",
"resource": {
"resourceType": "Claim",
"id": "67f5a8e9-df6a-eb11-6325-11493e56c590",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2014-08-24T15:29:53+02:00",
"end": "2014-08-24T15:44:53+02:00"
},
"created": "2014-08-24T15:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:05eb8859-8bcf-4b5f-813b-eefe3351c6ef"
} ]
} ],
"total": {
"value": 85.55,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:72b45a54-3276-4c66-861f-eafe4e68f4c9",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "72b45a54-3276-4c66-861f-eafe4e68f4c9",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "67f5a8e9-df6a-eb11-6325-11493e56c590"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2014-08-24T15:44:53+02:00",
"end": "2015-08-24T15:44:53+02:00"
},
"created": "2014-08-24T15:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:67f5a8e9-df6a-eb11-6325-11493e56c590"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2014-08-24T15:29:53+02:00",
"end": "2014-08-24T15:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:05eb8859-8bcf-4b5f-813b-eefe3351c6ef"
} ]
} ],
"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:7015ad16-1388-572c-2fc9-8fbc5709a5ab",
"resource": {
"resourceType": "Encounter",
"id": "7015ad16-1388-572c-2fc9-8fbc5709a5ab",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "7015ad16-1388-572c-2fc9-8fbc5709a5ab"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2014-11-20T10:29:53+01:00",
"end": "2014-11-20T10:46:02+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2014-11-20T10:29:53+01:00",
"end": "2014-11-20T10:46:02+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:36d51e2f-c19f-f34b-d869-79f64ef5079a",
"resource": {
"resourceType": "Procedure",
"id": "36d51e2f-c19f-f34b-d869-79f64ef5079a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7015ad16-1388-572c-2fc9-8fbc5709a5ab"
},
"performedPeriod": {
"start": "2014-11-20T10:29:53+01:00",
"end": "2014-11-20T10:46:02+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:93fab213-2840-2c21-fdef-eb8beb75f475",
"resource": {
"resourceType": "DiagnosticReport",
"id": "93fab213-2840-2c21-fdef-eb8beb75f475",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7015ad16-1388-572c-2fc9-8fbc5709a5ab"
},
"effectiveDateTime": "2014-11-20T10:29:53+01:00",
"issued": "2014-11-20T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:5b76d227-411e-12ef-09b9-7576eae9d905",
"resource": {
"resourceType": "DocumentReference",
"id": "5b76d227-411e-12ef-09b9-7576eae9d905",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:93fab213-2840-2c21-fdef-eb8beb75f475"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2014-11-20T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:7015ad16-1388-572c-2fc9-8fbc5709a5ab"
} ],
"period": {
"start": "2014-11-20T10:29:53+01:00",
"end": "2014-11-20T10:46:02+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:74e9a9cd-2c5a-bc07-7930-5225b1431c30",
"resource": {
"resourceType": "Claim",
"id": "74e9a9cd-2c5a-bc07-7930-5225b1431c30",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2014-11-20T10:29:53+01:00",
"end": "2014-11-20T10:46:02+01:00"
},
"created": "2014-11-20T10:46:02+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:36d51e2f-c19f-f34b-d869-79f64ef5079a"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:7015ad16-1388-572c-2fc9-8fbc5709a5ab"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 1332.93,
"currency": "USD"
}
} ],
"total": {
"value": 1475.51,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c8c5ed33-3927-239c-fe8e-424214a54826",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c8c5ed33-3927-239c-fe8e-424214a54826",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "74e9a9cd-2c5a-bc07-7930-5225b1431c30"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2014-11-20T10:46:02+01:00",
"end": "2015-11-20T10:46:02+01:00"
},
"created": "2014-11-20T10:46:02+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:74e9a9cd-2c5a-bc07-7930-5225b1431c30"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2014-11-20T10:29:53+01:00",
"end": "2014-11-20T10:46:02+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:7015ad16-1388-572c-2fc9-8fbc5709a5ab"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2014-11-20T10:29:53+01:00",
"end": "2014-11-20T10:46:02+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1332.93,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 266.586,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1066.344,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 1332.93,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 1332.93,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 1475.51,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1066.344,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:2aa17fcf-7960-8ccc-6cfc-17426b81e3de",
"resource": {
"resourceType": "Encounter",
"id": "2aa17fcf-7960-8ccc-6cfc-17426b81e3de",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "2aa17fcf-7960-8ccc-6cfc-17426b81e3de"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2015-02-19T10:29:53+01:00",
"end": "2015-02-19T10:45:52+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2015-02-19T10:29:53+01:00",
"end": "2015-02-19T10:45:52+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:e3b26b84-de59-ad6c-7271-9da53b882db2",
"resource": {
"resourceType": "Procedure",
"id": "e3b26b84-de59-ad6c-7271-9da53b882db2",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2aa17fcf-7960-8ccc-6cfc-17426b81e3de"
},
"performedPeriod": {
"start": "2015-02-19T10:29:53+01:00",
"end": "2015-02-19T10:45:52+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:13d593af-5d0e-f97b-df9b-a95d9fb24924",
"resource": {
"resourceType": "DiagnosticReport",
"id": "13d593af-5d0e-f97b-df9b-a95d9fb24924",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2aa17fcf-7960-8ccc-6cfc-17426b81e3de"
},
"effectiveDateTime": "2015-02-19T10:29:53+01:00",
"issued": "2015-02-19T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ea07350a-79e7-e245-0484-8368aab5545b",
"resource": {
"resourceType": "DocumentReference",
"id": "ea07350a-79e7-e245-0484-8368aab5545b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:13d593af-5d0e-f97b-df9b-a95d9fb24924"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2015-02-19T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:2aa17fcf-7960-8ccc-6cfc-17426b81e3de"
} ],
"period": {
"start": "2015-02-19T10:29:53+01:00",
"end": "2015-02-19T10:45:52+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:8671f354-f4ea-cd4f-5ba9-669438157169",
"resource": {
"resourceType": "Claim",
"id": "8671f354-f4ea-cd4f-5ba9-669438157169",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2015-02-19T10:29:53+01:00",
"end": "2015-02-19T10:45:52+01:00"
},
"created": "2015-02-19T10:45:52+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:e3b26b84-de59-ad6c-7271-9da53b882db2"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:2aa17fcf-7960-8ccc-6cfc-17426b81e3de"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 3675.20,
"currency": "USD"
}
} ],
"total": {
"value": 3817.78,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:6de8754a-b750-e18d-1075-e75ffb42556d",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "6de8754a-b750-e18d-1075-e75ffb42556d",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "8671f354-f4ea-cd4f-5ba9-669438157169"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2015-02-19T10:45:52+01:00",
"end": "2016-02-19T10:45:52+01:00"
},
"created": "2015-02-19T10:45:52+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:8671f354-f4ea-cd4f-5ba9-669438157169"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2015-02-19T10:29:53+01:00",
"end": "2015-02-19T10:45:52+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:2aa17fcf-7960-8ccc-6cfc-17426b81e3de"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2015-02-19T10:29:53+01:00",
"end": "2015-02-19T10:45:52+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 3675.20,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 735.04,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2940.16,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 3675.20,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 3675.20,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 3817.78,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2940.16,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:2c852c44-bec3-73a8-d37a-9e8cb6e86f22",
"resource": {
"resourceType": "Encounter",
"id": "2c852c44-bec3-73a8-d37a-9e8cb6e86f22",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "2c852c44-bec3-73a8-d37a-9e8cb6e86f22"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2015-05-21T11:29:53+02:00",
"end": "2015-05-21T11:46:21+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2015-05-21T11:29:53+02:00",
"end": "2015-05-21T11:46:21+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:b387a419-cb66-c074-4bdb-c7843160fd1f",
"resource": {
"resourceType": "Procedure",
"id": "b387a419-cb66-c074-4bdb-c7843160fd1f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c852c44-bec3-73a8-d37a-9e8cb6e86f22"
},
"performedPeriod": {
"start": "2015-05-21T11:29:53+02:00",
"end": "2015-05-21T11:46:21+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:d2eaa292-9e2e-566f-c470-0e23470240e2",
"resource": {
"resourceType": "DiagnosticReport",
"id": "d2eaa292-9e2e-566f-c470-0e23470240e2",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c852c44-bec3-73a8-d37a-9e8cb6e86f22"
},
"effectiveDateTime": "2015-05-21T11:29:53+02:00",
"issued": "2015-05-21T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:218a998a-ab7d-9dd8-c0de-3116deda231e",
"resource": {
"resourceType": "DocumentReference",
"id": "218a998a-ab7d-9dd8-c0de-3116deda231e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:d2eaa292-9e2e-566f-c470-0e23470240e2"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2015-05-21T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:2c852c44-bec3-73a8-d37a-9e8cb6e86f22"
} ],
"period": {
"start": "2015-05-21T11:29:53+02:00",
"end": "2015-05-21T11:46:21+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:22025c4c-d1fa-f7ca-0e34-0f4fd6b371e7",
"resource": {
"resourceType": "Claim",
"id": "22025c4c-d1fa-f7ca-0e34-0f4fd6b371e7",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2015-05-21T11:29:53+02:00",
"end": "2015-05-21T11:46:21+02:00"
},
"created": "2015-05-21T11:46:21+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:b387a419-cb66-c074-4bdb-c7843160fd1f"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:2c852c44-bec3-73a8-d37a-9e8cb6e86f22"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2374.12,
"currency": "USD"
}
} ],
"total": {
"value": 2516.70,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:5a6ccdc4-3462-e471-ab77-cfd1bd0640f6",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "5a6ccdc4-3462-e471-ab77-cfd1bd0640f6",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "22025c4c-d1fa-f7ca-0e34-0f4fd6b371e7"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2015-05-21T11:46:21+02:00",
"end": "2016-05-21T11:46:21+02:00"
},
"created": "2015-05-21T11:46:21+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:22025c4c-d1fa-f7ca-0e34-0f4fd6b371e7"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2015-05-21T11:29:53+02:00",
"end": "2015-05-21T11:46:21+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:2c852c44-bec3-73a8-d37a-9e8cb6e86f22"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2015-05-21T11:29:53+02:00",
"end": "2015-05-21T11:46:21+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2374.12,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 474.824,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1899.296,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2374.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2374.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2516.70,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1899.296,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:681af50c-e2c9-dfc0-ab2b-add080085190",
"resource": {
"resourceType": "Encounter",
"id": "681af50c-e2c9-dfc0-ab2b-add080085190",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "681af50c-e2c9-dfc0-ab2b-add080085190"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2015-07-17T17:29:53+02:00",
"end": "2015-07-17T17:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2015-07-17T17:29:53+02:00",
"end": "2015-07-17T17:44:53+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:65a4ac71-5784-54ee-165e-1b0a6d50cd19",
"resource": {
"resourceType": "Condition",
"id": "65a4ac71-5784-54ee-165e-1b0a6d50cd19",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:681af50c-e2c9-dfc0-ab2b-add080085190"
},
"onsetDateTime": "2015-07-17T17:29:53+02:00",
"abatementDateTime": "2015-07-29T17:29:53+02:00",
"recordedDate": "2015-07-17T17:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:c58d8307-1078-e8e3-daa8-00556ea9b655",
"resource": {
"resourceType": "DiagnosticReport",
"id": "c58d8307-1078-e8e3-daa8-00556ea9b655",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:681af50c-e2c9-dfc0-ab2b-add080085190"
},
"effectiveDateTime": "2015-07-17T17:29:53+02:00",
"issued": "2015-07-17T17:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:31b23ac8-e7f3-1be2-b71d-cb71bbdd8ed3",
"resource": {
"resourceType": "DocumentReference",
"id": "31b23ac8-e7f3-1be2-b71d-cb71bbdd8ed3",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:c58d8307-1078-e8e3-daa8-00556ea9b655"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2015-07-17T17:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:681af50c-e2c9-dfc0-ab2b-add080085190"
} ],
"period": {
"start": "2015-07-17T17:29:53+02:00",
"end": "2015-07-17T17:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:abc8c494-9f36-a076-beca-c850f866ef1a",
"resource": {
"resourceType": "Claim",
"id": "abc8c494-9f36-a076-beca-c850f866ef1a",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2015-07-17T17:29:53+02:00",
"end": "2015-07-17T17:44:53+02:00"
},
"created": "2015-07-17T17:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:65a4ac71-5784-54ee-165e-1b0a6d50cd19"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:681af50c-e2c9-dfc0-ab2b-add080085190"
} ]
}, {
"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:c42597af-f7db-7cad-df09-c23899a0edb2",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c42597af-f7db-7cad-df09-c23899a0edb2",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "abc8c494-9f36-a076-beca-c850f866ef1a"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2015-07-17T17:44:53+02:00",
"end": "2016-07-17T17:44:53+02:00"
},
"created": "2015-07-17T17:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:abc8c494-9f36-a076-beca-c850f866ef1a"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:65a4ac71-5784-54ee-165e-1b0a6d50cd19"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2015-07-17T17:29:53+02:00",
"end": "2015-07-17T17:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:681af50c-e2c9-dfc0-ab2b-add080085190"
} ]
}, {
"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": "2015-07-17T17:29:53+02:00",
"end": "2015-07-17T17:44:53+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:86fa2fa3-eea1-8763-e817-9a5c2c8f47f3",
"resource": {
"resourceType": "Encounter",
"id": "86fa2fa3-eea1-8763-e817-9a5c2c8f47f3",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "86fa2fa3-eea1-8763-e817-9a5c2c8f47f3"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2015-08-20T11:29:53+02:00",
"end": "2015-08-20T11:46:24+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2015-08-20T11:29:53+02:00",
"end": "2015-08-20T11:46:24+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:ece7b7e8-aa21-4304-a903-cd04b8e4845a",
"resource": {
"resourceType": "Procedure",
"id": "ece7b7e8-aa21-4304-a903-cd04b8e4845a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:86fa2fa3-eea1-8763-e817-9a5c2c8f47f3"
},
"performedPeriod": {
"start": "2015-08-20T11:29:53+02:00",
"end": "2015-08-20T11:46:24+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:9f6b1897-0ea1-56f6-2b9e-751c5540aa8e",
"resource": {
"resourceType": "DiagnosticReport",
"id": "9f6b1897-0ea1-56f6-2b9e-751c5540aa8e",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:86fa2fa3-eea1-8763-e817-9a5c2c8f47f3"
},
"effectiveDateTime": "2015-08-20T11:29:53+02:00",
"issued": "2015-08-20T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:01708c95-c40d-00cf-fc0d-48f75ef12b03",
"resource": {
"resourceType": "DocumentReference",
"id": "01708c95-c40d-00cf-fc0d-48f75ef12b03",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:9f6b1897-0ea1-56f6-2b9e-751c5540aa8e"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2015-08-20T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:86fa2fa3-eea1-8763-e817-9a5c2c8f47f3"
} ],
"period": {
"start": "2015-08-20T11:29:53+02:00",
"end": "2015-08-20T11:46:24+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:dc5aa22d-bc0e-191f-9cf2-de50ae2bb4fd",
"resource": {
"resourceType": "Claim",
"id": "dc5aa22d-bc0e-191f-9cf2-de50ae2bb4fd",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2015-08-20T11:29:53+02:00",
"end": "2015-08-20T11:46:24+02:00"
},
"created": "2015-08-20T11:46:24+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:ece7b7e8-aa21-4304-a903-cd04b8e4845a"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:86fa2fa3-eea1-8763-e817-9a5c2c8f47f3"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 1508.14,
"currency": "USD"
}
} ],
"total": {
"value": 1650.72,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:4c39bf2c-cb6a-233f-d18a-d8d3ee92c69b",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "4c39bf2c-cb6a-233f-d18a-d8d3ee92c69b",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "dc5aa22d-bc0e-191f-9cf2-de50ae2bb4fd"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2015-08-20T11:46:24+02:00",
"end": "2016-08-20T11:46:24+02:00"
},
"created": "2015-08-20T11:46:24+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:dc5aa22d-bc0e-191f-9cf2-de50ae2bb4fd"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2015-08-20T11:29:53+02:00",
"end": "2015-08-20T11:46:24+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:86fa2fa3-eea1-8763-e817-9a5c2c8f47f3"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2015-08-20T11:29:53+02:00",
"end": "2015-08-20T11:46:24+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1508.14,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 301.62800000000004,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1206.5120000000002,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 1508.14,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 1508.14,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 1650.72,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1206.5120000000002,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:c850c9cc-0803-9443-df71-b4cf407c6767",
"resource": {
"resourceType": "Encounter",
"id": "c850c9cc-0803-9443-df71-b4cf407c6767",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "c850c9cc-0803-9443-df71-b4cf407c6767"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2015-09-03T13:29:53+02:00",
"end": "2015-09-03T13:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2015-09-03T13:29:53+02:00",
"end": "2015-09-03T13:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "75498004",
"display": "Acute bacterial sinusitis (disorder)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:92ccf087-a00d-4c0a-0535-bdc337d9626c",
"resource": {
"resourceType": "Condition",
"id": "92ccf087-a00d-4c0a-0535-bdc337d9626c",
"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": "75498004",
"display": "Acute bacterial sinusitis (disorder)"
} ],
"text": "Acute bacterial sinusitis (disorder)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c850c9cc-0803-9443-df71-b4cf407c6767"
},
"onsetDateTime": "2015-09-03T13:29:53+02:00",
"abatementDateTime": "2015-10-19T13:29:53+02:00",
"recordedDate": "2015-09-03T13:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:e5fe277b-8cdb-ec4a-733c-ceaaa532a555",
"resource": {
"resourceType": "DiagnosticReport",
"id": "e5fe277b-8cdb-ec4a-733c-ceaaa532a555",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c850c9cc-0803-9443-df71-b4cf407c6767"
},
"effectiveDateTime": "2015-09-03T13:29:53+02:00",
"issued": "2015-09-03T13:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:48bfe588-dead-8b9c-7e88-39f2d3e7045f",
"resource": {
"resourceType": "DocumentReference",
"id": "48bfe588-dead-8b9c-7e88-39f2d3e7045f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:e5fe277b-8cdb-ec4a-733c-ceaaa532a555"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2015-09-03T13:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:c850c9cc-0803-9443-df71-b4cf407c6767"
} ],
"period": {
"start": "2015-09-03T13:29:53+02:00",
"end": "2015-09-03T13:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:07864dfb-2619-08ec-86c2-1c08db844698",
"resource": {
"resourceType": "Claim",
"id": "07864dfb-2619-08ec-86c2-1c08db844698",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2015-09-03T13:29:53+02:00",
"end": "2015-09-03T13:44:53+02:00"
},
"created": "2015-09-03T13:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:92ccf087-a00d-4c0a-0535-bdc337d9626c"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:c850c9cc-0803-9443-df71-b4cf407c6767"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "75498004",
"display": "Acute bacterial sinusitis (disorder)"
} ],
"text": "Acute bacterial sinusitis (disorder)"
}
} ],
"total": {
"value": 85.55,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c9738b9e-0ec8-7e7c-ff3b-e0afcd7e2386",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c9738b9e-0ec8-7e7c-ff3b-e0afcd7e2386",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "07864dfb-2619-08ec-86c2-1c08db844698"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2015-09-03T13:44:53+02:00",
"end": "2016-09-03T13:44:53+02:00"
},
"created": "2015-09-03T13:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:07864dfb-2619-08ec-86c2-1c08db844698"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:92ccf087-a00d-4c0a-0535-bdc337d9626c"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2015-09-03T13:29:53+02:00",
"end": "2015-09-03T13:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:c850c9cc-0803-9443-df71-b4cf407c6767"
} ]
}, {
"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": "75498004",
"display": "Acute bacterial sinusitis (disorder)"
} ],
"text": "Acute bacterial sinusitis (disorder)"
},
"servicedPeriod": {
"start": "2015-09-03T13:29:53+02:00",
"end": "2015-09-03T13:44:53+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:5734d894-23ae-85f8-675a-c38f785781ac",
"resource": {
"resourceType": "Encounter",
"id": "5734d894-23ae-85f8-675a-c38f785781ac",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "5734d894-23ae-85f8-675a-c38f785781ac"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2015-11-19T10:29:53+01:00",
"end": "2015-11-19T10:46:17+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2015-11-19T10:29:53+01:00",
"end": "2015-11-19T10:46:17+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:5ffe550d-46f3-0d60-5cdc-ad2d94219517",
"resource": {
"resourceType": "Procedure",
"id": "5ffe550d-46f3-0d60-5cdc-ad2d94219517",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:5734d894-23ae-85f8-675a-c38f785781ac"
},
"performedPeriod": {
"start": "2015-11-19T10:29:53+01:00",
"end": "2015-11-19T10:46:17+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:534670bd-76f7-e547-8cbf-33f33f4c4f3c",
"resource": {
"resourceType": "DiagnosticReport",
"id": "534670bd-76f7-e547-8cbf-33f33f4c4f3c",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:5734d894-23ae-85f8-675a-c38f785781ac"
},
"effectiveDateTime": "2015-11-19T10:29:53+01:00",
"issued": "2015-11-19T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:5bd9a627-ad33-7eaa-ff29-4ff373492cec",
"resource": {
"resourceType": "DocumentReference",
"id": "5bd9a627-ad33-7eaa-ff29-4ff373492cec",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:534670bd-76f7-e547-8cbf-33f33f4c4f3c"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2015-11-19T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:5734d894-23ae-85f8-675a-c38f785781ac"
} ],
"period": {
"start": "2015-11-19T10:29:53+01:00",
"end": "2015-11-19T10:46:17+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:daaf9457-a385-2499-183e-cb3ac2f182b3",
"resource": {
"resourceType": "Claim",
"id": "daaf9457-a385-2499-183e-cb3ac2f182b3",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2015-11-19T10:29:53+01:00",
"end": "2015-11-19T10:46:17+01:00"
},
"created": "2015-11-19T10:46:17+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:5ffe550d-46f3-0d60-5cdc-ad2d94219517"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:5734d894-23ae-85f8-675a-c38f785781ac"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2837.75,
"currency": "USD"
}
} ],
"total": {
"value": 2980.33,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:78c13ead-272d-26bf-02f7-070239b1ea4c",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "78c13ead-272d-26bf-02f7-070239b1ea4c",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "daaf9457-a385-2499-183e-cb3ac2f182b3"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2015-11-19T10:46:17+01:00",
"end": "2016-11-19T10:46:17+01:00"
},
"created": "2015-11-19T10:46:17+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:daaf9457-a385-2499-183e-cb3ac2f182b3"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2015-11-19T10:29:53+01:00",
"end": "2015-11-19T10:46:17+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:5734d894-23ae-85f8-675a-c38f785781ac"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2015-11-19T10:29:53+01:00",
"end": "2015-11-19T10:46:17+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2837.75,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 567.5500000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2270.2000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2837.75,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2837.75,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2980.33,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2270.2000000000003,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639",
"resource": {
"resourceType": "Encounter",
"id": "cd5e7dfe-93ca-4cfa-8878-dbdc2979d639",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:9a665041-0c35-85e7-8df5-a5b1aac70733",
"resource": {
"resourceType": "Condition",
"id": "9a665041-0c35-85e7-8df5-a5b1aac70733",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"onsetDateTime": "2015-12-24T10:29:53+01:00",
"abatementDateTime": "2017-04-20T11:29:53+02:00",
"recordedDate": "2015-12-24T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:c6c0c521-ed43-659b-242b-08c0ac818803",
"resource": {
"resourceType": "Condition",
"id": "c6c0c521-ed43-659b-242b-08c0ac818803",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160904001",
"display": "Part-time employment (finding)"
} ],
"text": "Part-time employment (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"onsetDateTime": "2015-12-24T11:29:15+01:00",
"abatementDateTime": "2017-12-28T11:13:20+01:00",
"recordedDate": "2015-12-24T11:29:15+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:a1c950ae-e65d-4f1a-2d37-3f8eda4281a4",
"resource": {
"resourceType": "Condition",
"id": "a1c950ae-e65d-4f1a-2d37-3f8eda4281a4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "422650009",
"display": "Social isolation (finding)"
} ],
"text": "Social isolation (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"onsetDateTime": "2015-12-24T11:29:15+01:00",
"abatementDateTime": "2017-04-20T12:27:07+02:00",
"recordedDate": "2015-12-24T11:29:15+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:d1b20e3d-f335-bc66-4519-9c0bd81a60b4",
"resource": {
"resourceType": "Condition",
"id": "d1b20e3d-f335-bc66-4519-9c0bd81a60b4",
"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": "10939881000119105",
"display": "Unhealthy alcohol drinking behavior (finding)"
} ],
"text": "Unhealthy alcohol drinking behavior (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"onsetDateTime": "2015-12-24T12:38:40+01:00",
"abatementDateTime": "2017-04-20T14:08:01+02:00",
"recordedDate": "2015-12-24T12:38:40+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:5011cd6e-3127-d505-9639-16417d37bfe8",
"resource": {
"resourceType": "Observation",
"id": "5011cd6e-3127-d505-9639-16417d37bfe8",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
} ],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 5.86,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7b5d7215-111c-d63c-4035-4b26d9fda165",
"resource": {
"resourceType": "Observation",
"id": "7b5d7215-111c-d63c-4035-4b26d9fda165",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 170.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:492c3d22-19a6-59ea-2eb8-648e114bfe62",
"resource": {
"resourceType": "Observation",
"id": "492c3d22-19a6-59ea-2eb8-648e114bfe62",
"status": "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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8ea5b49b-d263-b757-cf31-ebab8daea9eb",
"resource": {
"resourceType": "Observation",
"id": "8ea5b49b-d263-b757-cf31-ebab8daea9eb",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 88.1,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a92951aa-6c7d-1104-a563-802a037042f1",
"resource": {
"resourceType": "Observation",
"id": "a92951aa-6c7d-1104-a563-802a037042f1",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 30.38,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e31e9e6f-1caf-c399-ed52-9b0a22654d01",
"resource": {
"resourceType": "Observation",
"id": "e31e9e6f-1caf-c399-ed52-9b0a22654d01",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 94,
"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": 117,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:dfa98345-7da9-d638-9501-4eee10a8e32d",
"resource": {
"resourceType": "Observation",
"id": "dfa98345-7da9-d638-9501-4eee10a8e32d",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 77,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:96d24315-ae2a-b14f-c483-af9eef04794a",
"resource": {
"resourceType": "Observation",
"id": "96d24315-ae2a-b14f-c483-af9eef04794a",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 14,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9a1596f5-959d-cb65-f018-33060457d9bd",
"resource": {
"resourceType": "Observation",
"id": "9a1596f5-959d-cb65-f018-33060457d9bd",
"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": "2339-0",
"display": "Glucose [Mass/volume] in Blood"
} ],
"text": "Glucose [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 90.51,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6e1ee22a-50dc-f0df-b840-c682d15b3d24",
"resource": {
"resourceType": "Observation",
"id": "6e1ee22a-50dc-f0df-b840-c682d15b3d24",
"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": "6299-2",
"display": "Urea nitrogen [Mass/volume] in Blood"
} ],
"text": "Urea nitrogen [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 8.92,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:998fac68-e421-1844-28b8-c0ce736c99e8",
"resource": {
"resourceType": "Observation",
"id": "998fac68-e421-1844-28b8-c0ce736c99e8",
"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": "38483-4",
"display": "Creatinine [Mass/volume] in Blood"
} ],
"text": "Creatinine [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 0.98,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3b4b4ec2-50bf-d757-77bf-b381ed57716a",
"resource": {
"resourceType": "Observation",
"id": "3b4b4ec2-50bf-d757-77bf-b381ed57716a",
"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": "49765-1",
"display": "Calcium [Mass/volume] in Blood"
} ],
"text": "Calcium [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 9.76,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:cdd60abb-c0a2-9568-dc81-50de92afbc7c",
"resource": {
"resourceType": "Observation",
"id": "cdd60abb-c0a2-9568-dc81-50de92afbc7c",
"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": "2947-0",
"display": "Sodium [Moles/volume] in Blood"
} ],
"text": "Sodium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 136.77,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:206befbe-574e-0ee6-f3ef-69cb768aab13",
"resource": {
"resourceType": "Observation",
"id": "206befbe-574e-0ee6-f3ef-69cb768aab13",
"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": "6298-4",
"display": "Potassium [Moles/volume] in Blood"
} ],
"text": "Potassium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 3.88,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:49d632b1-46a5-fe39-dd2f-4819f3d72b3a",
"resource": {
"resourceType": "Observation",
"id": "49d632b1-46a5-fe39-dd2f-4819f3d72b3a",
"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": "2069-3",
"display": "Chloride [Moles/volume] in Blood"
} ],
"text": "Chloride [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 103.07,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:404bdbe3-5c01-fdce-d10b-e90e33436b48",
"resource": {
"resourceType": "Observation",
"id": "404bdbe3-5c01-fdce-d10b-e90e33436b48",
"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": "20565-8",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ],
"text": "Carbon dioxide, total [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 23.32,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:54757257-d501-b4e4-7619-ca009a62f1e9",
"resource": {
"resourceType": "Observation",
"id": "54757257-d501-b4e4-7619-ca009a62f1e9",
"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": "2093-3",
"display": "Cholesterol [Mass/volume] in Serum or Plasma"
} ],
"text": "Cholesterol [Mass/volume] in Serum or Plasma"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 177.06,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8ad7f5bc-c940-65a4-9ec6-e7dae0a9f7f6",
"resource": {
"resourceType": "Observation",
"id": "8ad7f5bc-c940-65a4-9ec6-e7dae0a9f7f6",
"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": "2571-8",
"display": "Triglycerides"
} ],
"text": "Triglycerides"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 126.55,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e585832a-beea-2e11-9696-dadc662ae008",
"resource": {
"resourceType": "Observation",
"id": "e585832a-beea-2e11-9696-dadc662ae008",
"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": "18262-6",
"display": "Low Density Lipoprotein Cholesterol"
} ],
"text": "Low Density Lipoprotein Cholesterol"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 101.82,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:65b3170c-4567-13b2-b73e-cff42f56ccba",
"resource": {
"resourceType": "Observation",
"id": "65b3170c-4567-13b2-b73e-cff42f56ccba",
"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": "2085-9",
"display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
} ],
"text": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 49.93,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f67c775a-7c44-4032-4a75-6b8a36ea82bc",
"resource": {
"resourceType": "Observation",
"id": "f67c775a-7c44-4032-4a75-6b8a36ea82bc",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 10.291,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:b2df8759-3995-f194-2c40-43c0ce9e0e61",
"resource": {
"resourceType": "Observation",
"id": "b2df8759-3995-f194-2c40-43c0ce9e0e61",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 4.9288,
"unit": "10*6/uL",
"system": "http://unitsofmeasure.org",
"code": "10*6/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8ebff455-fbcc-289f-85af-93e5be5f7153",
"resource": {
"resourceType": "Observation",
"id": "8ebff455-fbcc-289f-85af-93e5be5f7153",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 17.002,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6d645a32-b154-f7ae-8504-e6dd8b684f01",
"resource": {
"resourceType": "Observation",
"id": "6d645a32-b154-f7ae-8504-e6dd8b684f01",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 43.629,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ed5afb32-42a1-b540-4c3e-61b6ca8e34bd",
"resource": {
"resourceType": "Observation",
"id": "ed5afb32-42a1-b540-4c3e-61b6ca8e34bd",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 89.729,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d9b34185-cd5f-82f1-25f0-47f60edb7fbc",
"resource": {
"resourceType": "Observation",
"id": "d9b34185-cd5f-82f1-25f0-47f60edb7fbc",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 30.558,
"unit": "pg",
"system": "http://unitsofmeasure.org",
"code": "pg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7dde8f84-bacb-5bc4-3030-b07ff09c6a32",
"resource": {
"resourceType": "Observation",
"id": "7dde8f84-bacb-5bc4-3030-b07ff09c6a32",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 33.499,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0a1b1114-7d9f-76f2-7789-4e4abf7c4e6f",
"resource": {
"resourceType": "Observation",
"id": "0a1b1114-7d9f-76f2-7789-4e4abf7c4e6f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 40.394,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:388c6ce5-9299-2375-8c58-d660eac47816",
"resource": {
"resourceType": "Observation",
"id": "388c6ce5-9299-2375-8c58-d660eac47816",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 433.26,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:76a7fe9c-3b8e-de08-8730-00e37aeadab7",
"resource": {
"resourceType": "Observation",
"id": "76a7fe9c-3b8e-de08-8730-00e37aeadab7",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 264.89,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e707baf7-20b4-1655-8c4e-f4ff57960a78",
"resource": {
"resourceType": "Observation",
"id": "e707baf7-20b4-1655-8c4e-f4ff57960a78",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueQuantity": {
"value": 10.208,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1b74301b-d02c-ae92-0628-dfaae85065b4",
"resource": {
"resourceType": "Observation",
"id": "1b74301b-d02c-ae92-0628-dfaae85065b4",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Ex-smoker (finding)"
} ],
"text": "Ex-smoker (finding)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5706cab4-423e-563b-a02e-d55f1250c1f6",
"resource": {
"resourceType": "Observation",
"id": "5706cab4-423e-563b-a02e-d55f1250c1f6",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93025-5",
"display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T11:29:15+01:00",
"issued": "2015-12-24T11:29:15.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76501-6",
"display": "Within the last year, have you been afraid of your partner or ex-partner?"
} ],
"text": "Within the last year, have you been afraid of your partner or ex-partner?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93026-3",
"display": "Do you feel physically and emotionally safe where you currently live?"
} ],
"text": "Do you feel physically and emotionally safe where you currently live?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA33-6",
"display": "Yes"
} ],
"text": "Yes"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93027-1",
"display": "Are you a refugee?"
} ],
"text": "Are you a refugee?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93028-9",
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93038-8",
"display": "Stress level"
} ],
"text": "Stress level"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6568-5",
"display": "Not at all"
} ],
"text": "Not at all"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93029-7",
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA27722-0",
"display": "Less than once a week"
} ],
"text": "Less than once a week"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93030-5",
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
} ],
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93031-3",
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30122-8",
"display": "I choose not to answer this question"
} ],
"text": "I choose not to answer this question"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63586-2",
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
},
"valueQuantity": {
"value": 90472,
"unit": "/a",
"system": "http://unitsofmeasure.org",
"code": "/a"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76437-3",
"display": "Primary insurance"
} ],
"text": "Primary insurance"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6350-8",
"display": "Private insurance"
} ],
"text": "Private insurance"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "67875-5",
"display": "Employment status - current"
} ],
"text": "Employment status - current"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30138-4",
"display": "Part-time or temporary work"
} ],
"text": "Part-time or temporary work"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82589-3",
"display": "Highest level of education"
} ],
"text": "Highest level of education"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30191-3",
"display": "Less than high school degree"
} ],
"text": "Less than high school degree"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56799-0",
"display": "Address"
} ],
"text": "Address"
},
"valueString": "217 Bayer Drive Unit 35"
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93033-9",
"display": "Are you worried about losing your housing?"
} ],
"text": "Are you worried about losing your housing?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "71802-3",
"display": "Housing status"
} ],
"text": "Housing status"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30122-8",
"display": "I choose not to answer this question"
} ],
"text": "I choose not to answer this question"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63512-8",
"display": "How many people are living or staying at this address?"
} ],
"text": "How many people are living or staying at this address?"
},
"valueQuantity": {
"value": 5,
"unit": "{#}",
"system": "http://unitsofmeasure.org",
"code": "{#}"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "54899-0",
"display": "Preferred language"
} ],
"text": "Preferred language"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA43-5",
"display": "English"
} ],
"text": "English"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93034-7",
"display": "Have you been discharged from the armed forces of the United States?"
} ],
"text": "Have you been discharged from the armed forces of the United States?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93035-4",
"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "32624-9",
"display": "Race"
} ],
"text": "Race"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA4457-3",
"display": "White"
} ],
"text": "White"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56051-6",
"display": "Do you consider yourself Hispanic/Latino?"
} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:962d2c80-8e07-f536-4c1b-a129b3760ded",
"resource": {
"resourceType": "Observation",
"id": "962d2c80-8e07-f536-4c1b-a129b3760ded",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55758-7",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T12:03:18+01:00",
"issued": "2015-12-24T12:03:18.294+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:117921ea-5341-4356-2bdb-f089cde1ef19",
"resource": {
"resourceType": "Observation",
"id": "117921ea-5341-4356-2bdb-f089cde1ef19",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "75626-2",
"display": "Total score [AUDIT-C]"
} ],
"text": "Total score [AUDIT-C]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T12:38:40+01:00",
"issued": "2015-12-24T12:38:40.294+01:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:df1143b4-7519-a77a-ea42-36b01592a6cb",
"resource": {
"resourceType": "Procedure",
"id": "df1143b4-7519-a77a-ea42-36b01592a6cb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"performedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:d154287c-ff53-a94d-bf13-cc77760c3e72",
"resource": {
"resourceType": "Procedure",
"id": "d154287c-ff53-a94d-bf13-cc77760c3e72",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"performedPeriod": {
"start": "2015-12-24T11:29:15+01:00",
"end": "2015-12-24T11:43:09+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:bd2304d1-1b77-ba70-7e2b-e47011e0106d",
"resource": {
"resourceType": "Procedure",
"id": "bd2304d1-1b77-ba70-7e2b-e47011e0106d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"performedPeriod": {
"start": "2015-12-24T11:43:09+01:00",
"end": "2015-12-24T12:03:18+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a4b4160b-9aa8-4f51-13e0-cc0e207ca245",
"resource": {
"resourceType": "Procedure",
"id": "a4b4160b-9aa8-4f51-13e0-cc0e207ca245",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"performedPeriod": {
"start": "2015-12-24T12:03:18+01:00",
"end": "2015-12-24T12:14:44+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:27588a92-8a27-39ad-2777-8889e90e27ab",
"resource": {
"resourceType": "Procedure",
"id": "27588a92-8a27-39ad-2777-8889e90e27ab",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"performedPeriod": {
"start": "2015-12-24T12:14:44+01:00",
"end": "2015-12-24T12:38:40+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:23e0fad1-015d-a1b1-e052-c729a147c906",
"resource": {
"resourceType": "Immunization",
"id": "23e0fad1-015d-a1b1-e052-c729a147c906",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"occurrenceDateTime": "2015-12-24T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:2f14ef2e-45e5-f772-fef2-dc20c7bbcb55",
"resource": {
"resourceType": "DiagnosticReport",
"id": "2f14ef2e-45e5-f772-fef2-dc20c7bbcb55",
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:9a1596f5-959d-cb65-f018-33060457d9bd",
"display": "Glucose [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:6e1ee22a-50dc-f0df-b840-c682d15b3d24",
"display": "Urea nitrogen [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:998fac68-e421-1844-28b8-c0ce736c99e8",
"display": "Creatinine [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:3b4b4ec2-50bf-d757-77bf-b381ed57716a",
"display": "Calcium [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:cdd60abb-c0a2-9568-dc81-50de92afbc7c",
"display": "Sodium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:206befbe-574e-0ee6-f3ef-69cb768aab13",
"display": "Potassium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:49d632b1-46a5-fe39-dd2f-4819f3d72b3a",
"display": "Chloride [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:404bdbe3-5c01-fdce-d10b-e90e33436b48",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:8e8b07ca-6253-dad3-c1f1-cbdc352caa6b",
"resource": {
"resourceType": "DiagnosticReport",
"id": "8e8b07ca-6253-dad3-c1f1-cbdc352caa6b",
"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": "57698-3",
"display": "Lipid panel with direct LDL - Serum or Plasma"
} ],
"text": "Lipid panel with direct LDL - Serum or Plasma"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:54757257-d501-b4e4-7619-ca009a62f1e9",
"display": "Cholesterol [Mass/volume] in Serum or Plasma"
}, {
"reference": "urn:uuid:8ad7f5bc-c940-65a4-9ec6-e7dae0a9f7f6",
"display": "Triglycerides"
}, {
"reference": "urn:uuid:e585832a-beea-2e11-9696-dadc662ae008",
"display": "Low Density Lipoprotein Cholesterol"
}, {
"reference": "urn:uuid:65b3170c-4567-13b2-b73e-cff42f56ccba",
"display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ea516937-2e10-3b82-fde2-9588b5023187",
"resource": {
"resourceType": "DiagnosticReport",
"id": "ea516937-2e10-3b82-fde2-9588b5023187",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:f67c775a-7c44-4032-4a75-6b8a36ea82bc",
"display": "Leukocytes [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:b2df8759-3995-f194-2c40-43c0ce9e0e61",
"display": "Erythrocytes [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:8ebff455-fbcc-289f-85af-93e5be5f7153",
"display": "Hemoglobin [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:6d645a32-b154-f7ae-8504-e6dd8b684f01",
"display": "Hematocrit [Volume Fraction] of Blood by Automated count"
}, {
"reference": "urn:uuid:ed5afb32-42a1-b540-4c3e-61b6ca8e34bd",
"display": "MCV [Entitic volume] by Automated count"
}, {
"reference": "urn:uuid:d9b34185-cd5f-82f1-25f0-47f60edb7fbc",
"display": "MCH [Entitic mass] by Automated count"
}, {
"reference": "urn:uuid:7dde8f84-bacb-5bc4-3030-b07ff09c6a32",
"display": "MCHC [Mass/volume] by Automated count"
}, {
"reference": "urn:uuid:0a1b1114-7d9f-76f2-7789-4e4abf7c4e6f",
"display": "Erythrocyte distribution width [Entitic volume] by Automated count"
}, {
"reference": "urn:uuid:388c6ce5-9299-2375-8c58-d660eac47816",
"display": "Platelets [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:76a7fe9c-3b8e-de08-8730-00e37aeadab7",
"display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:e707baf7-20b4-1655-8c4e-f4ff57960a78",
"display": "Platelet mean volume [Entitic volume] in Blood by Automated count"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:08b0c0d8-7b04-f15c-000b-785edb9301a6",
"resource": {
"resourceType": "DiagnosticReport",
"id": "08b0c0d8-7b04-f15c-000b-785edb9301a6",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T12:03:18+01:00",
"issued": "2015-12-24T12:03:18.294+01:00",
"result": [ {
"reference": "urn:uuid:962d2c80-8e07-f536-4c1b-a129b3760ded",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:322e753e-c30d-02a0-a5c5-c8b44b2a215b",
"resource": {
"resourceType": "DiagnosticReport",
"id": "322e753e-c30d-02a0-a5c5-c8b44b2a215b",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T12:38:40+01:00",
"issued": "2015-12-24T12:38:40.294+01:00",
"result": [ {
"reference": "urn:uuid:117921ea-5341-4356-2bdb-f089cde1ef19",
"display": "Total score [AUDIT-C]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:c5b5e2ab-5473-fe60-38a7-6816e51cd24b",
"resource": {
"resourceType": "DiagnosticReport",
"id": "c5b5e2ab-5473-fe60-38a7-6816e51cd24b",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
},
"effectiveDateTime": "2015-12-24T10:29:53+01:00",
"issued": "2015-12-24T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:7c81dd48-a26b-007c-c321-30e02e9e5d01",
"resource": {
"resourceType": "DocumentReference",
"id": "7c81dd48-a26b-007c-c321-30e02e9e5d01",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:c5b5e2ab-5473-fe60-38a7-6816e51cd24b"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2015-12-24T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
} ],
"period": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:313cc8cb-b296-1eec-a9ca-ad074e4c1950",
"resource": {
"resourceType": "Claim",
"id": "313cc8cb-b296-1eec-a9ca-ad074e4c1950",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"created": "2015-12-24T11:29:15+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:23e0fad1-015d-a1b1-e052-c729a147c906"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:9a665041-0c35-85e7-8df5-a5b1aac70733"
}
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:c6c0c521-ed43-659b-242b-08c0ac818803"
}
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:a1c950ae-e65d-4f1a-2d37-3f8eda4281a4"
}
}, {
"sequence": 4,
"diagnosisReference": {
"reference": "urn:uuid:d1b20e3d-f335-bc66-4519-9c0bd81a60b4"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:df1143b4-7519-a77a-ea42-36b01592a6cb"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:d154287c-ff53-a94d-bf13-cc77760c3e72"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:bd2304d1-1b77-ba70-7e2b-e47011e0106d"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:a4b4160b-9aa8-4f51-13e0-cc0e207ca245"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:27588a92-8a27-39ad-2777-8889e90e27ab"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
} ]
}, {
"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,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "57698-3",
"display": "Lipid panel with direct LDL - Serum or Plasma"
} ],
"text": "Lipid panel with direct LDL - Serum or Plasma"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 6,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "58410-2",
"display": "CBC panel - Blood by Automated count"
} ],
"text": "CBC panel - Blood by Automated count"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 7,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 8,
"diagnosisSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160904001",
"display": "Part-time employment (finding)"
} ],
"text": "Part-time employment (finding)"
}
}, {
"sequence": 9,
"diagnosisSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "422650009",
"display": "Social isolation (finding)"
} ],
"text": "Social isolation (finding)"
}
}, {
"sequence": 10,
"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": 11,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 12,
"informationSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 13,
"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": 14,
"procedureSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 15,
"diagnosisSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "10939881000119105",
"display": "Unhealthy alcohol drinking behavior (finding)"
} ],
"text": "Unhealthy alcohol drinking behavior (finding)"
}
}, {
"sequence": 16,
"informationSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
} ],
"total": {
"value": 927.94,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:59257687-71d7-0f9d-9bce-0d7e888b5d4b",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "59257687-71d7-0f9d-9bce-0d7e888b5d4b",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "313cc8cb-b296-1eec-a9ca-ad074e4c1950"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2015-12-24T11:29:15+01:00",
"end": "2016-12-24T11:29:15+01:00"
},
"created": "2015-12-24T11:29:15+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:313cc8cb-b296-1eec-a9ca-ad074e4c1950"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:9a665041-0c35-85e7-8df5-a5b1aac70733"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:c6c0c521-ed43-659b-242b-08c0ac818803"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:a1c950ae-e65d-4f1a-2d37-3f8eda4281a4"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 4,
"diagnosisReference": {
"reference": "urn:uuid:d1b20e3d-f335-bc66-4519-9c0bd81a60b4"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
} ]
}, {
"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": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 4,
"informationSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 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": "57698-3",
"display": "Lipid panel with direct LDL - Serum or Plasma"
} ],
"text": "Lipid panel with direct LDL - Serum or Plasma"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"informationSequence": [ 4 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "58410-2",
"display": "CBC panel - Blood by Automated count"
} ],
"text": "CBC panel - Blood by Automated count"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"diagnosisSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160904001",
"display": "Part-time employment (finding)"
} ],
"text": "Part-time employment (finding)"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 9,
"diagnosisSequence": [ 3 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "422650009",
"display": "Social isolation (finding)"
} ],
"text": "Social isolation (finding)"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 10,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 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": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 12,
"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": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 13,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 14,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 15,
"diagnosisSequence": [ 4 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "10939881000119105",
"display": "Unhealthy alcohol drinking behavior (finding)"
} ],
"text": "Unhealthy alcohol drinking behavior (finding)"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 16,
"informationSequence": [ 6 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"servicedPeriod": {
"start": "2015-12-24T10:29:53+01:00",
"end": "2015-12-24T11:29:15+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 927.94,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2132.7200000000003,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:d9ad4cdb-db53-ba65-f1d2-b62c52f3f72c",
"resource": {
"resourceType": "Encounter",
"id": "d9ad4cdb-db53-ba65-f1d2-b62c52f3f72c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "d9ad4cdb-db53-ba65-f1d2-b62c52f3f72c"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2016-02-18T10:29:53+01:00",
"end": "2016-02-18T10:44:53+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2016-02-18T10:29:53+01:00",
"end": "2016-02-18T10:44:53+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:d405b88a-3622-faf0-baaf-d3ba75f96ad1",
"resource": {
"resourceType": "Procedure",
"id": "d405b88a-3622-faf0-baaf-d3ba75f96ad1",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:d9ad4cdb-db53-ba65-f1d2-b62c52f3f72c"
},
"performedPeriod": {
"start": "2016-02-18T10:29:53+01:00",
"end": "2016-02-18T10:43:26+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a16a8862-ab81-78d8-40be-1feededdfe1f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a16a8862-ab81-78d8-40be-1feededdfe1f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:d9ad4cdb-db53-ba65-f1d2-b62c52f3f72c"
},
"effectiveDateTime": "2016-02-18T10:29:53+01:00",
"issued": "2016-02-18T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:aa8f1f02-0d1a-affd-8eb9-53fca9d71158",
"resource": {
"resourceType": "DocumentReference",
"id": "aa8f1f02-0d1a-affd-8eb9-53fca9d71158",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:a16a8862-ab81-78d8-40be-1feededdfe1f"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2016-02-18T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:d9ad4cdb-db53-ba65-f1d2-b62c52f3f72c"
} ],
"period": {
"start": "2016-02-18T10:29:53+01:00",
"end": "2016-02-18T10:44:53+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:c0c68bb5-be7c-6a18-4f15-3c8a19398472",
"resource": {
"resourceType": "Claim",
"id": "c0c68bb5-be7c-6a18-4f15-3c8a19398472",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2016-02-18T10:29:53+01:00",
"end": "2016-02-18T10:44:53+01:00"
},
"created": "2016-02-18T10:44:53+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:d405b88a-3622-faf0-baaf-d3ba75f96ad1"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:d9ad4cdb-db53-ba65-f1d2-b62c52f3f72c"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 1851.94,
"currency": "USD"
}
} ],
"total": {
"value": 1994.52,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:fedc2f26-71fe-57dc-d012-e831146c3a79",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "fedc2f26-71fe-57dc-d012-e831146c3a79",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "c0c68bb5-be7c-6a18-4f15-3c8a19398472"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2016-02-18T10:44:53+01:00",
"end": "2017-02-18T10:44:53+01:00"
},
"created": "2016-02-18T10:44:53+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:c0c68bb5-be7c-6a18-4f15-3c8a19398472"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2016-02-18T10:29:53+01:00",
"end": "2016-02-18T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:d9ad4cdb-db53-ba65-f1d2-b62c52f3f72c"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2016-02-18T10:29:53+01:00",
"end": "2016-02-18T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1851.94,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 370.38800000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1481.5520000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 1851.94,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 1851.94,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 1994.52,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1481.5520000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:ff049f5d-1b48-3e40-2eef-ebf38a3a832b",
"resource": {
"resourceType": "Encounter",
"id": "ff049f5d-1b48-3e40-2eef-ebf38a3a832b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "ff049f5d-1b48-3e40-2eef-ebf38a3a832b"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2016-05-19T11:29:53+02:00",
"end": "2016-05-19T11:49:19+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2016-05-19T11:29:53+02:00",
"end": "2016-05-19T11:49:19+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:48dcbfdb-7db5-34b4-89e3-bb229a8e91e5",
"resource": {
"resourceType": "Procedure",
"id": "48dcbfdb-7db5-34b4-89e3-bb229a8e91e5",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:ff049f5d-1b48-3e40-2eef-ebf38a3a832b"
},
"performedPeriod": {
"start": "2016-05-19T11:29:53+02:00",
"end": "2016-05-19T11:49:19+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:0466ccb8-02e0-e8b0-1981-4a066111b622",
"resource": {
"resourceType": "DiagnosticReport",
"id": "0466ccb8-02e0-e8b0-1981-4a066111b622",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:ff049f5d-1b48-3e40-2eef-ebf38a3a832b"
},
"effectiveDateTime": "2016-05-19T11:29:53+02:00",
"issued": "2016-05-19T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:72b3d5c0-0040-a375-f81f-6668d42b1666",
"resource": {
"resourceType": "DocumentReference",
"id": "72b3d5c0-0040-a375-f81f-6668d42b1666",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:0466ccb8-02e0-e8b0-1981-4a066111b622"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2016-05-19T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:ff049f5d-1b48-3e40-2eef-ebf38a3a832b"
} ],
"period": {
"start": "2016-05-19T11:29:53+02:00",
"end": "2016-05-19T11:49:19+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:7df58aff-b099-ce96-394f-de6cec37040b",
"resource": {
"resourceType": "Claim",
"id": "7df58aff-b099-ce96-394f-de6cec37040b",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2016-05-19T11:29:53+02:00",
"end": "2016-05-19T11:49:19+02:00"
},
"created": "2016-05-19T11:49:19+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:48dcbfdb-7db5-34b4-89e3-bb229a8e91e5"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:ff049f5d-1b48-3e40-2eef-ebf38a3a832b"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 1452.14,
"currency": "USD"
}
} ],
"total": {
"value": 1594.72,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:e15da1de-d149-9fb2-8b86-54ab525d0b43",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "e15da1de-d149-9fb2-8b86-54ab525d0b43",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "7df58aff-b099-ce96-394f-de6cec37040b"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2016-05-19T11:49:19+02:00",
"end": "2017-05-19T11:49:19+02:00"
},
"created": "2016-05-19T11:49:19+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:7df58aff-b099-ce96-394f-de6cec37040b"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2016-05-19T11:29:53+02:00",
"end": "2016-05-19T11:49:19+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:ff049f5d-1b48-3e40-2eef-ebf38a3a832b"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2016-05-19T11:29:53+02:00",
"end": "2016-05-19T11:49:19+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1452.14,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 290.42800000000005,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1161.7120000000002,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 1452.14,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 1452.14,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 1594.72,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1161.7120000000002,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:b2b46933-cdf5-b71d-d01d-2398be4d39ef",
"resource": {
"resourceType": "Encounter",
"id": "b2b46933-cdf5-b71d-d01d-2398be4d39ef",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "b2b46933-cdf5-b71d-d01d-2398be4d39ef"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2016-08-18T11:29:53+02:00",
"end": "2016-08-18T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2016-08-18T11:29:53+02:00",
"end": "2016-08-18T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:e1254f76-4354-e73b-8fe9-97417c1f3133",
"resource": {
"resourceType": "Procedure",
"id": "e1254f76-4354-e73b-8fe9-97417c1f3133",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:b2b46933-cdf5-b71d-d01d-2398be4d39ef"
},
"performedPeriod": {
"start": "2016-08-18T11:29:53+02:00",
"end": "2016-08-18T11:44:06+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a6dc441c-fa40-3ab5-bf32-fd27877ee1e4",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a6dc441c-fa40-3ab5-bf32-fd27877ee1e4",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:b2b46933-cdf5-b71d-d01d-2398be4d39ef"
},
"effectiveDateTime": "2016-08-18T11:29:53+02:00",
"issued": "2016-08-18T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ef475c6c-4762-6bdf-e480-d52f7d2ac049",
"resource": {
"resourceType": "DocumentReference",
"id": "ef475c6c-4762-6bdf-e480-d52f7d2ac049",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:a6dc441c-fa40-3ab5-bf32-fd27877ee1e4"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2016-08-18T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:b2b46933-cdf5-b71d-d01d-2398be4d39ef"
} ],
"period": {
"start": "2016-08-18T11:29:53+02:00",
"end": "2016-08-18T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:6ffebfbd-d7f0-c1d7-abe5-e331ce7799bc",
"resource": {
"resourceType": "Claim",
"id": "6ffebfbd-d7f0-c1d7-abe5-e331ce7799bc",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2016-08-18T11:29:53+02:00",
"end": "2016-08-18T11:44:53+02:00"
},
"created": "2016-08-18T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:e1254f76-4354-e73b-8fe9-97417c1f3133"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:b2b46933-cdf5-b71d-d01d-2398be4d39ef"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2727.85,
"currency": "USD"
}
} ],
"total": {
"value": 2870.43,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:ee7a54ea-c55c-c9f2-29f3-fd8e21e21b47",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "ee7a54ea-c55c-c9f2-29f3-fd8e21e21b47",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "6ffebfbd-d7f0-c1d7-abe5-e331ce7799bc"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2016-08-18T11:44:53+02:00",
"end": "2017-08-18T11:44:53+02:00"
},
"created": "2016-08-18T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:6ffebfbd-d7f0-c1d7-abe5-e331ce7799bc"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2016-08-18T11:29:53+02:00",
"end": "2016-08-18T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:b2b46933-cdf5-b71d-d01d-2398be4d39ef"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2016-08-18T11:29:53+02:00",
"end": "2016-08-18T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2727.85,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 545.57,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2182.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2727.85,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2727.85,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2870.43,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2182.28,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:834321df-c050-2e9e-b058-5412c10714e2",
"resource": {
"resourceType": "Encounter",
"id": "834321df-c050-2e9e-b058-5412c10714e2",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "834321df-c050-2e9e-b058-5412c10714e2"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2016-11-17T10:29:53+01:00",
"end": "2016-11-17T10:49:18+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2016-11-17T10:29:53+01:00",
"end": "2016-11-17T10:49:18+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:050f9895-f222-60bb-7919-d29b49c10758",
"resource": {
"resourceType": "Procedure",
"id": "050f9895-f222-60bb-7919-d29b49c10758",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:834321df-c050-2e9e-b058-5412c10714e2"
},
"performedPeriod": {
"start": "2016-11-17T10:29:53+01:00",
"end": "2016-11-17T10:49:18+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:60d121b0-4870-c8ef-0f13-c4fff23c8f05",
"resource": {
"resourceType": "DiagnosticReport",
"id": "60d121b0-4870-c8ef-0f13-c4fff23c8f05",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:834321df-c050-2e9e-b058-5412c10714e2"
},
"effectiveDateTime": "2016-11-17T10:29:53+01:00",
"issued": "2016-11-17T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:f214c916-14c2-fd9f-5045-968829dd7aee",
"resource": {
"resourceType": "DocumentReference",
"id": "f214c916-14c2-fd9f-5045-968829dd7aee",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:60d121b0-4870-c8ef-0f13-c4fff23c8f05"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2016-11-17T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:834321df-c050-2e9e-b058-5412c10714e2"
} ],
"period": {
"start": "2016-11-17T10:29:53+01:00",
"end": "2016-11-17T10:49:18+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:7c16adf9-a8b3-989d-7b9d-f45b864da168",
"resource": {
"resourceType": "Claim",
"id": "7c16adf9-a8b3-989d-7b9d-f45b864da168",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2016-11-17T10:29:53+01:00",
"end": "2016-11-17T10:49:18+01:00"
},
"created": "2016-11-17T10:49:18+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:050f9895-f222-60bb-7919-d29b49c10758"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:834321df-c050-2e9e-b058-5412c10714e2"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 3885.87,
"currency": "USD"
}
} ],
"total": {
"value": 4028.45,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:09fa0a1e-53b4-3819-bb6a-51c2a1627ac1",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "09fa0a1e-53b4-3819-bb6a-51c2a1627ac1",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "7c16adf9-a8b3-989d-7b9d-f45b864da168"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2016-11-17T10:49:18+01:00",
"end": "2017-11-17T10:49:18+01:00"
},
"created": "2016-11-17T10:49:18+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:7c16adf9-a8b3-989d-7b9d-f45b864da168"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2016-11-17T10:29:53+01:00",
"end": "2016-11-17T10:49:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:834321df-c050-2e9e-b058-5412c10714e2"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2016-11-17T10:29:53+01:00",
"end": "2016-11-17T10:49:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 3885.87,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 777.174,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 3108.696,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 3885.87,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 3885.87,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 4028.45,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 3108.696,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:e539edc5-efb0-89f1-344e-b3cc11aa09ba",
"resource": {
"resourceType": "Encounter",
"id": "e539edc5-efb0-89f1-344e-b3cc11aa09ba",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "e539edc5-efb0-89f1-344e-b3cc11aa09ba"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2017-02-16T10:29:53+01:00",
"end": "2017-02-16T10:44:53+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2017-02-16T10:29:53+01:00",
"end": "2017-02-16T10:44:53+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:686b0a6e-5472-eb6c-f5f0-00c6c215b0bf",
"resource": {
"resourceType": "Procedure",
"id": "686b0a6e-5472-eb6c-f5f0-00c6c215b0bf",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e539edc5-efb0-89f1-344e-b3cc11aa09ba"
},
"performedPeriod": {
"start": "2017-02-16T10:29:53+01:00",
"end": "2017-02-16T10:44:27+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:3b2390bc-c5f7-2f31-749c-53f28e4b9926",
"resource": {
"resourceType": "DiagnosticReport",
"id": "3b2390bc-c5f7-2f31-749c-53f28e4b9926",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e539edc5-efb0-89f1-344e-b3cc11aa09ba"
},
"effectiveDateTime": "2017-02-16T10:29:53+01:00",
"issued": "2017-02-16T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:2c40f566-9633-7562-cf90-9f325c4923a4",
"resource": {
"resourceType": "DocumentReference",
"id": "2c40f566-9633-7562-cf90-9f325c4923a4",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:3b2390bc-c5f7-2f31-749c-53f28e4b9926"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2017-02-16T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:e539edc5-efb0-89f1-344e-b3cc11aa09ba"
} ],
"period": {
"start": "2017-02-16T10:29:53+01:00",
"end": "2017-02-16T10:44:53+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:8f587f15-0b3a-c192-08dc-ce403954efa0",
"resource": {
"resourceType": "Claim",
"id": "8f587f15-0b3a-c192-08dc-ce403954efa0",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2017-02-16T10:29:53+01:00",
"end": "2017-02-16T10:44:53+01:00"
},
"created": "2017-02-16T10:44:53+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:686b0a6e-5472-eb6c-f5f0-00c6c215b0bf"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:e539edc5-efb0-89f1-344e-b3cc11aa09ba"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 1434.98,
"currency": "USD"
}
} ],
"total": {
"value": 1577.56,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c0532460-e1ef-41ea-1cd8-75d267942a8e",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c0532460-e1ef-41ea-1cd8-75d267942a8e",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "8f587f15-0b3a-c192-08dc-ce403954efa0"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2017-02-16T10:44:53+01:00",
"end": "2018-02-16T10:44:53+01:00"
},
"created": "2017-02-16T10:44:53+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:8f587f15-0b3a-c192-08dc-ce403954efa0"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2017-02-16T10:29:53+01:00",
"end": "2017-02-16T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:e539edc5-efb0-89f1-344e-b3cc11aa09ba"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2017-02-16T10:29:53+01:00",
"end": "2017-02-16T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1434.98,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 286.99600000000004,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1147.9840000000002,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 1434.98,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 1434.98,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 1577.56,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1147.9840000000002,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab",
"resource": {
"resourceType": "Encounter",
"id": "adebe898-cb4a-3c89-103f-14f7e69a63ab",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "adebe898-cb4a-3c89-103f-14f7e69a63ab"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:219a7b20-257b-5fcf-722f-5e408187d8a5",
"resource": {
"resourceType": "Condition",
"id": "219a7b20-257b-5fcf-722f-5e408187d8a5",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "424393004",
"display": "Reports of violence in the environment (finding)"
} ],
"text": "Reports of violence in the environment (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"onsetDateTime": "2017-04-20T12:27:07+02:00",
"abatementDateTime": "2017-12-28T11:13:20+01:00",
"recordedDate": "2017-04-20T12:27:07+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:e89b9006-f8f6-860b-1980-085c8b959a13",
"resource": {
"resourceType": "Observation",
"id": "e89b9006-f8f6-860b-1980-085c8b959a13",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
} ],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 5.89,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:bf0d9a8f-c03c-db57-6d4c-516f6f99f9ce",
"resource": {
"resourceType": "Observation",
"id": "bf0d9a8f-c03c-db57-6d4c-516f6f99f9ce",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 170.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3ec20e26-cd07-627d-5d75-4760c28ac2b7",
"resource": {
"resourceType": "Observation",
"id": "3ec20e26-cd07-627d-5d75-4760c28ac2b7",
"status": "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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e5a733e9-59a1-33f4-dc46-88eacbea420b",
"resource": {
"resourceType": "Observation",
"id": "e5a733e9-59a1-33f4-dc46-88eacbea420b",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 88.1,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8a759397-c6af-1c7b-43d3-9011208f2420",
"resource": {
"resourceType": "Observation",
"id": "8a759397-c6af-1c7b-43d3-9011208f2420",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 30.38,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:abaf5a02-a9e4-f55d-9060-2f2213d6d6a4",
"resource": {
"resourceType": "Observation",
"id": "abaf5a02-a9e4-f55d-9060-2f2213d6d6a4",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 87,
"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": 116,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7ea32815-4573-2e58-ad37-37cd9fba266e",
"resource": {
"resourceType": "Observation",
"id": "7ea32815-4573-2e58-ad37-37cd9fba266e",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 82,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f27f4638-edff-949f-44e7-b91179c5b134",
"resource": {
"resourceType": "Observation",
"id": "f27f4638-edff-949f-44e7-b91179c5b134",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 15,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:635acba2-513b-ce64-b4a2-7b33d6d9c0b3",
"resource": {
"resourceType": "Observation",
"id": "635acba2-513b-ce64-b4a2-7b33d6d9c0b3",
"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": "2339-0",
"display": "Glucose [Mass/volume] in Blood"
} ],
"text": "Glucose [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 83.15,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:b47aae3c-fd6d-4b30-ee17-285a5b71ecf9",
"resource": {
"resourceType": "Observation",
"id": "b47aae3c-fd6d-4b30-ee17-285a5b71ecf9",
"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": "6299-2",
"display": "Urea nitrogen [Mass/volume] in Blood"
} ],
"text": "Urea nitrogen [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 7.26,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:72088064-4317-6fb6-280d-c32067df02e7",
"resource": {
"resourceType": "Observation",
"id": "72088064-4317-6fb6-280d-c32067df02e7",
"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": "38483-4",
"display": "Creatinine [Mass/volume] in Blood"
} ],
"text": "Creatinine [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 1.52,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:b297044e-ddd8-9638-6709-a93572701538",
"resource": {
"resourceType": "Observation",
"id": "b297044e-ddd8-9638-6709-a93572701538",
"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": "49765-1",
"display": "Calcium [Mass/volume] in Blood"
} ],
"text": "Calcium [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 8.88,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:879802c9-bb6c-3129-4b81-ab2f0a2d19c1",
"resource": {
"resourceType": "Observation",
"id": "879802c9-bb6c-3129-4b81-ab2f0a2d19c1",
"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": "2947-0",
"display": "Sodium [Moles/volume] in Blood"
} ],
"text": "Sodium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 137.37,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c2cc5928-2dd9-f413-38e1-4d9ce94796fa",
"resource": {
"resourceType": "Observation",
"id": "c2cc5928-2dd9-f413-38e1-4d9ce94796fa",
"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": "6298-4",
"display": "Potassium [Moles/volume] in Blood"
} ],
"text": "Potassium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 4.84,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:79d27276-c3f4-26ba-df34-87582daa25bc",
"resource": {
"resourceType": "Observation",
"id": "79d27276-c3f4-26ba-df34-87582daa25bc",
"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": "2069-3",
"display": "Chloride [Moles/volume] in Blood"
} ],
"text": "Chloride [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 106.01,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a2869ff3-90c5-8682-dda0-911dc557cb4c",
"resource": {
"resourceType": "Observation",
"id": "a2869ff3-90c5-8682-dda0-911dc557cb4c",
"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": "20565-8",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ],
"text": "Carbon dioxide, total [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueQuantity": {
"value": 28.37,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a58c08d4-8a0e-9b28-6c2e-7759f5fff3bf",
"resource": {
"resourceType": "Observation",
"id": "a58c08d4-8a0e-9b28-6c2e-7759f5fff3bf",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Ex-smoker (finding)"
} ],
"text": "Ex-smoker (finding)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9998dd61-fc0b-6fcc-74dc-8885916cecdc",
"resource": {
"resourceType": "Observation",
"id": "9998dd61-fc0b-6fcc-74dc-8885916cecdc",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93025-5",
"display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T12:27:07+02:00",
"issued": "2017-04-20T12:27:07.294+02:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76501-6",
"display": "Within the last year, have you been afraid of your partner or ex-partner?"
} ],
"text": "Within the last year, have you been afraid of your partner or ex-partner?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93026-3",
"display": "Do you feel physically and emotionally safe where you currently live?"
} ],
"text": "Do you feel physically and emotionally safe where you currently live?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93027-1",
"display": "Are you a refugee?"
} ],
"text": "Are you a refugee?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93028-9",
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93038-8",
"display": "Stress level"
} ],
"text": "Stress level"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6568-5",
"display": "Not at all"
} ],
"text": "Not at all"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93029-7",
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30131-9",
"display": "3 to 5 times a week"
} ],
"text": "3 to 5 times a week"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93030-5",
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
} ],
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93031-3",
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30122-8",
"display": "I choose not to answer this question"
} ],
"text": "I choose not to answer this question"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63586-2",
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
},
"valueQuantity": {
"value": 90472,
"unit": "/a",
"system": "http://unitsofmeasure.org",
"code": "/a"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76437-3",
"display": "Primary insurance"
} ],
"text": "Primary insurance"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6350-8",
"display": "Private insurance"
} ],
"text": "Private insurance"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "67875-5",
"display": "Employment status - current"
} ],
"text": "Employment status - current"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30138-4",
"display": "Part-time or temporary work"
} ],
"text": "Part-time or temporary work"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82589-3",
"display": "Highest level of education"
} ],
"text": "Highest level of education"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30191-3",
"display": "Less than high school degree"
} ],
"text": "Less than high school degree"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56799-0",
"display": "Address"
} ],
"text": "Address"
},
"valueString": "217 Bayer Drive Unit 35"
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93033-9",
"display": "Are you worried about losing your housing?"
} ],
"text": "Are you worried about losing your housing?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "71802-3",
"display": "Housing status"
} ],
"text": "Housing status"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30189-7",
"display": "I have housing"
} ],
"text": "I have housing"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63512-8",
"display": "How many people are living or staying at this address?"
} ],
"text": "How many people are living or staying at this address?"
},
"valueQuantity": {
"value": 5,
"unit": "{#}",
"system": "http://unitsofmeasure.org",
"code": "{#}"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "54899-0",
"display": "Preferred language"
} ],
"text": "Preferred language"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA43-5",
"display": "English"
} ],
"text": "English"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93034-7",
"display": "Have you been discharged from the armed forces of the United States?"
} ],
"text": "Have you been discharged from the armed forces of the United States?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93035-4",
"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "32624-9",
"display": "Race"
} ],
"text": "Race"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA4457-3",
"display": "White"
} ],
"text": "White"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56051-6",
"display": "Do you consider yourself Hispanic/Latino?"
} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c9208a04-fa2a-68cd-b7b1-7a3eb6c36b44",
"resource": {
"resourceType": "Observation",
"id": "c9208a04-fa2a-68cd-b7b1-7a3eb6c36b44",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T12:54:29+02:00",
"issued": "2017-04-20T12:54:29.294+02:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:109df281-93bf-901e-c95e-771f0989b54a",
"resource": {
"resourceType": "Observation",
"id": "109df281-93bf-901e-c95e-771f0989b54a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55758-7",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T13:34:47+02:00",
"issued": "2017-04-20T13:34:47.294+02:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:edca1344-df2e-ca46-a642-545d1d40bd90",
"resource": {
"resourceType": "Observation",
"id": "edca1344-df2e-ca46-a642-545d1d40bd90",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "75626-2",
"display": "Total score [AUDIT-C]"
} ],
"text": "Total score [AUDIT-C]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T14:08:01+02:00",
"issued": "2017-04-20T14:08:01.294+02:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8b5733aa-582a-856a-56fb-84611396b3f6",
"resource": {
"resourceType": "Procedure",
"id": "8b5733aa-582a-856a-56fb-84611396b3f6",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"performedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T11:44:53+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:88a58732-b431-5ae7-1f60-9c63e231acd6",
"resource": {
"resourceType": "Procedure",
"id": "88a58732-b431-5ae7-1f60-9c63e231acd6",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"performedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:20243a05-588d-24a8-4e13-a2d5f64bc48a",
"resource": {
"resourceType": "Procedure",
"id": "20243a05-588d-24a8-4e13-a2d5f64bc48a",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"performedPeriod": {
"start": "2017-04-20T12:27:07+02:00",
"end": "2017-04-20T12:54:29+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a2b7f759-2de9-004a-dd61-fc68c2534b63",
"resource": {
"resourceType": "Procedure",
"id": "a2b7f759-2de9-004a-dd61-fc68c2534b63",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"performedPeriod": {
"start": "2017-04-20T12:54:29+02:00",
"end": "2017-04-20T13:07:01+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:ca7ccf2e-255f-0452-8695-20ea2906ca76",
"resource": {
"resourceType": "Procedure",
"id": "ca7ccf2e-255f-0452-8695-20ea2906ca76",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"performedPeriod": {
"start": "2017-04-20T13:07:01+02:00",
"end": "2017-04-20T13:34:47+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:98e3352c-60db-7b5f-bfb2-313fbabc4bb2",
"resource": {
"resourceType": "Procedure",
"id": "98e3352c-60db-7b5f-bfb2-313fbabc4bb2",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"performedPeriod": {
"start": "2017-04-20T13:34:47+02:00",
"end": "2017-04-20T13:47:10+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:cca102f9-2698-2d80-565f-eb4a4bcdfa85",
"resource": {
"resourceType": "Procedure",
"id": "cca102f9-2698-2d80-565f-eb4a4bcdfa85",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"performedPeriod": {
"start": "2017-04-20T13:47:10+02:00",
"end": "2017-04-20T14:08:01+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:86d9d715-f5c7-1894-04f8-47275146490e",
"resource": {
"resourceType": "SupplyDelivery",
"id": "86d9d715-f5c7-1894-04f8-47275146490e",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2017-04-20T11:29:53+02:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:48d32b3f-7b7d-ce80-3b50-04977671d16d",
"resource": {
"resourceType": "SupplyDelivery",
"id": "48d32b3f-7b7d-ce80-3b50-04977671d16d",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 100
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
}
},
"occurrenceDateTime": "2017-04-20T11:29:53+02:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:41228a53-9830-50ec-db59-0b2c6429ecc9",
"resource": {
"resourceType": "Immunization",
"id": "41228a53-9830-50ec-db59-0b2c6429ecc9",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"occurrenceDateTime": "2017-04-20T11:29:53+02:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:562c04c0-e9b1-5a0d-dae1-9a6057d86f97",
"resource": {
"resourceType": "DiagnosticReport",
"id": "562c04c0-e9b1-5a0d-dae1-9a6057d86f97",
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
} ],
"result": [ {
"reference": "urn:uuid:635acba2-513b-ce64-b4a2-7b33d6d9c0b3",
"display": "Glucose [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:b47aae3c-fd6d-4b30-ee17-285a5b71ecf9",
"display": "Urea nitrogen [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:72088064-4317-6fb6-280d-c32067df02e7",
"display": "Creatinine [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:b297044e-ddd8-9638-6709-a93572701538",
"display": "Calcium [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:879802c9-bb6c-3129-4b81-ab2f0a2d19c1",
"display": "Sodium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:c2cc5928-2dd9-f413-38e1-4d9ce94796fa",
"display": "Potassium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:79d27276-c3f4-26ba-df34-87582daa25bc",
"display": "Chloride [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:a2869ff3-90c5-8682-dda0-911dc557cb4c",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:791044ca-a0c0-24e0-ef9b-dfcb409c0386",
"resource": {
"resourceType": "DiagnosticReport",
"id": "791044ca-a0c0-24e0-ef9b-dfcb409c0386",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T12:54:29+02:00",
"issued": "2017-04-20T12:54:29.294+02:00",
"result": [ {
"reference": "urn:uuid:c9208a04-fa2a-68cd-b7b1-7a3eb6c36b44",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:76d4cc07-5a95-c7f3-8045-92614b217e56",
"resource": {
"resourceType": "DiagnosticReport",
"id": "76d4cc07-5a95-c7f3-8045-92614b217e56",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T13:34:47+02:00",
"issued": "2017-04-20T13:34:47.294+02:00",
"result": [ {
"reference": "urn:uuid:109df281-93bf-901e-c95e-771f0989b54a",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:84d04c37-31a3-b418-7e3c-7f05c29cf441",
"resource": {
"resourceType": "DiagnosticReport",
"id": "84d04c37-31a3-b418-7e3c-7f05c29cf441",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T14:08:01+02:00",
"issued": "2017-04-20T14:08:01.294+02:00",
"result": [ {
"reference": "urn:uuid:edca1344-df2e-ca46-a642-545d1d40bd90",
"display": "Total score [AUDIT-C]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:a7a484e5-1e50-6c5d-b231-c38c4d68c316",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a7a484e5-1e50-6c5d-b231-c38c4d68c316",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
},
"effectiveDateTime": "2017-04-20T11:29:53+02:00",
"issued": "2017-04-20T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:b8c1cdb6-7a14-9aa1-7bf7-960ae409d41a",
"resource": {
"resourceType": "DocumentReference",
"id": "b8c1cdb6-7a14-9aa1-7bf7-960ae409d41a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:a7a484e5-1e50-6c5d-b231-c38c4d68c316"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2017-04-20T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:adebe898-cb4a-3c89-103f-14f7e69a63ab"
} ],
"period": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:8542a651-6cae-867f-5487-da9972ee1d67",
"resource": {
"resourceType": "Claim",
"id": "8542a651-6cae-867f-5487-da9972ee1d67",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"created": "2017-04-20T12:27:07+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:41228a53-9830-50ec-db59-0b2c6429ecc9"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:219a7b20-257b-5fcf-722f-5e408187d8a5"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:8b5733aa-582a-856a-56fb-84611396b3f6"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:88a58732-b431-5ae7-1f60-9c63e231acd6"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:20243a05-588d-24a8-4e13-a2d5f64bc48a"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:a2b7f759-2de9-004a-dd61-fc68c2534b63"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:ca7ccf2e-255f-0452-8695-20ea2906ca76"
}
}, {
"sequence": 6,
"procedureReference": {
"reference": "urn:uuid:98e3352c-60db-7b5f-bfb2-313fbabc4bb2"
}
}, {
"sequence": 7,
"procedureReference": {
"reference": "urn:uuid:cca102f9-2698-2d80-565f-eb4a4bcdfa85"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"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:adebe898-cb4a-3c89-103f-14f7e69a63ab"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 418.48,
"currency": "USD"
}
}, {
"sequence": 4,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
},
"net": {
"value": 0.00,
"currency": "USD"
}
}, {
"sequence": 6,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 7,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 8,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "424393004",
"display": "Reports of violence in the environment (finding)"
} ],
"text": "Reports of violence in the environment (finding)"
}
}, {
"sequence": 9,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 10,
"informationSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 11,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 12,
"procedureSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 13,
"informationSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 14,
"procedureSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 15,
"procedureSequence": [ 7 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 16,
"informationSequence": [ 7 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
} ],
"total": {
"value": 1152.81,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:a613ab6f-6aad-1bd6-7aa8-afbd18efc494",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "a613ab6f-6aad-1bd6-7aa8-afbd18efc494",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "8542a651-6cae-867f-5487-da9972ee1d67"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2017-04-20T12:27:07+02:00",
"end": "2018-04-20T12:27:07+02:00"
},
"created": "2017-04-20T12:27:07+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:8542a651-6cae-867f-5487-da9972ee1d67"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:219a7b20-257b-5fcf-722f-5e408187d8a5"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
} ]
}, {
"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": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "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": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 418.48,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 83.69600000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 334.78400000000005,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 418.48,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 418.48,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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": [ 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": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 0.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 0.0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 0.0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 0.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 0.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"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": "424393004",
"display": "Reports of violence in the environment (finding)"
} ],
"text": "Reports of violence in the environment (finding)"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
}
}, {
"sequence": 9,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 10,
"informationSequence": [ 5 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 11,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 12,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 13,
"informationSequence": [ 6 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 14,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 15,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 16,
"informationSequence": [ 7 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"servicedPeriod": {
"start": "2017-04-20T11:29:53+02:00",
"end": "2017-04-20T12:27:07+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 1152.81,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2758.4,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:09b04520-f90c-6e31-37d5-e85ed6b4e3fb",
"resource": {
"resourceType": "Encounter",
"id": "09b04520-f90c-6e31-37d5-e85ed6b4e3fb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "09b04520-f90c-6e31-37d5-e85ed6b4e3fb"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2017-04-27T11:29:53+02:00",
"end": "2017-04-27T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2017-04-27T11:29:53+02:00",
"end": "2017-04-27T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:264a3ae5-3c05-1c9a-be15-311c192cd57e",
"resource": {
"resourceType": "Condition",
"id": "264a3ae5-3c05-1c9a-be15-311c192cd57e",
"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": "195662009",
"display": "Acute viral pharyngitis (disorder)"
} ],
"text": "Acute viral pharyngitis (disorder)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:09b04520-f90c-6e31-37d5-e85ed6b4e3fb"
},
"onsetDateTime": "2017-04-27T11:29:53+02:00",
"abatementDateTime": "2017-05-06T03:29:53+02:00",
"recordedDate": "2017-04-27T11:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:1a657b6b-343f-2fb8-296c-2dc1c0e71193",
"resource": {
"resourceType": "Observation",
"id": "1a657b6b-343f-2fb8-296c-2dc1c0e71193",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8310-5",
"display": "Body temperature"
}, {
"system": "http://loinc.org",
"code": "8331-1",
"display": "Oral temperature"
} ],
"text": "Body temperature"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:09b04520-f90c-6e31-37d5-e85ed6b4e3fb"
},
"effectiveDateTime": "2017-04-27T11:29:53+02:00",
"issued": "2017-04-27T11:29:53.294+02:00",
"valueQuantity": {
"value": 37.133,
"unit": "Cel",
"system": "http://unitsofmeasure.org",
"code": "Cel"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:95e81c04-9c08-6803-c6b5-8e19b685b661",
"resource": {
"resourceType": "DiagnosticReport",
"id": "95e81c04-9c08-6803-c6b5-8e19b685b661",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:09b04520-f90c-6e31-37d5-e85ed6b4e3fb"
},
"effectiveDateTime": "2017-04-27T11:29:53+02:00",
"issued": "2017-04-27T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:1e237b1a-99a5-c03c-0896-6ca005366910",
"resource": {
"resourceType": "DocumentReference",
"id": "1e237b1a-99a5-c03c-0896-6ca005366910",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:95e81c04-9c08-6803-c6b5-8e19b685b661"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2017-04-27T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:09b04520-f90c-6e31-37d5-e85ed6b4e3fb"
} ],
"period": {
"start": "2017-04-27T11:29:53+02:00",
"end": "2017-04-27T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:2bdc2f21-fb44-46dc-3813-8090e79b8ce7",
"resource": {
"resourceType": "Claim",
"id": "2bdc2f21-fb44-46dc-3813-8090e79b8ce7",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2017-04-27T11:29:53+02:00",
"end": "2017-04-27T11:44:53+02:00"
},
"created": "2017-04-27T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:264a3ae5-3c05-1c9a-be15-311c192cd57e"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:09b04520-f90c-6e31-37d5-e85ed6b4e3fb"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
} ],
"text": "Acute viral pharyngitis (disorder)"
}
} ],
"total": {
"value": 85.55,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:ba81cc93-b86a-ec2f-0bfe-9621e10e48b5",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "ba81cc93-b86a-ec2f-0bfe-9621e10e48b5",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "2bdc2f21-fb44-46dc-3813-8090e79b8ce7"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2017-04-27T11:44:53+02:00",
"end": "2018-04-27T11:44:53+02:00"
},
"created": "2017-04-27T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:2bdc2f21-fb44-46dc-3813-8090e79b8ce7"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:264a3ae5-3c05-1c9a-be15-311c192cd57e"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2017-04-27T11:29:53+02:00",
"end": "2017-04-27T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:09b04520-f90c-6e31-37d5-e85ed6b4e3fb"
} ]
}, {
"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": "195662009",
"display": "Acute viral pharyngitis (disorder)"
} ],
"text": "Acute viral pharyngitis (disorder)"
},
"servicedPeriod": {
"start": "2017-04-27T11:29:53+02:00",
"end": "2017-04-27T11:44:53+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:f99f6b1d-ee6d-d401-f290-a9c242b525d9",
"resource": {
"resourceType": "Encounter",
"id": "f99f6b1d-ee6d-d401-f290-a9c242b525d9",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "f99f6b1d-ee6d-d401-f290-a9c242b525d9"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2017-05-18T11:29:53+02:00",
"end": "2017-05-18T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2017-05-18T11:29:53+02:00",
"end": "2017-05-18T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:31c86df1-32fd-3afc-1164-aec2417af3f9",
"resource": {
"resourceType": "Procedure",
"id": "31c86df1-32fd-3afc-1164-aec2417af3f9",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:f99f6b1d-ee6d-d401-f290-a9c242b525d9"
},
"performedPeriod": {
"start": "2017-05-18T11:29:53+02:00",
"end": "2017-05-18T11:43:42+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:12345484-22ba-2b3c-977a-f3d7ba465e98",
"resource": {
"resourceType": "DiagnosticReport",
"id": "12345484-22ba-2b3c-977a-f3d7ba465e98",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:f99f6b1d-ee6d-d401-f290-a9c242b525d9"
},
"effectiveDateTime": "2017-05-18T11:29:53+02:00",
"issued": "2017-05-18T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:6c00552c-b59a-d9ed-cd9b-3956ea9576a9",
"resource": {
"resourceType": "DocumentReference",
"id": "6c00552c-b59a-d9ed-cd9b-3956ea9576a9",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:12345484-22ba-2b3c-977a-f3d7ba465e98"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2017-05-18T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:f99f6b1d-ee6d-d401-f290-a9c242b525d9"
} ],
"period": {
"start": "2017-05-18T11:29:53+02:00",
"end": "2017-05-18T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:5f332a1b-8883-d1e4-9b1a-6027225a270d",
"resource": {
"resourceType": "Claim",
"id": "5f332a1b-8883-d1e4-9b1a-6027225a270d",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2017-05-18T11:29:53+02:00",
"end": "2017-05-18T11:44:53+02:00"
},
"created": "2017-05-18T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:31c86df1-32fd-3afc-1164-aec2417af3f9"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:f99f6b1d-ee6d-d401-f290-a9c242b525d9"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 1865.75,
"currency": "USD"
}
} ],
"total": {
"value": 2008.33,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:9ff8b814-642b-844e-c14d-181f12cdad25",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "9ff8b814-642b-844e-c14d-181f12cdad25",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "5f332a1b-8883-d1e4-9b1a-6027225a270d"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2017-05-18T11:44:53+02:00",
"end": "2018-05-18T11:44:53+02:00"
},
"created": "2017-05-18T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:5f332a1b-8883-d1e4-9b1a-6027225a270d"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2017-05-18T11:29:53+02:00",
"end": "2017-05-18T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:f99f6b1d-ee6d-d401-f290-a9c242b525d9"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2017-05-18T11:29:53+02:00",
"end": "2017-05-18T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1865.75,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 373.15000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1492.6000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 1865.75,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 1865.75,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2008.33,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1492.6000000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:d31198f1-5e23-f2ec-6b07-82abc29d858c",
"resource": {
"resourceType": "Encounter",
"id": "d31198f1-5e23-f2ec-6b07-82abc29d858c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "d31198f1-5e23-f2ec-6b07-82abc29d858c"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2017-08-17T11:29:53+02:00",
"end": "2017-08-17T11:44:59+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2017-08-17T11:29:53+02:00",
"end": "2017-08-17T11:44:59+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:c71a4134-0207-fc6c-256b-7089f6bda3f3",
"resource": {
"resourceType": "Procedure",
"id": "c71a4134-0207-fc6c-256b-7089f6bda3f3",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:d31198f1-5e23-f2ec-6b07-82abc29d858c"
},
"performedPeriod": {
"start": "2017-08-17T11:29:53+02:00",
"end": "2017-08-17T11:44:59+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:73f84075-11ad-d624-47e2-b366971966cd",
"resource": {
"resourceType": "DiagnosticReport",
"id": "73f84075-11ad-d624-47e2-b366971966cd",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:d31198f1-5e23-f2ec-6b07-82abc29d858c"
},
"effectiveDateTime": "2017-08-17T11:29:53+02:00",
"issued": "2017-08-17T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:a896074e-991e-9be2-051b-4dedecb62816",
"resource": {
"resourceType": "DocumentReference",
"id": "a896074e-991e-9be2-051b-4dedecb62816",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:73f84075-11ad-d624-47e2-b366971966cd"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2017-08-17T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:d31198f1-5e23-f2ec-6b07-82abc29d858c"
} ],
"period": {
"start": "2017-08-17T11:29:53+02:00",
"end": "2017-08-17T11:44:59+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:3951eb8e-a50c-1eef-d6a9-0acc4ada4aa5",
"resource": {
"resourceType": "Claim",
"id": "3951eb8e-a50c-1eef-d6a9-0acc4ada4aa5",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2017-08-17T11:29:53+02:00",
"end": "2017-08-17T11:44:59+02:00"
},
"created": "2017-08-17T11:44:59+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:c71a4134-0207-fc6c-256b-7089f6bda3f3"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:d31198f1-5e23-f2ec-6b07-82abc29d858c"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2158.14,
"currency": "USD"
}
} ],
"total": {
"value": 2300.72,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:72b3b681-a433-e1f1-861f-472bd60ddbf6",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "72b3b681-a433-e1f1-861f-472bd60ddbf6",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "3951eb8e-a50c-1eef-d6a9-0acc4ada4aa5"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2017-08-17T11:44:59+02:00",
"end": "2018-08-17T11:44:59+02:00"
},
"created": "2017-08-17T11:44:59+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:3951eb8e-a50c-1eef-d6a9-0acc4ada4aa5"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2017-08-17T11:29:53+02:00",
"end": "2017-08-17T11:44:59+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:d31198f1-5e23-f2ec-6b07-82abc29d858c"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2017-08-17T11:29:53+02:00",
"end": "2017-08-17T11:44:59+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2158.14,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 431.628,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1726.512,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2158.14,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2158.14,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2300.72,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1726.512,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:ce828f10-ce3e-4f78-325c-da53b9c95806",
"resource": {
"resourceType": "Encounter",
"id": "ce828f10-ce3e-4f78-325c-da53b9c95806",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "ce828f10-ce3e-4f78-325c-da53b9c95806"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2017-11-16T10:29:53+01:00",
"end": "2017-11-16T10:47:13+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2017-11-16T10:29:53+01:00",
"end": "2017-11-16T10:47:13+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:ac118d95-2fbf-d748-101b-9e3513248659",
"resource": {
"resourceType": "Procedure",
"id": "ac118d95-2fbf-d748-101b-9e3513248659",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:ce828f10-ce3e-4f78-325c-da53b9c95806"
},
"performedPeriod": {
"start": "2017-11-16T10:29:53+01:00",
"end": "2017-11-16T10:47:13+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:0d72e1aa-9559-07f1-8064-67162601dbdb",
"resource": {
"resourceType": "DiagnosticReport",
"id": "0d72e1aa-9559-07f1-8064-67162601dbdb",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:ce828f10-ce3e-4f78-325c-da53b9c95806"
},
"effectiveDateTime": "2017-11-16T10:29:53+01:00",
"issued": "2017-11-16T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ecce5f86-8a62-fd98-336d-b31e16965a1e",
"resource": {
"resourceType": "DocumentReference",
"id": "ecce5f86-8a62-fd98-336d-b31e16965a1e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:0d72e1aa-9559-07f1-8064-67162601dbdb"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2017-11-16T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:ce828f10-ce3e-4f78-325c-da53b9c95806"
} ],
"period": {
"start": "2017-11-16T10:29:53+01:00",
"end": "2017-11-16T10:47:13+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:a8e4bf4b-3217-83a8-c64a-e5b4ad5dd9c4",
"resource": {
"resourceType": "Claim",
"id": "a8e4bf4b-3217-83a8-c64a-e5b4ad5dd9c4",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2017-11-16T10:29:53+01:00",
"end": "2017-11-16T10:47:13+01:00"
},
"created": "2017-11-16T10:47:13+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:ac118d95-2fbf-d748-101b-9e3513248659"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:ce828f10-ce3e-4f78-325c-da53b9c95806"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2722.34,
"currency": "USD"
}
} ],
"total": {
"value": 2864.92,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:0a532362-5c01-9fb1-f01b-c6bee1533d25",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "0a532362-5c01-9fb1-f01b-c6bee1533d25",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "a8e4bf4b-3217-83a8-c64a-e5b4ad5dd9c4"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2017-11-16T10:47:13+01:00",
"end": "2018-11-16T10:47:13+01:00"
},
"created": "2017-11-16T10:47:13+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:a8e4bf4b-3217-83a8-c64a-e5b4ad5dd9c4"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2017-11-16T10:29:53+01:00",
"end": "2017-11-16T10:47:13+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:ce828f10-ce3e-4f78-325c-da53b9c95806"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2017-11-16T10:29:53+01:00",
"end": "2017-11-16T10:47:13+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2722.34,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 544.4680000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2177.8720000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2722.34,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2722.34,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2864.92,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2177.8720000000003,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb",
"resource": {
"resourceType": "Encounter",
"id": "e9ce9cd8-392c-dd73-30af-d44b236264eb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "e9ce9cd8-392c-dd73-30af-d44b236264eb"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:39ea5fb2-1f0e-dce1-259e-bc1db0049d41",
"resource": {
"resourceType": "Condition",
"id": "39ea5fb2-1f0e-dce1-259e-bc1db0049d41",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"onsetDateTime": "2017-12-28T10:29:53+01:00",
"abatementDateTime": "2019-12-19T10:29:53+01:00",
"recordedDate": "2017-12-28T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:1efa9d97-9751-50f3-2ef3-86f326e4d293",
"resource": {
"resourceType": "Condition",
"id": "1efa9d97-9751-50f3-2ef3-86f326e4d293",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"onsetDateTime": "2017-12-28T11:13:20+01:00",
"abatementDateTime": "2019-11-28T11:16:28+01:00",
"recordedDate": "2017-12-28T11:13:20+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:593883f7-aff7-a959-ffab-3ee151c0b481",
"resource": {
"resourceType": "Condition",
"id": "593883f7-aff7-a959-ffab-3ee151c0b481",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"onsetDateTime": "2017-12-28T11:13:20+01:00",
"abatementDateTime": "2019-12-19T11:21:51+01:00",
"recordedDate": "2017-12-28T11:13:20+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:e169e0b0-b727-1bd4-0520-2176c42b076a",
"resource": {
"resourceType": "Observation",
"id": "e169e0b0-b727-1bd4-0520-2176c42b076a",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
} ],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 6.19,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:fd4d1bb7-0201-5503-cd38-efbd7515dfe2",
"resource": {
"resourceType": "Observation",
"id": "fd4d1bb7-0201-5503-cd38-efbd7515dfe2",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 170.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f946c60b-0857-64b9-7253-80fd5ff14f91",
"resource": {
"resourceType": "Observation",
"id": "f946c60b-0857-64b9-7253-80fd5ff14f91",
"status": "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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d92e9f83-d850-0661-3e0f-6525e1f03fb2",
"resource": {
"resourceType": "Observation",
"id": "d92e9f83-d850-0661-3e0f-6525e1f03fb2",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 88.1,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5026fb43-2ff5-9dca-8a4b-b5e9bcb55eba",
"resource": {
"resourceType": "Observation",
"id": "5026fb43-2ff5-9dca-8a4b-b5e9bcb55eba",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 30.38,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:15f0009e-d78d-d186-6034-6d1fce0dd037",
"resource": {
"resourceType": "Observation",
"id": "15f0009e-d78d-d186-6034-6d1fce0dd037",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 95,
"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": 117,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:880568d1-2bb6-19e1-8c15-fcd2be1afdb5",
"resource": {
"resourceType": "Observation",
"id": "880568d1-2bb6-19e1-8c15-fcd2be1afdb5",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 92,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:77a1b0e2-dca0-91c4-c5bc-44157727818a",
"resource": {
"resourceType": "Observation",
"id": "77a1b0e2-dca0-91c4-c5bc-44157727818a",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 12,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:bfddec70-5d85-688b-f38c-ed74175436ab",
"resource": {
"resourceType": "Observation",
"id": "bfddec70-5d85-688b-f38c-ed74175436ab",
"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": "2339-0",
"display": "Glucose [Mass/volume] in Blood"
} ],
"text": "Glucose [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 73.44,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:acb90aff-3969-904a-3f86-fa3a376aa126",
"resource": {
"resourceType": "Observation",
"id": "acb90aff-3969-904a-3f86-fa3a376aa126",
"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": "6299-2",
"display": "Urea nitrogen [Mass/volume] in Blood"
} ],
"text": "Urea nitrogen [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 9.74,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e9d6e14d-52e6-3718-4cf7-97d70db12219",
"resource": {
"resourceType": "Observation",
"id": "e9d6e14d-52e6-3718-4cf7-97d70db12219",
"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": "38483-4",
"display": "Creatinine [Mass/volume] in Blood"
} ],
"text": "Creatinine [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 0.96,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:821cfd84-5885-d93a-5397-3138e84cd075",
"resource": {
"resourceType": "Observation",
"id": "821cfd84-5885-d93a-5397-3138e84cd075",
"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": "49765-1",
"display": "Calcium [Mass/volume] in Blood"
} ],
"text": "Calcium [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 9.37,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:b0cc0aab-e2dd-d180-bc55-c15ffae19a05",
"resource": {
"resourceType": "Observation",
"id": "b0cc0aab-e2dd-d180-bc55-c15ffae19a05",
"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": "2947-0",
"display": "Sodium [Moles/volume] in Blood"
} ],
"text": "Sodium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 143.92,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:34077760-3e06-0bef-5b01-3b30fb24f0ae",
"resource": {
"resourceType": "Observation",
"id": "34077760-3e06-0bef-5b01-3b30fb24f0ae",
"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": "6298-4",
"display": "Potassium [Moles/volume] in Blood"
} ],
"text": "Potassium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 4.35,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:71a453c5-2606-be9f-674a-1a89589787f8",
"resource": {
"resourceType": "Observation",
"id": "71a453c5-2606-be9f-674a-1a89589787f8",
"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": "2069-3",
"display": "Chloride [Moles/volume] in Blood"
} ],
"text": "Chloride [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 104.41,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3f339ab7-c4ee-4ce6-f357-7293cbdee6cc",
"resource": {
"resourceType": "Observation",
"id": "3f339ab7-c4ee-4ce6-f357-7293cbdee6cc",
"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": "20565-8",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ],
"text": "Carbon dioxide, total [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 27.81,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:62556f60-578c-4643-35bb-70abc846d00f",
"resource": {
"resourceType": "Observation",
"id": "62556f60-578c-4643-35bb-70abc846d00f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Ex-smoker (finding)"
} ],
"text": "Ex-smoker (finding)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6c350403-525a-0cd5-6218-aaeac113bf6f",
"resource": {
"resourceType": "Observation",
"id": "6c350403-525a-0cd5-6218-aaeac113bf6f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93025-5",
"display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T11:13:20+01:00",
"issued": "2017-12-28T11:13:20.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76501-6",
"display": "Within the last year, have you been afraid of your partner or ex-partner?"
} ],
"text": "Within the last year, have you been afraid of your partner or ex-partner?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93026-3",
"display": "Do you feel physically and emotionally safe where you currently live?"
} ],
"text": "Do you feel physically and emotionally safe where you currently live?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA33-6",
"display": "Yes"
} ],
"text": "Yes"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93027-1",
"display": "Are you a refugee?"
} ],
"text": "Are you a refugee?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93028-9",
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93038-8",
"display": "Stress level"
} ],
"text": "Stress level"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA13863-8",
"display": "A little bit"
} ],
"text": "A little bit"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93029-7",
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30131-9",
"display": "3 to 5 times a week"
} ],
"text": "3 to 5 times a week"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93030-5",
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
} ],
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93031-3",
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30124-4",
"display": "Utilities"
} ],
"text": "Utilities"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63586-2",
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
},
"valueQuantity": {
"value": 90472,
"unit": "/a",
"system": "http://unitsofmeasure.org",
"code": "/a"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76437-3",
"display": "Primary insurance"
} ],
"text": "Primary insurance"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6350-8",
"display": "Private insurance"
} ],
"text": "Private insurance"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "67875-5",
"display": "Employment status - current"
} ],
"text": "Employment status - current"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30136-8",
"display": "Full-time work"
} ],
"text": "Full-time work"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82589-3",
"display": "Highest level of education"
} ],
"text": "Highest level of education"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30191-3",
"display": "Less than high school degree"
} ],
"text": "Less than high school degree"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56799-0",
"display": "Address"
} ],
"text": "Address"
},
"valueString": "217 Bayer Drive Unit 35"
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93033-9",
"display": "Are you worried about losing your housing?"
} ],
"text": "Are you worried about losing your housing?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "71802-3",
"display": "Housing status"
} ],
"text": "Housing status"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30189-7",
"display": "I have housing"
} ],
"text": "I have housing"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63512-8",
"display": "How many people are living or staying at this address?"
} ],
"text": "How many people are living or staying at this address?"
},
"valueQuantity": {
"value": 5,
"unit": "{#}",
"system": "http://unitsofmeasure.org",
"code": "{#}"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "54899-0",
"display": "Preferred language"
} ],
"text": "Preferred language"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA43-5",
"display": "English"
} ],
"text": "English"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93034-7",
"display": "Have you been discharged from the armed forces of the United States?"
} ],
"text": "Have you been discharged from the armed forces of the United States?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93035-4",
"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "32624-9",
"display": "Race"
} ],
"text": "Race"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA4457-3",
"display": "White"
} ],
"text": "White"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56051-6",
"display": "Do you consider yourself Hispanic/Latino?"
} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3ffe8d56-342f-d04d-3794-384e6967bcfb",
"resource": {
"resourceType": "Observation",
"id": "3ffe8d56-342f-d04d-3794-384e6967bcfb",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T11:41:38+01:00",
"issued": "2017-12-28T11:41:38.294+01:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0861c8cf-3411-35e8-eb5a-dc0580bc54ab",
"resource": {
"resourceType": "Procedure",
"id": "0861c8cf-3411-35e8-eb5a-dc0580bc54ab",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"performedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:83a38729-523d-898a-d4a6-9a38602aa5b5",
"resource": {
"resourceType": "Procedure",
"id": "83a38729-523d-898a-d4a6-9a38602aa5b5",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"performedPeriod": {
"start": "2017-12-28T11:13:20+01:00",
"end": "2017-12-28T11:41:38+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:0e587b08-4c03-b0c3-4b3e-5406215db6be",
"resource": {
"resourceType": "SupplyDelivery",
"id": "0e587b08-4c03-b0c3-4b3e-5406215db6be",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2017-12-28T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:8ce7b2d7-d825-9aaf-9bb1-df8dde2215cc",
"resource": {
"resourceType": "SupplyDelivery",
"id": "8ce7b2d7-d825-9aaf-9bb1-df8dde2215cc",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2017-12-28T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:b11d9a38-90df-5f77-805e-3577672f4fb4",
"resource": {
"resourceType": "SupplyDelivery",
"id": "b11d9a38-90df-5f77-805e-3577672f4fb4",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 100
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
}
},
"occurrenceDateTime": "2017-12-28T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:c375c5d9-54c5-4fd6-92d6-80178668fa93",
"resource": {
"resourceType": "Immunization",
"id": "c375c5d9-54c5-4fd6-92d6-80178668fa93",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"occurrenceDateTime": "2017-12-28T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:bccb5a46-77bf-b8b6-3f5d-0d60427fd17f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "bccb5a46-77bf-b8b6-3f5d-0d60427fd17f",
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:bfddec70-5d85-688b-f38c-ed74175436ab",
"display": "Glucose [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:acb90aff-3969-904a-3f86-fa3a376aa126",
"display": "Urea nitrogen [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:e9d6e14d-52e6-3718-4cf7-97d70db12219",
"display": "Creatinine [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:821cfd84-5885-d93a-5397-3138e84cd075",
"display": "Calcium [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:b0cc0aab-e2dd-d180-bc55-c15ffae19a05",
"display": "Sodium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:34077760-3e06-0bef-5b01-3b30fb24f0ae",
"display": "Potassium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:71a453c5-2606-be9f-674a-1a89589787f8",
"display": "Chloride [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:3f339ab7-c4ee-4ce6-f357-7293cbdee6cc",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:9dd94fec-a069-3949-5450-b900a2814f68",
"resource": {
"resourceType": "DiagnosticReport",
"id": "9dd94fec-a069-3949-5450-b900a2814f68",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T11:41:38+01:00",
"issued": "2017-12-28T11:41:38.294+01:00",
"result": [ {
"reference": "urn:uuid:3ffe8d56-342f-d04d-3794-384e6967bcfb",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:e859885e-7060-064b-09ab-303356431323",
"resource": {
"resourceType": "DiagnosticReport",
"id": "e859885e-7060-064b-09ab-303356431323",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
},
"effectiveDateTime": "2017-12-28T10:29:53+01:00",
"issued": "2017-12-28T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:e6dc46dc-85c0-a1b8-ff32-ffe712ff48e7",
"resource": {
"resourceType": "DocumentReference",
"id": "e6dc46dc-85c0-a1b8-ff32-ffe712ff48e7",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:e859885e-7060-064b-09ab-303356431323"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2017-12-28T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
} ],
"period": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:cb5bc246-a079-6f27-159c-550b0097000b",
"resource": {
"resourceType": "Claim",
"id": "cb5bc246-a079-6f27-159c-550b0097000b",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"created": "2017-12-28T11:13:20+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:c375c5d9-54c5-4fd6-92d6-80178668fa93"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:39ea5fb2-1f0e-dce1-259e-bc1db0049d41"
}
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:1efa9d97-9751-50f3-2ef3-86f326e4d293"
}
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:593883f7-aff7-a959-ffab-3ee151c0b481"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:0861c8cf-3411-35e8-eb5a-dc0580bc54ab"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:83a38729-523d-898a-d4a6-9a38602aa5b5"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
} ]
}, {
"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,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
}, {
"sequence": 6,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
},
"net": {
"value": 0.00,
"currency": "USD"
}
}, {
"sequence": 7,
"informationSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 8,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 9,
"diagnosisSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
}
}, {
"sequence": 10,
"diagnosisSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
}
}, {
"sequence": 11,
"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": 12,
"informationSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"net": {
"value": 74.58,
"currency": "USD"
}
} ],
"total": {
"value": 792.38,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:2d826e10-a311-3176-04a3-c279b0e0d39f",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "2d826e10-a311-3176-04a3-c279b0e0d39f",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "cb5bc246-a079-6f27-159c-550b0097000b"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2017-12-28T11:13:20+01:00",
"end": "2018-12-28T11:13:20+01:00"
},
"created": "2017-12-28T11:13:20+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:cb5bc246-a079-6f27-159c-550b0097000b"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:39ea5fb2-1f0e-dce1-259e-bc1db0049d41"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:1efa9d97-9751-50f3-2ef3-86f326e4d293"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:593883f7-aff7-a959-ffab-3ee151c0b481"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
} ]
}, {
"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": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+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": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 4,
"informationSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"informationSequence": [ 4 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
},
"servicedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 0.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 0.0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 0.0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 0.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 0.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"servicedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+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": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"servicedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+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,
"diagnosisSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"servicedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 10,
"diagnosisSequence": [ 3 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"servicedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"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": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"servicedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 12,
"informationSequence": [ 6 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"servicedPeriod": {
"start": "2017-12-28T10:29:53+01:00",
"end": "2017-12-28T11:13:20+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": 792.38,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 929.2479999999999,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:4808275d-e7d2-a983-aa24-9c4fe367229d",
"resource": {
"resourceType": "Encounter",
"id": "4808275d-e7d2-a983-aa24-9c4fe367229d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "4808275d-e7d2-a983-aa24-9c4fe367229d"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2018-02-15T10:29:53+01:00",
"end": "2018-02-15T10:48:35+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2018-02-15T10:29:53+01:00",
"end": "2018-02-15T10:48:35+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:0b90a9b2-3c07-493c-83d4-d1f2027f2704",
"resource": {
"resourceType": "Procedure",
"id": "0b90a9b2-3c07-493c-83d4-d1f2027f2704",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:4808275d-e7d2-a983-aa24-9c4fe367229d"
},
"performedPeriod": {
"start": "2018-02-15T10:29:53+01:00",
"end": "2018-02-15T10:48:35+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:bcc2bc9f-dc6d-19e2-1948-033f3004a616",
"resource": {
"resourceType": "DiagnosticReport",
"id": "bcc2bc9f-dc6d-19e2-1948-033f3004a616",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:4808275d-e7d2-a983-aa24-9c4fe367229d"
},
"effectiveDateTime": "2018-02-15T10:29:53+01:00",
"issued": "2018-02-15T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMTgtMDItMTUKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzClBldHJvbmlsYTcyNAogaXMgYSA0OCB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBhY3V0ZSBiYWN0ZXJpYWwgc2ludXNpdGlzIChkaXNvcmRlciksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCB1bmhlYWx0aHkgYWxjb2hvbCBkcmlua2luZyBiZWhhdmlvciAoZmluZGluZyksIHJlcG9ydHMgb2YgdmlvbGVuY2UgaW4gdGhlIGVudmlyb25tZW50IChmaW5kaW5nKSwgZnVsbC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBhY3V0ZSB2aXJhbCBwaGFyeW5naXRpcyAoZGlzb3JkZXIpLCB2aWN0aW0gb2YgaW50aW1hdGUgcGFydG5lciBhYnVzZSAoZmluZGluZyksIHZpcmFsIHNpbnVzaXRpcyAoZGlzb3JkZXIpLCBzdHJlc3MgKGZpbmRpbmcpLCBzb2NpYWwgaXNvbGF0aW9uIChmaW5kaW5nKS4KCiMgU29jaWFsIEhpc3RvcnkKUGF0aWVudCBpcyBzaW5nbGUuIFBhdGllbnQgcXVpdCBzbW9raW5nIGF0IGFnZSAxNy4KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuCgpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgogUGF0aWVudCBkaWQgbm90IGZpbmlzaCBoaWdoIHNjaG9vbC4KUGF0aWVudCBjdXJyZW50bHkgaGFzIFVuaXRlZEhlYWx0aGNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCk5vIEFjdGl2ZSBNZWRpY2F0aW9ucy4KCiMgQXNzZXNzbWVudCBhbmQgUGxhbgoKCiMjIFBsYW4KClRoZSBmb2xsb3dpbmcgcHJvY2VkdXJlcyB3ZXJlIGNvbmR1Y3RlZDoKLSBpbnRyYW11c2N1bGFyIGluamVjdGlvbgo="
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:4069c24f-c78b-f59c-fccb-5d33f1c0f038",
"resource": {
"resourceType": "DocumentReference",
"id": "4069c24f-c78b-f59c-fccb-5d33f1c0f038",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:bcc2bc9f-dc6d-19e2-1948-033f3004a616"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2018-02-15T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:4808275d-e7d2-a983-aa24-9c4fe367229d"
} ],
"period": {
"start": "2018-02-15T10:29:53+01:00",
"end": "2018-02-15T10:48:35+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:2c06f9d1-88c2-028e-857f-d4f249af105c",
"resource": {
"resourceType": "Claim",
"id": "2c06f9d1-88c2-028e-857f-d4f249af105c",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2018-02-15T10:29:53+01:00",
"end": "2018-02-15T10:48:35+01:00"
},
"created": "2018-02-15T10:48:35+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:0b90a9b2-3c07-493c-83d4-d1f2027f2704"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:4808275d-e7d2-a983-aa24-9c4fe367229d"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2045.97,
"currency": "USD"
}
} ],
"total": {
"value": 2188.55,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:22b64fef-dea4-0f97-655f-25fcdc585d45",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "22b64fef-dea4-0f97-655f-25fcdc585d45",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "2c06f9d1-88c2-028e-857f-d4f249af105c"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2018-02-15T10:48:35+01:00",
"end": "2019-02-15T10:48:35+01:00"
},
"created": "2018-02-15T10:48:35+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:2c06f9d1-88c2-028e-857f-d4f249af105c"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2018-02-15T10:29:53+01:00",
"end": "2018-02-15T10:48:35+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:4808275d-e7d2-a983-aa24-9c4fe367229d"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2018-02-15T10:29:53+01:00",
"end": "2018-02-15T10:48:35+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2045.97,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 409.194,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1636.776,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2045.97,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2045.97,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2188.55,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1636.776,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:2910de8e-3135-619d-d6bf-952b03b2216b",
"resource": {
"resourceType": "Encounter",
"id": "2910de8e-3135-619d-d6bf-952b03b2216b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "2910de8e-3135-619d-d6bf-952b03b2216b"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2018-05-17T11:29:53+02:00",
"end": "2018-05-17T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2018-05-17T11:29:53+02:00",
"end": "2018-05-17T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:700c359a-1c04-4776-12dc-3664975ba4d0",
"resource": {
"resourceType": "Procedure",
"id": "700c359a-1c04-4776-12dc-3664975ba4d0",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2910de8e-3135-619d-d6bf-952b03b2216b"
},
"performedPeriod": {
"start": "2018-05-17T11:29:53+02:00",
"end": "2018-05-17T11:42:59+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:7f3b8fa9-ca82-a750-4b01-a5580d25f6fa",
"resource": {
"resourceType": "DiagnosticReport",
"id": "7f3b8fa9-ca82-a750-4b01-a5580d25f6fa",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2910de8e-3135-619d-d6bf-952b03b2216b"
},
"effectiveDateTime": "2018-05-17T11:29:53+02:00",
"issued": "2018-05-17T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:b8b5e065-a9c7-fcf8-d333-2ec3da956f0d",
"resource": {
"resourceType": "DocumentReference",
"id": "b8b5e065-a9c7-fcf8-d333-2ec3da956f0d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:7f3b8fa9-ca82-a750-4b01-a5580d25f6fa"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2018-05-17T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:2910de8e-3135-619d-d6bf-952b03b2216b"
} ],
"period": {
"start": "2018-05-17T11:29:53+02:00",
"end": "2018-05-17T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:cca1c795-4920-6eda-eb58-92f5b3293442",
"resource": {
"resourceType": "Claim",
"id": "cca1c795-4920-6eda-eb58-92f5b3293442",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2018-05-17T11:29:53+02:00",
"end": "2018-05-17T11:44:53+02:00"
},
"created": "2018-05-17T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:700c359a-1c04-4776-12dc-3664975ba4d0"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:2910de8e-3135-619d-d6bf-952b03b2216b"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 3870.11,
"currency": "USD"
}
} ],
"total": {
"value": 4012.69,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:32ec1998-2b84-7616-4422-d2a2cef9f438",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "32ec1998-2b84-7616-4422-d2a2cef9f438",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "cca1c795-4920-6eda-eb58-92f5b3293442"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2018-05-17T11:44:53+02:00",
"end": "2019-05-17T11:44:53+02:00"
},
"created": "2018-05-17T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:cca1c795-4920-6eda-eb58-92f5b3293442"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2018-05-17T11:29:53+02:00",
"end": "2018-05-17T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:2910de8e-3135-619d-d6bf-952b03b2216b"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2018-05-17T11:29:53+02:00",
"end": "2018-05-17T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 3870.11,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 774.022,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 3096.088,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 3870.11,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 3870.11,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 4012.69,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 3096.088,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:74519b9e-b5a4-704e-8d13-758d7b3a2b92",
"resource": {
"resourceType": "Encounter",
"id": "74519b9e-b5a4-704e-8d13-758d7b3a2b92",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "74519b9e-b5a4-704e-8d13-758d7b3a2b92"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2018-08-16T11:29:53+02:00",
"end": "2018-08-16T11:45:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2018-08-16T11:29:53+02:00",
"end": "2018-08-16T11:45:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:3b2bfa4d-3d6a-79be-7192-f21afcba6074",
"resource": {
"resourceType": "Procedure",
"id": "3b2bfa4d-3d6a-79be-7192-f21afcba6074",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:74519b9e-b5a4-704e-8d13-758d7b3a2b92"
},
"performedPeriod": {
"start": "2018-08-16T11:29:53+02:00",
"end": "2018-08-16T11:45:53+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:6bc5c0a3-3fa8-5c4a-7652-ff4a6ec0b303",
"resource": {
"resourceType": "DiagnosticReport",
"id": "6bc5c0a3-3fa8-5c4a-7652-ff4a6ec0b303",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:74519b9e-b5a4-704e-8d13-758d7b3a2b92"
},
"effectiveDateTime": "2018-08-16T11:29:53+02:00",
"issued": "2018-08-16T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:784160d4-8ff2-8bac-3b77-2928f9e7c525",
"resource": {
"resourceType": "DocumentReference",
"id": "784160d4-8ff2-8bac-3b77-2928f9e7c525",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:6bc5c0a3-3fa8-5c4a-7652-ff4a6ec0b303"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2018-08-16T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:74519b9e-b5a4-704e-8d13-758d7b3a2b92"
} ],
"period": {
"start": "2018-08-16T11:29:53+02:00",
"end": "2018-08-16T11:45:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:062b9cf7-d6e8-3d0c-8212-a08d1d1163a7",
"resource": {
"resourceType": "Claim",
"id": "062b9cf7-d6e8-3d0c-8212-a08d1d1163a7",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2018-08-16T11:29:53+02:00",
"end": "2018-08-16T11:45:53+02:00"
},
"created": "2018-08-16T11:45:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:3b2bfa4d-3d6a-79be-7192-f21afcba6074"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:74519b9e-b5a4-704e-8d13-758d7b3a2b92"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2407.66,
"currency": "USD"
}
} ],
"total": {
"value": 2550.24,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:90a5956f-6f66-427f-42b8-e9bd1da8eb64",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "90a5956f-6f66-427f-42b8-e9bd1da8eb64",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "062b9cf7-d6e8-3d0c-8212-a08d1d1163a7"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2018-08-16T11:45:53+02:00",
"end": "2019-08-16T11:45:53+02:00"
},
"created": "2018-08-16T11:45:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:062b9cf7-d6e8-3d0c-8212-a08d1d1163a7"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2018-08-16T11:29:53+02:00",
"end": "2018-08-16T11:45:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:74519b9e-b5a4-704e-8d13-758d7b3a2b92"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2018-08-16T11:29:53+02:00",
"end": "2018-08-16T11:45:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2407.66,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 481.532,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1926.128,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2407.66,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2407.66,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2550.24,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1926.128,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:c9fe3182-3c32-759f-8d9c-cca569a09b4c",
"resource": {
"resourceType": "Encounter",
"id": "c9fe3182-3c32-759f-8d9c-cca569a09b4c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "c9fe3182-3c32-759f-8d9c-cca569a09b4c"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2018-11-15T10:29:53+01:00",
"end": "2018-11-15T10:44:53+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2018-11-15T10:29:53+01:00",
"end": "2018-11-15T10:44:53+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:b609c2e6-70aa-d8f9-fdc4-0d8bccb6515e",
"resource": {
"resourceType": "Procedure",
"id": "b609c2e6-70aa-d8f9-fdc4-0d8bccb6515e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c9fe3182-3c32-759f-8d9c-cca569a09b4c"
},
"performedPeriod": {
"start": "2018-11-15T10:29:53+01:00",
"end": "2018-11-15T10:41:39+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a2d58291-5790-c89c-b7ef-ffdfb5c1960e",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a2d58291-5790-c89c-b7ef-ffdfb5c1960e",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c9fe3182-3c32-759f-8d9c-cca569a09b4c"
},
"effectiveDateTime": "2018-11-15T10:29:53+01:00",
"issued": "2018-11-15T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMTgtMTEtMTUKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzClBldHJvbmlsYTcyNAogaXMgYSA0OCB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBhY3V0ZSBiYWN0ZXJpYWwgc2ludXNpdGlzIChkaXNvcmRlciksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCB1bmhlYWx0aHkgYWxjb2hvbCBkcmlua2luZyBiZWhhdmlvciAoZmluZGluZyksIHJlcG9ydHMgb2YgdmlvbGVuY2UgaW4gdGhlIGVudmlyb25tZW50IChmaW5kaW5nKSwgZnVsbC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBhY3V0ZSB2aXJhbCBwaGFyeW5naXRpcyAoZGlzb3JkZXIpLCB2aWN0aW0gb2YgaW50aW1hdGUgcGFydG5lciBhYnVzZSAoZmluZGluZyksIHZpcmFsIHNpbnVzaXRpcyAoZGlzb3JkZXIpLCBzdHJlc3MgKGZpbmRpbmcpLCBzb2NpYWwgaXNvbGF0aW9uIChmaW5kaW5nKS4KCiMgU29jaWFsIEhpc3RvcnkKUGF0aWVudCBpcyBzaW5nbGUuIFBhdGllbnQgcXVpdCBzbW9raW5nIGF0IGFnZSAxNy4KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuCgpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgogUGF0aWVudCBkaWQgbm90IGZpbmlzaCBoaWdoIHNjaG9vbC4KUGF0aWVudCBjdXJyZW50bHkgaGFzIFVuaXRlZEhlYWx0aGNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCk5vIEFjdGl2ZSBNZWRpY2F0aW9ucy4KCiMgQXNzZXNzbWVudCBhbmQgUGxhbgoKCiMjIFBsYW4KClRoZSBmb2xsb3dpbmcgcHJvY2VkdXJlcyB3ZXJlIGNvbmR1Y3RlZDoKLSBpbnRyYW11c2N1bGFyIGluamVjdGlvbgo="
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:f1b29fde-c7ef-6e1a-771e-30879bd9e10c",
"resource": {
"resourceType": "DocumentReference",
"id": "f1b29fde-c7ef-6e1a-771e-30879bd9e10c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:a2d58291-5790-c89c-b7ef-ffdfb5c1960e"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2018-11-15T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:c9fe3182-3c32-759f-8d9c-cca569a09b4c"
} ],
"period": {
"start": "2018-11-15T10:29:53+01:00",
"end": "2018-11-15T10:44:53+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:5e01ce02-da4e-ed1e-512c-1732664a515c",
"resource": {
"resourceType": "Claim",
"id": "5e01ce02-da4e-ed1e-512c-1732664a515c",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2018-11-15T10:29:53+01:00",
"end": "2018-11-15T10:44:53+01:00"
},
"created": "2018-11-15T10:44:53+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:b609c2e6-70aa-d8f9-fdc4-0d8bccb6515e"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:c9fe3182-3c32-759f-8d9c-cca569a09b4c"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2452.72,
"currency": "USD"
}
} ],
"total": {
"value": 2595.30,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:75cad644-d1e7-90ff-bd2a-fb35f4750314",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "75cad644-d1e7-90ff-bd2a-fb35f4750314",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "5e01ce02-da4e-ed1e-512c-1732664a515c"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2018-11-15T10:44:53+01:00",
"end": "2019-11-15T10:44:53+01:00"
},
"created": "2018-11-15T10:44:53+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:5e01ce02-da4e-ed1e-512c-1732664a515c"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2018-11-15T10:29:53+01:00",
"end": "2018-11-15T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:c9fe3182-3c32-759f-8d9c-cca569a09b4c"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2018-11-15T10:29:53+01:00",
"end": "2018-11-15T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2452.72,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 490.544,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1962.176,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2452.72,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2452.72,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2595.30,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1962.176,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:2b18aacb-f656-601f-5090-8348a0d78ae1",
"resource": {
"resourceType": "Encounter",
"id": "2b18aacb-f656-601f-5090-8348a0d78ae1",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "2b18aacb-f656-601f-5090-8348a0d78ae1"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2019-02-14T10:29:53+01:00",
"end": "2019-02-14T10:48:31+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2019-02-14T10:29:53+01:00",
"end": "2019-02-14T10:48:31+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:5c5ac2da-85bc-4342-8d5c-f5e99890ea00",
"resource": {
"resourceType": "Procedure",
"id": "5c5ac2da-85bc-4342-8d5c-f5e99890ea00",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2b18aacb-f656-601f-5090-8348a0d78ae1"
},
"performedPeriod": {
"start": "2019-02-14T10:29:53+01:00",
"end": "2019-02-14T10:48:31+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:aa044568-3ceb-f1de-3742-ec975542aae9",
"resource": {
"resourceType": "DiagnosticReport",
"id": "aa044568-3ceb-f1de-3742-ec975542aae9",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2b18aacb-f656-601f-5090-8348a0d78ae1"
},
"effectiveDateTime": "2019-02-14T10:29:53+01:00",
"issued": "2019-02-14T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:c91d465e-0f9c-f11c-fee5-9ac804d669df",
"resource": {
"resourceType": "DocumentReference",
"id": "c91d465e-0f9c-f11c-fee5-9ac804d669df",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:aa044568-3ceb-f1de-3742-ec975542aae9"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2019-02-14T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:2b18aacb-f656-601f-5090-8348a0d78ae1"
} ],
"period": {
"start": "2019-02-14T10:29:53+01:00",
"end": "2019-02-14T10:48:31+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:0b4f8a6a-d9c0-5ff7-8589-223ef61315ee",
"resource": {
"resourceType": "Claim",
"id": "0b4f8a6a-d9c0-5ff7-8589-223ef61315ee",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2019-02-14T10:29:53+01:00",
"end": "2019-02-14T10:48:31+01:00"
},
"created": "2019-02-14T10:48:31+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:5c5ac2da-85bc-4342-8d5c-f5e99890ea00"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:2b18aacb-f656-601f-5090-8348a0d78ae1"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 1470.69,
"currency": "USD"
}
} ],
"total": {
"value": 1613.27,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:a22aa506-7892-020e-ccb9-da7907d71cf2",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "a22aa506-7892-020e-ccb9-da7907d71cf2",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "0b4f8a6a-d9c0-5ff7-8589-223ef61315ee"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2019-02-14T10:48:31+01:00",
"end": "2020-02-14T10:48:31+01:00"
},
"created": "2019-02-14T10:48:31+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:0b4f8a6a-d9c0-5ff7-8589-223ef61315ee"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2019-02-14T10:29:53+01:00",
"end": "2019-02-14T10:48:31+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:2b18aacb-f656-601f-5090-8348a0d78ae1"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2019-02-14T10:29:53+01:00",
"end": "2019-02-14T10:48:31+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1470.69,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 294.13800000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1176.5520000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 1470.69,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 1470.69,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 1613.27,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1176.5520000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:1e8f082a-5d15-3e76-902d-d1eadb5e183c",
"resource": {
"resourceType": "Encounter",
"id": "1e8f082a-5d15-3e76-902d-d1eadb5e183c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "1e8f082a-5d15-3e76-902d-d1eadb5e183c"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2019-05-16T11:29:53+02:00",
"end": "2019-05-16T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2019-05-16T11:29:53+02:00",
"end": "2019-05-16T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:4ea5d8e5-6377-5f9e-1837-c34b42c13fb2",
"resource": {
"resourceType": "Procedure",
"id": "4ea5d8e5-6377-5f9e-1837-c34b42c13fb2",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:1e8f082a-5d15-3e76-902d-d1eadb5e183c"
},
"performedPeriod": {
"start": "2019-05-16T11:29:53+02:00",
"end": "2019-05-16T11:39:53+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:b2b128e7-1e65-7eab-381c-b98ff24ff19d",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b2b128e7-1e65-7eab-381c-b98ff24ff19d",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:1e8f082a-5d15-3e76-902d-d1eadb5e183c"
},
"effectiveDateTime": "2019-05-16T11:29:53+02:00",
"issued": "2019-05-16T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:031050ea-d274-1402-56a7-dd1e2ef95aa1",
"resource": {
"resourceType": "DocumentReference",
"id": "031050ea-d274-1402-56a7-dd1e2ef95aa1",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:b2b128e7-1e65-7eab-381c-b98ff24ff19d"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2019-05-16T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:1e8f082a-5d15-3e76-902d-d1eadb5e183c"
} ],
"period": {
"start": "2019-05-16T11:29:53+02:00",
"end": "2019-05-16T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:fd334c8b-cf4f-b3bc-0b49-b623a87d25ab",
"resource": {
"resourceType": "Claim",
"id": "fd334c8b-cf4f-b3bc-0b49-b623a87d25ab",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2019-05-16T11:29:53+02:00",
"end": "2019-05-16T11:44:53+02:00"
},
"created": "2019-05-16T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:4ea5d8e5-6377-5f9e-1837-c34b42c13fb2"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:1e8f082a-5d15-3e76-902d-d1eadb5e183c"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2151.20,
"currency": "USD"
}
} ],
"total": {
"value": 2293.78,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:d71c37fe-ad92-b56a-7258-7cd991bd4515",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "d71c37fe-ad92-b56a-7258-7cd991bd4515",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "fd334c8b-cf4f-b3bc-0b49-b623a87d25ab"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2019-05-16T11:44:53+02:00",
"end": "2020-05-16T11:44:53+02:00"
},
"created": "2019-05-16T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:fd334c8b-cf4f-b3bc-0b49-b623a87d25ab"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2019-05-16T11:29:53+02:00",
"end": "2019-05-16T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:1e8f082a-5d15-3e76-902d-d1eadb5e183c"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2019-05-16T11:29:53+02:00",
"end": "2019-05-16T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2151.20,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 430.24,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1720.96,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2151.20,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2151.20,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2293.78,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1720.96,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:fcaa028f-ed99-faf7-d6a2-4da41c3a72d5",
"resource": {
"resourceType": "Encounter",
"id": "fcaa028f-ed99-faf7-d6a2-4da41c3a72d5",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "fcaa028f-ed99-faf7-d6a2-4da41c3a72d5"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2019-08-15T11:29:53+02:00",
"end": "2019-08-15T11:49:41+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2019-08-15T11:29:53+02:00",
"end": "2019-08-15T11:49:41+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:b74c770d-24b9-8de5-797c-685f268cc6ae",
"resource": {
"resourceType": "Procedure",
"id": "b74c770d-24b9-8de5-797c-685f268cc6ae",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:fcaa028f-ed99-faf7-d6a2-4da41c3a72d5"
},
"performedPeriod": {
"start": "2019-08-15T11:29:53+02:00",
"end": "2019-08-15T11:49:41+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:82c04973-70c0-6ff0-2c8c-0f891f031340",
"resource": {
"resourceType": "DiagnosticReport",
"id": "82c04973-70c0-6ff0-2c8c-0f891f031340",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:fcaa028f-ed99-faf7-d6a2-4da41c3a72d5"
},
"effectiveDateTime": "2019-08-15T11:29:53+02:00",
"issued": "2019-08-15T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:b6f27f72-6e18-c8d6-cc0c-fcc0cc499648",
"resource": {
"resourceType": "DocumentReference",
"id": "b6f27f72-6e18-c8d6-cc0c-fcc0cc499648",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:82c04973-70c0-6ff0-2c8c-0f891f031340"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2019-08-15T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMTktMDgtMTUKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzClBldHJvbmlsYTcyNAogaXMgYSA0OSB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBhY3V0ZSBiYWN0ZXJpYWwgc2ludXNpdGlzIChkaXNvcmRlciksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgbWVkaWNhdGlvbiByZXZpZXcgZHVlIChzaXR1YXRpb24pLCB1bmhlYWx0aHkgYWxjb2hvbCBkcmlua2luZyBiZWhhdmlvciAoZmluZGluZyksIHJlcG9ydHMgb2YgdmlvbGVuY2UgaW4gdGhlIGVudmlyb25tZW50IChmaW5kaW5nKSwgZnVsbC10aW1lIGVtcGxveW1lbnQgKGZpbmRpbmcpLCBhY3V0ZSB2aXJhbCBwaGFyeW5naXRpcyAoZGlzb3JkZXIpLCB2aWN0aW0gb2YgaW50aW1hdGUgcGFydG5lciBhYnVzZSAoZmluZGluZyksIHZpcmFsIHNpbnVzaXRpcyAoZGlzb3JkZXIpLCBzdHJlc3MgKGZpbmRpbmcpLCBzb2NpYWwgaXNvbGF0aW9uIChmaW5kaW5nKS4KCiMgU29jaWFsIEhpc3RvcnkKUGF0aWVudCBpcyBzaW5nbGUuIFBhdGllbnQgcXVpdCBzbW9raW5nIGF0IGFnZSAxNy4KIFBhdGllbnQgaWRlbnRpZmllcyBhcyBoZXRlcm9zZXh1YWwuCgpQYXRpZW50IGNvbWVzIGZyb20gYSBtaWRkbGUgc29jaW9lY29ub21pYyBiYWNrZ3JvdW5kLgogUGF0aWVudCBkaWQgbm90IGZpbmlzaCBoaWdoIHNjaG9vbC4KUGF0aWVudCBjdXJyZW50bHkgaGFzIFVuaXRlZEhlYWx0aGNhcmUuCgojIEFsbGVyZ2llcwpObyBLbm93biBBbGxlcmdpZXMuCgojIE1lZGljYXRpb25zCk5vIEFjdGl2ZSBNZWRpY2F0aW9ucy4KCiMgQXNzZXNzbWVudCBhbmQgUGxhbgoKCiMjIFBsYW4KClRoZSBmb2xsb3dpbmcgcHJvY2VkdXJlcyB3ZXJlIGNvbmR1Y3RlZDoKLSBpbnRyYW11c2N1bGFyIGluamVjdGlvbgo="
},
"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:fcaa028f-ed99-faf7-d6a2-4da41c3a72d5"
} ],
"period": {
"start": "2019-08-15T11:29:53+02:00",
"end": "2019-08-15T11:49:41+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:20db7d00-adae-acc2-9956-a2d824f42648",
"resource": {
"resourceType": "Claim",
"id": "20db7d00-adae-acc2-9956-a2d824f42648",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2019-08-15T11:29:53+02:00",
"end": "2019-08-15T11:49:41+02:00"
},
"created": "2019-08-15T11:49:41+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:b74c770d-24b9-8de5-797c-685f268cc6ae"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:fcaa028f-ed99-faf7-d6a2-4da41c3a72d5"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2600.97,
"currency": "USD"
}
} ],
"total": {
"value": 2743.55,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:ce571cca-a37e-060e-d24f-99f346da8b60",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "ce571cca-a37e-060e-d24f-99f346da8b60",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "20db7d00-adae-acc2-9956-a2d824f42648"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2019-08-15T11:49:41+02:00",
"end": "2020-08-15T11:49:41+02:00"
},
"created": "2019-08-15T11:49:41+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:20db7d00-adae-acc2-9956-a2d824f42648"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2019-08-15T11:29:53+02:00",
"end": "2019-08-15T11:49:41+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:fcaa028f-ed99-faf7-d6a2-4da41c3a72d5"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2019-08-15T11:29:53+02:00",
"end": "2019-08-15T11:49:41+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2600.97,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 520.194,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2080.776,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2600.97,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2600.97,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2743.55,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2080.776,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:64f6afb3-39ff-3390-a849-c570bfb567cb",
"resource": {
"resourceType": "Encounter",
"id": "64f6afb3-39ff-3390-a849-c570bfb567cb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "64f6afb3-39ff-3390-a849-c570bfb567cb"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2019-11-14T10:29:53+01:00",
"end": "2019-11-14T10:47:06+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2019-11-14T10:29:53+01:00",
"end": "2019-11-14T10:47:06+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:85f6e76a-43f6-9806-1186-e68542c97279",
"resource": {
"resourceType": "Procedure",
"id": "85f6e76a-43f6-9806-1186-e68542c97279",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:64f6afb3-39ff-3390-a849-c570bfb567cb"
},
"performedPeriod": {
"start": "2019-11-14T10:29:53+01:00",
"end": "2019-11-14T10:47:06+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:f8418a5a-7201-a3d9-bb77-52aedbf6dd52",
"resource": {
"resourceType": "DiagnosticReport",
"id": "f8418a5a-7201-a3d9-bb77-52aedbf6dd52",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:64f6afb3-39ff-3390-a849-c570bfb567cb"
},
"effectiveDateTime": "2019-11-14T10:29:53+01:00",
"issued": "2019-11-14T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:78ac496f-70bf-40ff-2278-0f851f01e44f",
"resource": {
"resourceType": "DocumentReference",
"id": "78ac496f-70bf-40ff-2278-0f851f01e44f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:f8418a5a-7201-a3d9-bb77-52aedbf6dd52"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2019-11-14T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:64f6afb3-39ff-3390-a849-c570bfb567cb"
} ],
"period": {
"start": "2019-11-14T10:29:53+01:00",
"end": "2019-11-14T10:47:06+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:a97b8b60-f485-1087-15dc-627860e31a8d",
"resource": {
"resourceType": "Claim",
"id": "a97b8b60-f485-1087-15dc-627860e31a8d",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2019-11-14T10:29:53+01:00",
"end": "2019-11-14T10:47:06+01:00"
},
"created": "2019-11-14T10:47:06+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:85f6e76a-43f6-9806-1186-e68542c97279"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:64f6afb3-39ff-3390-a849-c570bfb567cb"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2150.36,
"currency": "USD"
}
} ],
"total": {
"value": 2292.94,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:535fea9d-4727-17db-0c6a-8ec2824ca912",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "535fea9d-4727-17db-0c6a-8ec2824ca912",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "a97b8b60-f485-1087-15dc-627860e31a8d"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2019-11-14T10:47:06+01:00",
"end": "2020-11-14T10:47:06+01:00"
},
"created": "2019-11-14T10:47:06+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:a97b8b60-f485-1087-15dc-627860e31a8d"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2019-11-14T10:29:53+01:00",
"end": "2019-11-14T10:47:06+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:64f6afb3-39ff-3390-a849-c570bfb567cb"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2019-11-14T10:29:53+01:00",
"end": "2019-11-14T10:47:06+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2150.36,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 430.07200000000006,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1720.2880000000002,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2150.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2150.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2292.94,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1720.2880000000002,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9",
"resource": {
"resourceType": "Encounter",
"id": "cc358caa-553c-33e1-4106-e3983c66d8a9",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "cc358caa-553c-33e1-4106-e3983c66d8a9"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:b1de685a-5b66-ceb1-d03b-63ccff424b73",
"resource": {
"resourceType": "Condition",
"id": "b1de685a-5b66-ceb1-d03b-63ccff424b73",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160904001",
"display": "Part-time employment (finding)"
} ],
"text": "Part-time employment (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"onsetDateTime": "2019-11-28T11:16:28+01:00",
"abatementDateTime": "2021-12-09T11:06:08+01:00",
"recordedDate": "2019-11-28T11:16:28+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:b2c1f1ad-bc9b-ece5-65ac-07c40150800d",
"resource": {
"resourceType": "Observation",
"id": "b2c1f1ad-bc9b-ece5-65ac-07c40150800d",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
} ],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 6.19,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:09e41a53-046d-5b7c-5728-1dda6ddc5248",
"resource": {
"resourceType": "Observation",
"id": "09e41a53-046d-5b7c-5728-1dda6ddc5248",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 170.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5b332417-0c51-e7ec-301a-ff0748327ec8",
"resource": {
"resourceType": "Observation",
"id": "5b332417-0c51-e7ec-301a-ff0748327ec8",
"status": "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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 4,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:fc06c801-5593-9bdb-4c4d-2edaf70ad31a",
"resource": {
"resourceType": "Observation",
"id": "fc06c801-5593-9bdb-4c4d-2edaf70ad31a",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 80.4,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3a5b974a-d1bf-8280-71b7-861b9aeccc44",
"resource": {
"resourceType": "Observation",
"id": "3a5b974a-d1bf-8280-71b7-861b9aeccc44",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 27.71,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3a50b8d9-8e89-5d4f-2537-a7f60296ac1f",
"resource": {
"resourceType": "Observation",
"id": "3a50b8d9-8e89-5d4f-2537-a7f60296ac1f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 92,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 125,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:cf07d47b-2782-8c20-0574-ede0867fdefd",
"resource": {
"resourceType": "Observation",
"id": "cf07d47b-2782-8c20-0574-ede0867fdefd",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 82,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ede17fe1-8b87-5c15-e943-c42183a67417",
"resource": {
"resourceType": "Observation",
"id": "ede17fe1-8b87-5c15-e943-c42183a67417",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 14,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6363bb39-6022-72cf-4543-0a96d0a3fac7",
"resource": {
"resourceType": "Observation",
"id": "6363bb39-6022-72cf-4543-0a96d0a3fac7",
"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": "2339-0",
"display": "Glucose [Mass/volume] in Blood"
} ],
"text": "Glucose [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 73,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:323de323-648d-6dc3-7ec7-b5b1980c23f5",
"resource": {
"resourceType": "Observation",
"id": "323de323-648d-6dc3-7ec7-b5b1980c23f5",
"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": "6299-2",
"display": "Urea nitrogen [Mass/volume] in Blood"
} ],
"text": "Urea nitrogen [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 15.05,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c67a22d5-8dbc-7754-a08f-158d98af9d88",
"resource": {
"resourceType": "Observation",
"id": "c67a22d5-8dbc-7754-a08f-158d98af9d88",
"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": "38483-4",
"display": "Creatinine [Mass/volume] in Blood"
} ],
"text": "Creatinine [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 1.16,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8c5ce4da-ef81-6242-104b-be52ff94dcf8",
"resource": {
"resourceType": "Observation",
"id": "8c5ce4da-ef81-6242-104b-be52ff94dcf8",
"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": "49765-1",
"display": "Calcium [Mass/volume] in Blood"
} ],
"text": "Calcium [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 8.82,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5dc40c15-e300-8860-546e-12ded21a7f20",
"resource": {
"resourceType": "Observation",
"id": "5dc40c15-e300-8860-546e-12ded21a7f20",
"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": "2947-0",
"display": "Sodium [Moles/volume] in Blood"
} ],
"text": "Sodium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 141.63,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c4523903-e608-6089-b218-55a1c03f5158",
"resource": {
"resourceType": "Observation",
"id": "c4523903-e608-6089-b218-55a1c03f5158",
"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": "6298-4",
"display": "Potassium [Moles/volume] in Blood"
} ],
"text": "Potassium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 3.86,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f0b29f44-2277-ffd4-1fc8-63c8b23957c3",
"resource": {
"resourceType": "Observation",
"id": "f0b29f44-2277-ffd4-1fc8-63c8b23957c3",
"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": "2069-3",
"display": "Chloride [Moles/volume] in Blood"
} ],
"text": "Chloride [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 108.12,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:61062f57-d6ef-fa06-453f-7e9e5d4664e5",
"resource": {
"resourceType": "Observation",
"id": "61062f57-d6ef-fa06-453f-7e9e5d4664e5",
"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": "20565-8",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ],
"text": "Carbon dioxide, total [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 27.06,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:cedbe7d6-541d-8519-7fd5-502af7d64b7e",
"resource": {
"resourceType": "Observation",
"id": "cedbe7d6-541d-8519-7fd5-502af7d64b7e",
"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": "2093-3",
"display": "Cholesterol [Mass/volume] in Serum or Plasma"
} ],
"text": "Cholesterol [Mass/volume] in Serum or Plasma"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 150.97,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2dd3c51e-3341-a085-9f76-ea1438686799",
"resource": {
"resourceType": "Observation",
"id": "2dd3c51e-3341-a085-9f76-ea1438686799",
"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": "2571-8",
"display": "Triglycerides"
} ],
"text": "Triglycerides"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 107.15,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ac399741-1c1e-4797-5381-0d91ecd6f79b",
"resource": {
"resourceType": "Observation",
"id": "ac399741-1c1e-4797-5381-0d91ecd6f79b",
"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": "18262-6",
"display": "Low Density Lipoprotein Cholesterol"
} ],
"text": "Low Density Lipoprotein Cholesterol"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 78.67,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e2fc0e72-3e0e-ec0b-cf0d-88249dc88b59",
"resource": {
"resourceType": "Observation",
"id": "e2fc0e72-3e0e-ec0b-cf0d-88249dc88b59",
"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": "2085-9",
"display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
} ],
"text": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueQuantity": {
"value": 50.87,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:efe997fe-197e-578c-4c0c-1c2f19767c39",
"resource": {
"resourceType": "Observation",
"id": "efe997fe-197e-578c-4c0c-1c2f19767c39",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Ex-smoker (finding)"
} ],
"text": "Ex-smoker (finding)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:76fcba5b-6c8f-f1b5-d75a-aea857963c6f",
"resource": {
"resourceType": "Observation",
"id": "76fcba5b-6c8f-f1b5-d75a-aea857963c6f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93025-5",
"display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T11:16:28+01:00",
"issued": "2019-11-28T11:16:28.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76501-6",
"display": "Within the last year, have you been afraid of your partner or ex-partner?"
} ],
"text": "Within the last year, have you been afraid of your partner or ex-partner?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93026-3",
"display": "Do you feel physically and emotionally safe where you currently live?"
} ],
"text": "Do you feel physically and emotionally safe where you currently live?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA33-6",
"display": "Yes"
} ],
"text": "Yes"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93027-1",
"display": "Are you a refugee?"
} ],
"text": "Are you a refugee?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93028-9",
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93038-8",
"display": "Stress level"
} ],
"text": "Stress level"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA13863-8",
"display": "A little bit"
} ],
"text": "A little bit"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93029-7",
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30132-7",
"display": "5 or more times a week"
} ],
"text": "5 or more times a week"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93030-5",
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
} ],
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93031-3",
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30128-5",
"display": "Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)"
} ],
"text": "Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63586-2",
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
},
"valueQuantity": {
"value": 90472,
"unit": "/a",
"system": "http://unitsofmeasure.org",
"code": "/a"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76437-3",
"display": "Primary insurance"
} ],
"text": "Primary insurance"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6350-8",
"display": "Private insurance"
} ],
"text": "Private insurance"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "67875-5",
"display": "Employment status - current"
} ],
"text": "Employment status - current"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30138-4",
"display": "Part-time or temporary work"
} ],
"text": "Part-time or temporary work"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82589-3",
"display": "Highest level of education"
} ],
"text": "Highest level of education"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30191-3",
"display": "Less than high school degree"
} ],
"text": "Less than high school degree"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56799-0",
"display": "Address"
} ],
"text": "Address"
},
"valueString": "217 Bayer Drive Unit 35"
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93033-9",
"display": "Are you worried about losing your housing?"
} ],
"text": "Are you worried about losing your housing?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "71802-3",
"display": "Housing status"
} ],
"text": "Housing status"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30189-7",
"display": "I have housing"
} ],
"text": "I have housing"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63512-8",
"display": "How many people are living or staying at this address?"
} ],
"text": "How many people are living or staying at this address?"
},
"valueQuantity": {
"value": 5,
"unit": "{#}",
"system": "http://unitsofmeasure.org",
"code": "{#}"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "54899-0",
"display": "Preferred language"
} ],
"text": "Preferred language"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA43-5",
"display": "English"
} ],
"text": "English"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93034-7",
"display": "Have you been discharged from the armed forces of the United States?"
} ],
"text": "Have you been discharged from the armed forces of the United States?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93035-4",
"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "32624-9",
"display": "Race"
} ],
"text": "Race"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA4457-3",
"display": "White"
} ],
"text": "White"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56051-6",
"display": "Do you consider yourself Hispanic/Latino?"
} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:da724fab-16d1-31eb-42aa-10f2e24ed189",
"resource": {
"resourceType": "Observation",
"id": "da724fab-16d1-31eb-42aa-10f2e24ed189",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T11:42:45+01:00",
"issued": "2019-11-28T11:42:45.294+01:00",
"valueQuantity": {
"value": 4,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:12b6e12b-a496-d390-bf87-aeca0dd0f8fc",
"resource": {
"resourceType": "Observation",
"id": "12b6e12b-a496-d390-bf87-aeca0dd0f8fc",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76504-0",
"display": "Total score [HARK]"
} ],
"text": "Total score [HARK]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T12:21:55+01:00",
"issued": "2019-11-28T12:21:55.294+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ee8866a8-d431-a8ff-0bbf-b6d8544887dd",
"resource": {
"resourceType": "Observation",
"id": "ee8866a8-d431-a8ff-0bbf-b6d8544887dd",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55758-7",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T12:59:46+01:00",
"issued": "2019-11-28T12:59:46.294+01:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:336520c0-0a6c-e668-e4b9-ba01eed8ea17",
"resource": {
"resourceType": "Procedure",
"id": "336520c0-0a6c-e668-e4b9-ba01eed8ea17",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"performedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:274f83e6-b62e-9a2a-7a63-223664d0b5e1",
"resource": {
"resourceType": "Procedure",
"id": "274f83e6-b62e-9a2a-7a63-223664d0b5e1",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"performedPeriod": {
"start": "2019-11-28T11:16:28+01:00",
"end": "2019-11-28T11:42:45+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:92c5208e-62e3-43cf-178a-5dac40034a51",
"resource": {
"resourceType": "Procedure",
"id": "92c5208e-62e3-43cf-178a-5dac40034a51",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "866148006",
"display": "Screening for domestic abuse (procedure)"
} ],
"text": "Screening for domestic abuse (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"performedPeriod": {
"start": "2019-11-28T11:42:45+01:00",
"end": "2019-11-28T12:21:55+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:2956955f-6944-076b-3481-31c5771bc33e",
"resource": {
"resourceType": "Procedure",
"id": "2956955f-6944-076b-3481-31c5771bc33e",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"performedPeriod": {
"start": "2019-11-28T12:21:55+01:00",
"end": "2019-11-28T12:35:46+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:2cd7bc6d-bb19-6916-1f5b-0b754b321178",
"resource": {
"resourceType": "Procedure",
"id": "2cd7bc6d-bb19-6916-1f5b-0b754b321178",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"performedPeriod": {
"start": "2019-11-28T12:35:46+01:00",
"end": "2019-11-28T12:59:46+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:5d3a1bee-bf7e-3406-d42b-d907ed89a5a8",
"resource": {
"resourceType": "SupplyDelivery",
"id": "5d3a1bee-bf7e-3406-d42b-d907ed89a5a8",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2019-11-28T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:6e2fac1d-bc89-6498-a24e-475729f7c52c",
"resource": {
"resourceType": "Immunization",
"id": "6e2fac1d-bc89-6498-a24e-475729f7c52c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "121",
"display": "zoster vaccine, live"
} ],
"text": "zoster vaccine, live"
},
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"occurrenceDateTime": "2019-11-28T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:ef862565-2f5b-495f-7edc-09f970d83d10",
"resource": {
"resourceType": "Immunization",
"id": "ef862565-2f5b-495f-7edc-09f970d83d10",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"occurrenceDateTime": "2019-11-28T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:ba5318ac-6dcc-5548-96d2-c72e67361677",
"resource": {
"resourceType": "DiagnosticReport",
"id": "ba5318ac-6dcc-5548-96d2-c72e67361677",
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:6363bb39-6022-72cf-4543-0a96d0a3fac7",
"display": "Glucose [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:323de323-648d-6dc3-7ec7-b5b1980c23f5",
"display": "Urea nitrogen [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:c67a22d5-8dbc-7754-a08f-158d98af9d88",
"display": "Creatinine [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:8c5ce4da-ef81-6242-104b-be52ff94dcf8",
"display": "Calcium [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:5dc40c15-e300-8860-546e-12ded21a7f20",
"display": "Sodium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:c4523903-e608-6089-b218-55a1c03f5158",
"display": "Potassium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:f0b29f44-2277-ffd4-1fc8-63c8b23957c3",
"display": "Chloride [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:61062f57-d6ef-fa06-453f-7e9e5d4664e5",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:b024dba0-a4a2-7147-4ee8-ceff5f25d8c4",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b024dba0-a4a2-7147-4ee8-ceff5f25d8c4",
"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": "57698-3",
"display": "Lipid panel with direct LDL - Serum or Plasma"
} ],
"text": "Lipid panel with direct LDL - Serum or Plasma"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:cedbe7d6-541d-8519-7fd5-502af7d64b7e",
"display": "Cholesterol [Mass/volume] in Serum or Plasma"
}, {
"reference": "urn:uuid:2dd3c51e-3341-a085-9f76-ea1438686799",
"display": "Triglycerides"
}, {
"reference": "urn:uuid:ac399741-1c1e-4797-5381-0d91ecd6f79b",
"display": "Low Density Lipoprotein Cholesterol"
}, {
"reference": "urn:uuid:e2fc0e72-3e0e-ec0b-cf0d-88249dc88b59",
"display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:b7cc44d9-3cdd-6f64-db7c-f50f1a302915",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b7cc44d9-3cdd-6f64-db7c-f50f1a302915",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T11:42:45+01:00",
"issued": "2019-11-28T11:42:45.294+01:00",
"result": [ {
"reference": "urn:uuid:da724fab-16d1-31eb-42aa-10f2e24ed189",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:75193486-761b-3363-180c-005add5b2728",
"resource": {
"resourceType": "DiagnosticReport",
"id": "75193486-761b-3363-180c-005add5b2728",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76499-3",
"display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
} ],
"text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T12:21:55+01:00",
"issued": "2019-11-28T12:21:55.294+01:00",
"result": [ {
"reference": "urn:uuid:12b6e12b-a496-d390-bf87-aeca0dd0f8fc",
"display": "Total score [HARK]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:99961a16-b9f6-f23a-afe5-ffb367a68be8",
"resource": {
"resourceType": "DiagnosticReport",
"id": "99961a16-b9f6-f23a-afe5-ffb367a68be8",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T12:59:46+01:00",
"issued": "2019-11-28T12:59:46.294+01:00",
"result": [ {
"reference": "urn:uuid:ee8866a8-d431-a8ff-0bbf-b6d8544887dd",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:139d4e9e-2ed4-2325-98e3-edf1c6605681",
"resource": {
"resourceType": "DiagnosticReport",
"id": "139d4e9e-2ed4-2325-98e3-edf1c6605681",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
},
"effectiveDateTime": "2019-11-28T10:29:53+01:00",
"issued": "2019-11-28T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:3bc0b0e3-f16b-aa4e-9d5b-950e2666470a",
"resource": {
"resourceType": "DocumentReference",
"id": "3bc0b0e3-f16b-aa4e-9d5b-950e2666470a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:139d4e9e-2ed4-2325-98e3-edf1c6605681"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2019-11-28T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
} ],
"period": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:0b9d36b7-de94-3bec-a3be-2093ea3b246e",
"resource": {
"resourceType": "Claim",
"id": "0b9d36b7-de94-3bec-a3be-2093ea3b246e",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"created": "2019-11-28T11:16:28+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:6e2fac1d-bc89-6498-a24e-475729f7c52c"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:ef862565-2f5b-495f-7edc-09f970d83d10"
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 8,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:b1de685a-5b66-ceb1-d03b-63ccff424b73"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:336520c0-0a6c-e668-e4b9-ba01eed8ea17"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:274f83e6-b62e-9a2a-7a63-223664d0b5e1"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:92c5208e-62e3-43cf-178a-5dac40034a51"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:2956955f-6944-076b-3481-31c5771bc33e"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:2cd7bc6d-bb19-6916-1f5b-0b754b321178"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "121",
"display": "zoster vaccine, live"
} ],
"text": "zoster vaccine, live"
},
"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://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 6,
"informationSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "57698-3",
"display": "Lipid panel with direct LDL - Serum or Plasma"
} ],
"text": "Lipid panel with direct LDL - Serum or Plasma"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 7,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 8,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160904001",
"display": "Part-time employment (finding)"
} ],
"text": "Part-time employment (finding)"
}
}, {
"sequence": 9,
"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": 10,
"informationSequence": [ 6 ],
"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": 11,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "866148006",
"display": "Screening for domestic abuse (procedure)"
} ],
"text": "Screening for domestic abuse (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 12,
"informationSequence": [ 7 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "76499-3",
"display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
} ],
"text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 13,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 14,
"procedureSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 15,
"informationSequence": [ 8 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
} ],
"total": {
"value": 996.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:6735178f-3896-4041-bbba-4f25fabf1762",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "6735178f-3896-4041-bbba-4f25fabf1762",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "0b9d36b7-de94-3bec-a3be-2093ea3b246e"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2019-11-28T11:16:28+01:00",
"end": "2020-11-28T11:16:28+01:00"
},
"created": "2019-11-28T11:16:28+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:0b9d36b7-de94-3bec-a3be-2093ea3b246e"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:b1de685a-5b66-ceb1-d03b-63ccff424b73"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
} ]
}, {
"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": "121",
"display": "zoster vaccine, live"
} ],
"text": "zoster vaccine, live"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+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": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+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://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+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,
"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": "57698-3",
"display": "Lipid panel with direct LDL - Serum or Plasma"
} ],
"text": "Lipid panel with direct LDL - Serum or Plasma"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160904001",
"display": "Part-time employment (finding)"
} ],
"text": "Part-time employment (finding)"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 9,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 10,
"informationSequence": [ 6 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 11,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "866148006",
"display": "Screening for domestic abuse (procedure)"
} ],
"text": "Screening for domestic abuse (procedure)"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 12,
"informationSequence": [ 7 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "76499-3",
"display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
} ],
"text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 13,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 14,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 15,
"informationSequence": [ 8 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"servicedPeriod": {
"start": "2019-11-28T10:29:53+01:00",
"end": "2019-11-28T11:16:28+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": 996.16,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2246.9600000000005,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:ec2bf21e-2ee7-8cd4-d167-57a668b895cf",
"resource": {
"resourceType": "Encounter",
"id": "ec2bf21e-2ee7-8cd4-d167-57a668b895cf",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "ec2bf21e-2ee7-8cd4-d167-57a668b895cf"
} ],
"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"
} ],
"text": "Encounter for check up"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2019-12-05T10:29:53+01:00",
"end": "2019-12-05T11:02:30+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2019-12-05T10:29:53+01:00",
"end": "2019-12-05T11:02:30+01:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "275978004",
"display": "Screening for malignant neoplasm of colon (procedure)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:05f5781b-882d-0e66-c0b7-5fa6ed4a949c",
"resource": {
"resourceType": "Procedure",
"id": "05f5781b-882d-0e66-c0b7-5fa6ed4a949c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73761001",
"display": "Colonoscopy"
} ],
"text": "Colonoscopy"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:ec2bf21e-2ee7-8cd4-d167-57a668b895cf"
},
"performedPeriod": {
"start": "2019-12-05T10:29:53+01:00",
"end": "2019-12-05T11:02:30+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:e9d1de59-9c62-7957-d444-cfdf07f3222b",
"resource": {
"resourceType": "DiagnosticReport",
"id": "e9d1de59-9c62-7957-d444-cfdf07f3222b",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:ec2bf21e-2ee7-8cd4-d167-57a668b895cf"
},
"effectiveDateTime": "2019-12-05T10:29:53+01:00",
"issued": "2019-12-05T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:1b610e25-a9e6-2337-a0a7-ad7941725693",
"resource": {
"resourceType": "DocumentReference",
"id": "1b610e25-a9e6-2337-a0a7-ad7941725693",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:e9d1de59-9c62-7957-d444-cfdf07f3222b"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2019-12-05T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:ec2bf21e-2ee7-8cd4-d167-57a668b895cf"
} ],
"period": {
"start": "2019-12-05T10:29:53+01:00",
"end": "2019-12-05T11:02:30+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:cbba6dea-5f8f-c90c-f0b8-61f8c1177898",
"resource": {
"resourceType": "Claim",
"id": "cbba6dea-5f8f-c90c-f0b8-61f8c1177898",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2019-12-05T10:29:53+01:00",
"end": "2019-12-05T11:02:30+01:00"
},
"created": "2019-12-05T11:02:30+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:05f5781b-882d-0e66-c0b7-5fa6ed4a949c"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185349003",
"display": "Encounter for check up"
} ],
"text": "Encounter for check up"
},
"encounter": [ {
"reference": "urn:uuid:ec2bf21e-2ee7-8cd4-d167-57a668b895cf"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73761001",
"display": "Colonoscopy"
} ],
"text": "Colonoscopy"
},
"net": {
"value": 12316.46,
"currency": "USD"
}
} ],
"total": {
"value": 12402.01,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:ce39a44c-4665-df46-2e25-96d67c2e3468",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "ce39a44c-4665-df46-2e25-96d67c2e3468",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "cbba6dea-5f8f-c90c-f0b8-61f8c1177898"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2019-12-05T11:02:30+01:00",
"end": "2020-12-05T11:02:30+01:00"
},
"created": "2019-12-05T11:02:30+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:cbba6dea-5f8f-c90c-f0b8-61f8c1177898"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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"
} ],
"text": "Encounter for check up"
},
"servicedPeriod": {
"start": "2019-12-05T10:29:53+01:00",
"end": "2019-12-05T11:02:30+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:ec2bf21e-2ee7-8cd4-d167-57a668b895cf"
} ]
}, {
"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": "73761001",
"display": "Colonoscopy"
} ],
"text": "Colonoscopy"
},
"servicedPeriod": {
"start": "2019-12-05T10:29:53+01:00",
"end": "2019-12-05T11:02:30+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 12316.46,
"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": 2463.292,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 9853.168,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 12316.46,
"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": 12316.46,
"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"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 12402.01,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 9853.168,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d",
"resource": {
"resourceType": "Encounter",
"id": "7b2d1dc1-636c-1961-a2da-ef245906922d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "7b2d1dc1-636c-1961-a2da-ef245906922d"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "702927004",
"display": "Urgent care clinic (environment)"
} ],
"text": "Urgent care clinic (environment)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999937797",
"display": "Dr. Elmer371 Kutch271"
}
} ],
"period": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|61728ca7-d723-3602-a9b5-e6efddc42982",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|d4e48a16-0a60-3e90-81e5-c35b22ffe6af",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:1fea56de-2eef-fccb-4fa7-d27e092dd666",
"resource": {
"resourceType": "Condition",
"id": "1fea56de-2eef-fccb-4fa7-d27e092dd666",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "422650009",
"display": "Social isolation (finding)"
} ],
"text": "Social isolation (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"onsetDateTime": "2019-12-19T11:21:51+01:00",
"abatementDateTime": "2020-12-03T11:01:18+01:00",
"recordedDate": "2019-12-19T11:21:51+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:6bc14475-a0d0-be8e-e7ab-79952117da82",
"resource": {
"resourceType": "Observation",
"id": "6bc14475-a0d0-be8e-e7ab-79952117da82",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
} ],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 6.34,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a376c260-4469-7be6-1dfd-31562600735b",
"resource": {
"resourceType": "Observation",
"id": "a376c260-4469-7be6-1dfd-31562600735b",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 170.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:dfa09cbf-73b2-e231-2540-b0b705f8e9ad",
"resource": {
"resourceType": "Observation",
"id": "dfa09cbf-73b2-e231-2540-b0b705f8e9ad",
"status": "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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:550004c3-339c-790c-26f2-c5179721411b",
"resource": {
"resourceType": "Observation",
"id": "550004c3-339c-790c-26f2-c5179721411b",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 79.9,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1e000f0b-ab66-f74e-4e30-b0a5fe4d3c80",
"resource": {
"resourceType": "Observation",
"id": "1e000f0b-ab66-f74e-4e30-b0a5fe4d3c80",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 27.54,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:aebdff2a-1371-e75b-5208-733fe0b44e08",
"resource": {
"resourceType": "Observation",
"id": "aebdff2a-1371-e75b-5208-733fe0b44e08",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 88,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure"
},
"valueQuantity": {
"value": 125,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f3ff8cba-7712-fb71-a505-ada6d2d59e32",
"resource": {
"resourceType": "Observation",
"id": "f3ff8cba-7712-fb71-a505-ada6d2d59e32",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 84,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:4c5a121c-fb2c-7e7a-5495-2d9714c8c231",
"resource": {
"resourceType": "Observation",
"id": "4c5a121c-fb2c-7e7a-5495-2d9714c8c231",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 14,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:438b2c92-57f3-1fb0-167f-3a6e06305978",
"resource": {
"resourceType": "Observation",
"id": "438b2c92-57f3-1fb0-167f-3a6e06305978",
"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": "2339-0",
"display": "Glucose [Mass/volume] in Blood"
} ],
"text": "Glucose [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 68.22,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:61cdca27-e4ec-77f3-0787-67baaab5bf36",
"resource": {
"resourceType": "Observation",
"id": "61cdca27-e4ec-77f3-0787-67baaab5bf36",
"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": "6299-2",
"display": "Urea nitrogen [Mass/volume] in Blood"
} ],
"text": "Urea nitrogen [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 9.85,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:17fa2aee-75b1-1b48-d8ca-1ed13f215afa",
"resource": {
"resourceType": "Observation",
"id": "17fa2aee-75b1-1b48-d8ca-1ed13f215afa",
"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": "38483-4",
"display": "Creatinine [Mass/volume] in Blood"
} ],
"text": "Creatinine [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 0.86,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:229a4935-7096-a48f-3da7-afe04d3ff4c3",
"resource": {
"resourceType": "Observation",
"id": "229a4935-7096-a48f-3da7-afe04d3ff4c3",
"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": "49765-1",
"display": "Calcium [Mass/volume] in Blood"
} ],
"text": "Calcium [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 8.91,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d9ee5551-f87a-7ff8-23f0-bd523778468f",
"resource": {
"resourceType": "Observation",
"id": "d9ee5551-f87a-7ff8-23f0-bd523778468f",
"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": "2947-0",
"display": "Sodium [Moles/volume] in Blood"
} ],
"text": "Sodium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 137.86,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8dd6a9a0-ac4a-68b5-dbe3-7977d02f9331",
"resource": {
"resourceType": "Observation",
"id": "8dd6a9a0-ac4a-68b5-dbe3-7977d02f9331",
"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": "6298-4",
"display": "Potassium [Moles/volume] in Blood"
} ],
"text": "Potassium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 3.8,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3e9a7acb-4caa-8df1-8e0c-9a6533e05667",
"resource": {
"resourceType": "Observation",
"id": "3e9a7acb-4caa-8df1-8e0c-9a6533e05667",
"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": "2069-3",
"display": "Chloride [Moles/volume] in Blood"
} ],
"text": "Chloride [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 109.75,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8532c84c-29a4-9300-70e9-281a3f63622b",
"resource": {
"resourceType": "Observation",
"id": "8532c84c-29a4-9300-70e9-281a3f63622b",
"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": "20565-8",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ],
"text": "Carbon dioxide, total [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueQuantity": {
"value": 24.28,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:19f3911b-f7e6-eebd-53a0-6ffef4c4d731",
"resource": {
"resourceType": "Observation",
"id": "19f3911b-f7e6-eebd-53a0-6ffef4c4d731",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Ex-smoker (finding)"
} ],
"text": "Ex-smoker (finding)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:679c9754-6741-cf37-fdaa-c37f4ff5148e",
"resource": {
"resourceType": "Observation",
"id": "679c9754-6741-cf37-fdaa-c37f4ff5148e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93025-5",
"display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T11:21:51+01:00",
"issued": "2019-12-19T11:21:51.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76501-6",
"display": "Within the last year, have you been afraid of your partner or ex-partner?"
} ],
"text": "Within the last year, have you been afraid of your partner or ex-partner?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93026-3",
"display": "Do you feel physically and emotionally safe where you currently live?"
} ],
"text": "Do you feel physically and emotionally safe where you currently live?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA33-6",
"display": "Yes"
} ],
"text": "Yes"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93027-1",
"display": "Are you a refugee?"
} ],
"text": "Are you a refugee?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93028-9",
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93038-8",
"display": "Stress level"
} ],
"text": "Stress level"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6568-5",
"display": "Not at all"
} ],
"text": "Not at all"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93029-7",
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA27722-0",
"display": "Less than once a week"
} ],
"text": "Less than once a week"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93030-5",
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
} ],
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93031-3",
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30122-8",
"display": "I choose not to answer this question"
} ],
"text": "I choose not to answer this question"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63586-2",
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
},
"valueQuantity": {
"value": 90472,
"unit": "/a",
"system": "http://unitsofmeasure.org",
"code": "/a"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76437-3",
"display": "Primary insurance"
} ],
"text": "Primary insurance"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6350-8",
"display": "Private insurance"
} ],
"text": "Private insurance"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "67875-5",
"display": "Employment status - current"
} ],
"text": "Employment status - current"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30138-4",
"display": "Part-time or temporary work"
} ],
"text": "Part-time or temporary work"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82589-3",
"display": "Highest level of education"
} ],
"text": "Highest level of education"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30191-3",
"display": "Less than high school degree"
} ],
"text": "Less than high school degree"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56799-0",
"display": "Address"
} ],
"text": "Address"
},
"valueString": "217 Bayer Drive Unit 35"
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93033-9",
"display": "Are you worried about losing your housing?"
} ],
"text": "Are you worried about losing your housing?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "71802-3",
"display": "Housing status"
} ],
"text": "Housing status"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30189-7",
"display": "I have housing"
} ],
"text": "I have housing"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63512-8",
"display": "How many people are living or staying at this address?"
} ],
"text": "How many people are living or staying at this address?"
},
"valueQuantity": {
"value": 5,
"unit": "{#}",
"system": "http://unitsofmeasure.org",
"code": "{#}"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "54899-0",
"display": "Preferred language"
} ],
"text": "Preferred language"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA43-5",
"display": "English"
} ],
"text": "English"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93034-7",
"display": "Have you been discharged from the armed forces of the United States?"
} ],
"text": "Have you been discharged from the armed forces of the United States?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93035-4",
"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "32624-9",
"display": "Race"
} ],
"text": "Race"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA4457-3",
"display": "White"
} ],
"text": "White"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56051-6",
"display": "Do you consider yourself Hispanic/Latino?"
} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f452d00f-a1fe-30a1-c30f-4ae74ff67c7a",
"resource": {
"resourceType": "Observation",
"id": "f452d00f-a1fe-30a1-c30f-4ae74ff67c7a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55758-7",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T11:57:10+01:00",
"issued": "2019-12-19T11:57:10.294+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:00bbdf5d-2bf2-e2b0-33fa-6e2f887301eb",
"resource": {
"resourceType": "Observation",
"id": "00bbdf5d-2bf2-e2b0-33fa-6e2f887301eb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "75626-2",
"display": "Total score [AUDIT-C]"
} ],
"text": "Total score [AUDIT-C]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T12:38:31+01:00",
"issued": "2019-12-19T12:38:31.294+01:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1ad1d967-23ec-2f01-4a28-733732204fc6",
"resource": {
"resourceType": "Procedure",
"id": "1ad1d967-23ec-2f01-4a28-733732204fc6",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"performedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T10:44:53+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|61728ca7-d723-3602-a9b5-e6efddc42982",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:cb1e0993-920c-a042-44ea-92858598e50e",
"resource": {
"resourceType": "Procedure",
"id": "cb1e0993-920c-a042-44ea-92858598e50e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"performedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|61728ca7-d723-3602-a9b5-e6efddc42982",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:e036a0df-1ad3-3e61-26ae-d4e266760587",
"resource": {
"resourceType": "Procedure",
"id": "e036a0df-1ad3-3e61-26ae-d4e266760587",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"performedPeriod": {
"start": "2019-12-19T11:21:51+01:00",
"end": "2019-12-19T11:36:28+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|61728ca7-d723-3602-a9b5-e6efddc42982",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:367c5147-7898-c86e-d02f-12d80e13beee",
"resource": {
"resourceType": "Procedure",
"id": "367c5147-7898-c86e-d02f-12d80e13beee",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"performedPeriod": {
"start": "2019-12-19T11:36:28+01:00",
"end": "2019-12-19T11:57:10+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|61728ca7-d723-3602-a9b5-e6efddc42982",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:515220bd-6276-7af3-0eee-7f6858fd20b1",
"resource": {
"resourceType": "Procedure",
"id": "515220bd-6276-7af3-0eee-7f6858fd20b1",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"performedPeriod": {
"start": "2019-12-19T11:57:10+01:00",
"end": "2019-12-19T12:09:14+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|61728ca7-d723-3602-a9b5-e6efddc42982",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:deca7f79-0b07-557a-04be-d874f8bd414e",
"resource": {
"resourceType": "Procedure",
"id": "deca7f79-0b07-557a-04be-d874f8bd414e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"performedPeriod": {
"start": "2019-12-19T12:09:14+01:00",
"end": "2019-12-19T12:38:31+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|61728ca7-d723-3602-a9b5-e6efddc42982",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:44dd2e02-ea4b-c37a-278c-68af797ecdfd",
"resource": {
"resourceType": "SupplyDelivery",
"id": "44dd2e02-ea4b-c37a-278c-68af797ecdfd",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2019-12-19T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:d2e96750-4e73-6067-6850-a158c004b464",
"resource": {
"resourceType": "Immunization",
"id": "d2e96750-4e73-6067-6850-a158c004b464",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"occurrenceDateTime": "2019-12-19T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|61728ca7-d723-3602-a9b5-e6efddc42982",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:8235512e-9149-ded7-8e54-88e2a31cfd49",
"resource": {
"resourceType": "DiagnosticReport",
"id": "8235512e-9149-ded7-8e54-88e2a31cfd49",
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|d4e48a16-0a60-3e90-81e5-c35b22ffe6af",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
} ],
"result": [ {
"reference": "urn:uuid:438b2c92-57f3-1fb0-167f-3a6e06305978",
"display": "Glucose [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:61cdca27-e4ec-77f3-0787-67baaab5bf36",
"display": "Urea nitrogen [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:17fa2aee-75b1-1b48-d8ca-1ed13f215afa",
"display": "Creatinine [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:229a4935-7096-a48f-3da7-afe04d3ff4c3",
"display": "Calcium [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:d9ee5551-f87a-7ff8-23f0-bd523778468f",
"display": "Sodium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:8dd6a9a0-ac4a-68b5-dbe3-7977d02f9331",
"display": "Potassium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:3e9a7acb-4caa-8df1-8e0c-9a6533e05667",
"display": "Chloride [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:8532c84c-29a4-9300-70e9-281a3f63622b",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:493533a1-cc87-3363-93da-885dc08b5891",
"resource": {
"resourceType": "DiagnosticReport",
"id": "493533a1-cc87-3363-93da-885dc08b5891",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T11:57:10+01:00",
"issued": "2019-12-19T11:57:10.294+01:00",
"result": [ {
"reference": "urn:uuid:f452d00f-a1fe-30a1-c30f-4ae74ff67c7a",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:b4c8f564-b740-48f7-e9c2-c16df0337f3a",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b4c8f564-b740-48f7-e9c2-c16df0337f3a",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T12:38:31+01:00",
"issued": "2019-12-19T12:38:31.294+01:00",
"result": [ {
"reference": "urn:uuid:00bbdf5d-2bf2-e2b0-33fa-6e2f887301eb",
"display": "Total score [AUDIT-C]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ea78da2a-cd3d-7f2e-b7ea-ef454a8bdd5f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "ea78da2a-cd3d-7f2e-b7ea-ef454a8bdd5f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
},
"effectiveDateTime": "2019-12-19T10:29:53+01:00",
"issued": "2019-12-19T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999937797",
"display": "Dr. Elmer371 Kutch271"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:cf57e2ab-019a-2044-4249-68169242f42f",
"resource": {
"resourceType": "DocumentReference",
"id": "cf57e2ab-019a-2044-4249-68169242f42f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:ea78da2a-cd3d-7f2e-b7ea-ef454a8bdd5f"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2019-12-19T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999937797",
"display": "Dr. Elmer371 Kutch271"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|d4e48a16-0a60-3e90-81e5-c35b22ffe6af",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
} ],
"period": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:61279836-22d7-3c0a-8874-15a14d325691",
"resource": {
"resourceType": "Claim",
"id": "61279836-22d7-3c0a-8874-15a14d325691",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"created": "2019-12-19T11:21:51+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|d4e48a16-0a60-3e90-81e5-c35b22ffe6af",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|61728ca7-d723-3602-a9b5-e6efddc42982",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:d2e96750-4e73-6067-6850-a158c004b464"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:1fea56de-2eef-fccb-4fa7-d27e092dd666"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:1ad1d967-23ec-2f01-4a28-733732204fc6"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:cb1e0993-920c-a042-44ea-92858598e50e"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:e036a0df-1ad3-3e61-26ae-d4e266760587"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:367c5147-7898-c86e-d02f-12d80e13beee"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:515220bd-6276-7af3-0eee-7f6858fd20b1"
}
}, {
"sequence": 6,
"procedureReference": {
"reference": "urn:uuid:deca7f79-0b07-557a-04be-d874f8bd414e"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "702927004",
"display": "Urgent care clinic (environment)"
} ],
"text": "Urgent care clinic (environment)"
},
"encounter": [ {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 613.74,
"currency": "USD"
}
}, {
"sequence": 4,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 6,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 7,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "422650009",
"display": "Social isolation (finding)"
} ],
"text": "Social isolation (finding)"
}
}, {
"sequence": 8,
"procedureSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 9,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 10,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 11,
"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": 12,
"procedureSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 13,
"informationSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
} ],
"total": {
"value": 1405.10,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:8dc5913c-a368-3fdf-a605-18a546c4c531",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "8dc5913c-a368-3fdf-a605-18a546c4c531",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999937797"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999937797"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "61279836-22d7-3c0a-8874-15a14d325691"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2019-12-19T11:21:51+01:00",
"end": "2020-12-19T11:21:51+01:00"
},
"created": "2019-12-19T11:21:51+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999937797"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|61728ca7-d723-3602-a9b5-e6efddc42982",
"display": "GREEN MOUNTAIN URGENT CARE LLC"
},
"claim": {
"reference": "urn:uuid:61279836-22d7-3c0a-8874-15a14d325691"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999937797"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:1fea56de-2eef-fccb-4fa7-d27e092dd666"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "702927004",
"display": "Urgent care clinic (environment)"
} ],
"text": "Urgent care clinic (environment)"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"encounter": [ {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
} ]
}, {
"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": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"net": {
"value": 613.74,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 122.748,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 490.992,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 613.74,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 613.74,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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": [ 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": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"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": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"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,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "422650009",
"display": "Social isolation (finding)"
} ],
"text": "Social isolation (finding)"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
}
}, {
"sequence": 8,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 9,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 10,
"informationSequence": [ 4 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 11,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"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": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 13,
"informationSequence": [ 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": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"servicedPeriod": {
"start": "2019-12-19T10:29:53+01:00",
"end": "2019-12-19T11:21:51+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "20",
"display": "Urgent Care Facility"
} ]
},
"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": 1405.10,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2509.824,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:3a4e706f-df66-3d24-65f7-56d2eb8a764f",
"resource": {
"resourceType": "Encounter",
"id": "3a4e706f-df66-3d24-65f7-56d2eb8a764f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "3a4e706f-df66-3d24-65f7-56d2eb8a764f"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2019-12-26T10:29:53+01:00",
"end": "2019-12-26T10:44:53+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2019-12-26T10:29:53+01:00",
"end": "2019-12-26T10:44:53+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:392fd281-ed04-8f1c-71e1-7cef503fe3ce",
"resource": {
"resourceType": "Condition",
"id": "392fd281-ed04-8f1c-71e1-7cef503fe3ce",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:3a4e706f-df66-3d24-65f7-56d2eb8a764f"
},
"onsetDateTime": "2019-12-26T10:29:53+01:00",
"abatementDateTime": "2019-12-26T10:29:53+01:00",
"recordedDate": "2019-12-26T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:188c5154-974d-b138-36b4-e32407eb4184",
"resource": {
"resourceType": "Observation",
"id": "188c5154-974d-b138-36b4-e32407eb4184",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
} ],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:3a4e706f-df66-3d24-65f7-56d2eb8a764f"
},
"effectiveDateTime": "2019-12-26T10:29:53+01:00",
"issued": "2019-12-26T10:29:53.294+01:00",
"valueQuantity": {
"value": 5.87,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:aa828a26-304a-7b28-d868-b639b7cc239d",
"resource": {
"resourceType": "Procedure",
"id": "aa828a26-304a-7b28-d868-b639b7cc239d",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:3a4e706f-df66-3d24-65f7-56d2eb8a764f"
},
"performedPeriod": {
"start": "2019-12-26T10:29:53+01:00",
"end": "2019-12-26T10:44:53+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:34a4d1d9-e75e-fd9b-25e1-046a311931a7",
"resource": {
"resourceType": "SupplyDelivery",
"id": "34a4d1d9-e75e-fd9b-25e1-046a311931a7",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2019-12-26T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:e86f235b-7a68-4e89-7ffb-56b7ffaeeddd",
"resource": {
"resourceType": "DiagnosticReport",
"id": "e86f235b-7a68-4e89-7ffb-56b7ffaeeddd",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:3a4e706f-df66-3d24-65f7-56d2eb8a764f"
},
"effectiveDateTime": "2019-12-26T10:29:53+01:00",
"issued": "2019-12-26T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:256b081b-13c0-0a88-5a65-a4d7755aeeb2",
"resource": {
"resourceType": "DocumentReference",
"id": "256b081b-13c0-0a88-5a65-a4d7755aeeb2",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:e86f235b-7a68-4e89-7ffb-56b7ffaeeddd"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2019-12-26T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:3a4e706f-df66-3d24-65f7-56d2eb8a764f"
} ],
"period": {
"start": "2019-12-26T10:29:53+01:00",
"end": "2019-12-26T10:44:53+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:61f662b1-b7c4-a583-a8d0-380fb5301dd1",
"resource": {
"resourceType": "Claim",
"id": "61f662b1-b7c4-a583-a8d0-380fb5301dd1",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2019-12-26T10:29:53+01:00",
"end": "2019-12-26T10:44:53+01:00"
},
"created": "2019-12-26T10:44:53+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:392fd281-ed04-8f1c-71e1-7cef503fe3ce"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:aa828a26-304a-7b28-d868-b639b7cc239d"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"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:3a4e706f-df66-3d24-65f7-56d2eb8a764f"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
}
}, {
"sequence": 3,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 399.23,
"currency": "USD"
}
}, {
"sequence": 4,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
} ],
"total": {
"value": 491.58,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:096b0dd7-6702-19b7-920e-6a5cb91b79a2",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "096b0dd7-6702-19b7-920e-6a5cb91b79a2",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "61f662b1-b7c4-a583-a8d0-380fb5301dd1"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2019-12-26T10:44:53+01:00",
"end": "2020-12-26T10:44:53+01:00"
},
"created": "2019-12-26T10:44:53+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:61f662b1-b7c4-a583-a8d0-380fb5301dd1"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:392fd281-ed04-8f1c-71e1-7cef503fe3ce"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2019-12-26T10:29:53+01:00",
"end": "2019-12-26T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:3a4e706f-df66-3d24-65f7-56d2eb8a764f"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"servicedPeriod": {
"start": "2019-12-26T10:29:53+01:00",
"end": "2019-12-26T10:44:53+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": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"servicedPeriod": {
"start": "2019-12-26T10:29:53+01:00",
"end": "2019-12-26T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 399.23,
"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": 79.846,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 319.384,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 399.23,
"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": 399.23,
"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": 4,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2019-12-26T10:29:53+01:00",
"end": "2019-12-26T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 491.58,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 324.824,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae",
"resource": {
"resourceType": "Encounter",
"id": "c34b60ae-8431-6999-37b7-cd487adbd0ae",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "c34b60ae-8431-6999-37b7-cd487adbd0ae"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2020-01-02T10:29:53+01:00",
"end": "2020-01-02T10:53:03+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2020-01-02T10:29:53+01:00",
"end": "2020-01-02T10:53:03+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:a8235e51-4f0d-fe7b-8213-f39427809112",
"resource": {
"resourceType": "Condition",
"id": "a8235e51-4f0d-fe7b-8213-f39427809112",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae"
},
"onsetDateTime": "2020-01-02T10:29:53+01:00",
"abatementDateTime": "2020-01-21T10:53:03+01:00",
"recordedDate": "2020-01-02T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:d8df1ab2-cec1-0d81-5cb6-363cd010bf50",
"resource": {
"resourceType": "Procedure",
"id": "d8df1ab2-cec1-0d81-5cb6-363cd010bf50",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae"
},
"performedPeriod": {
"start": "2020-01-02T10:29:53+01:00",
"end": "2020-01-02T10:53:03+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"reasonReference": [ {
"reference": "urn:uuid:a8235e51-4f0d-fe7b-8213-f39427809112",
"display": "Acute bronchitis (disorder)"
} ]
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:36c2050f-7618-cf50-1335-497b7637c322",
"resource": {
"resourceType": "MedicationRequest",
"id": "36c2050f-7618-cf50-1335-497b7637c322",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae"
},
"authoredOn": "2020-01-02T10:53:03+01:00",
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
},
"reasonReference": [ {
"reference": "urn:uuid:a8235e51-4f0d-fe7b-8213-f39427809112",
"display": "Acute bronchitis (disorder)"
} ]
},
"request": {
"method": "POST",
"url": "MedicationRequest"
}
}, {
"fullUrl": "urn:uuid:32a913b3-eb53-7103-ebfd-9cedd23e1c4e",
"resource": {
"resourceType": "Claim",
"id": "32a913b3-eb53-7103-ebfd-9cedd23e1c4e",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2020-01-02T10:29:53+01:00",
"end": "2020-01-02T10:53:03+01:00"
},
"created": "2020-01-02T10:53:03+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"prescription": {
"reference": "urn:uuid:36c2050f-7618-cf50-1335-497b7637c322"
},
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"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:c34b60ae-8431-6999-37b7-cd487adbd0ae"
} ]
} ],
"total": {
"value": 117.83,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c5e6a373-8dba-844f-e73b-2a13cc100d26",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c5e6a373-8dba-844f-e73b-2a13cc100d26",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "32a913b3-eb53-7103-ebfd-9cedd23e1c4e"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2020-01-02T10:53:03+01:00",
"end": "2021-01-02T10:53:03+01:00"
},
"created": "2020-01-02T10:53:03+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:32a913b3-eb53-7103-ebfd-9cedd23e1c4e"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2020-01-02T10:29:53+01:00",
"end": "2020-01-02T10:53:03+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae"
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 117.83,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 0.0,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:d3cefda9-7989-5465-e17d-405286c9d110",
"resource": {
"resourceType": "CareTeam",
"id": "d3cefda9-7989-5465-e17d-405286c9d110",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ]
},
"status": "inactive",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae"
},
"period": {
"start": "2020-01-02T10:53:03+01:00",
"end": "2020-12-03T10:29:53+01:00"
},
"participant": [ {
"role": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "116154003",
"display": "Patient"
} ],
"text": "Patient"
} ],
"member": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
}
}, {
"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|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
}, {
"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|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"managingOrganization": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
} ]
},
"request": {
"method": "POST",
"url": "CareTeam"
}
}, {
"fullUrl": "urn:uuid:8da23adc-68b8-b87e-e0ef-ef933f63307b",
"resource": {
"resourceType": "CarePlan",
"id": "8da23adc-68b8-b87e-e0ef-ef933f63307b",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae"
},
"period": {
"start": "2020-01-02T10:53:03+01:00",
"end": "2020-12-03T10:29:53+01:00"
},
"careTeam": [ {
"reference": "urn:uuid:d3cefda9-7989-5465-e17d-405286c9d110"
} ],
"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": "BERKSHIRE MEDICAL CENTER INC - 1"
}
}
}, {
"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": "BERKSHIRE MEDICAL CENTER INC - 1"
}
}
} ]
},
"request": {
"method": "POST",
"url": "CarePlan"
}
}, {
"fullUrl": "urn:uuid:2655c3c7-4d1f-9dfb-74b3-f494bf34b878",
"resource": {
"resourceType": "DiagnosticReport",
"id": "2655c3c7-4d1f-9dfb-74b3-f494bf34b878",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae"
},
"effectiveDateTime": "2020-01-02T10:29:53+01:00",
"issued": "2020-01-02T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:68a5b416-0c89-9cee-1179-9e88fe0f087f",
"resource": {
"resourceType": "DocumentReference",
"id": "68a5b416-0c89-9cee-1179-9e88fe0f087f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:2655c3c7-4d1f-9dfb-74b3-f494bf34b878"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2020-01-02T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:c34b60ae-8431-6999-37b7-cd487adbd0ae"
} ],
"period": {
"start": "2020-01-02T10:29:53+01:00",
"end": "2020-01-02T10:53:03+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:2e5ad192-3ef3-1390-7c7f-98f838edcc0a",
"resource": {
"resourceType": "Claim",
"id": "2e5ad192-3ef3-1390-7c7f-98f838edcc0a",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2020-01-02T10:29:53+01:00",
"end": "2020-01-02T10:53:03+01:00"
},
"created": "2020-01-02T10:53:03+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:a8235e51-4f0d-fe7b-8213-f39427809112"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:d8df1ab2-cec1-0d81-5cb6-363cd010bf50"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae"
} ]
}, {
"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": 343.43,
"currency": "USD"
}
} ],
"total": {
"value": 428.98,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:f40eb072-d43f-eb20-84e2-b2f0191acf4b",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "f40eb072-d43f-eb20-84e2-b2f0191acf4b",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "2e5ad192-3ef3-1390-7c7f-98f838edcc0a"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2020-01-02T10:53:03+01:00",
"end": "2021-01-02T10:53:03+01:00"
},
"created": "2020-01-02T10:53:03+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:2e5ad192-3ef3-1390-7c7f-98f838edcc0a"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:a8235e51-4f0d-fe7b-8213-f39427809112"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2020-01-02T10:29:53+01:00",
"end": "2020-01-02T10:53:03+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae"
} ]
}, {
"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": "2020-01-02T10:29:53+01:00",
"end": "2020-01-02T10:53:03+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": "2020-01-02T10:29:53+01:00",
"end": "2020-01-02T10:53:03+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 343.43,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 68.686,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 274.744,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 343.43,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 343.43,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 428.98,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 274.744,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:c2038d21-8f7f-ad62-54a1-5804e23e2003",
"resource": {
"resourceType": "Encounter",
"id": "c2038d21-8f7f-ad62-54a1-5804e23e2003",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "c2038d21-8f7f-ad62-54a1-5804e23e2003"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2020-02-13T10:29:53+01:00",
"end": "2020-02-13T10:46:28+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2020-02-13T10:29:53+01:00",
"end": "2020-02-13T10:46:28+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:67d5a1c9-9fc7-b1a0-a88b-c2076c7b6b30",
"resource": {
"resourceType": "Procedure",
"id": "67d5a1c9-9fc7-b1a0-a88b-c2076c7b6b30",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c2038d21-8f7f-ad62-54a1-5804e23e2003"
},
"performedPeriod": {
"start": "2020-02-13T10:29:53+01:00",
"end": "2020-02-13T10:46:28+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:8563058d-1120-26fa-1196-621257bf7a92",
"resource": {
"resourceType": "DiagnosticReport",
"id": "8563058d-1120-26fa-1196-621257bf7a92",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c2038d21-8f7f-ad62-54a1-5804e23e2003"
},
"effectiveDateTime": "2020-02-13T10:29:53+01:00",
"issued": "2020-02-13T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:f7f0abc5-c35d-40df-f28d-68275e416b14",
"resource": {
"resourceType": "DocumentReference",
"id": "f7f0abc5-c35d-40df-f28d-68275e416b14",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:8563058d-1120-26fa-1196-621257bf7a92"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2020-02-13T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:c2038d21-8f7f-ad62-54a1-5804e23e2003"
} ],
"period": {
"start": "2020-02-13T10:29:53+01:00",
"end": "2020-02-13T10:46:28+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:45a4f3c1-abd8-9721-085d-36d61ea90033",
"resource": {
"resourceType": "Claim",
"id": "45a4f3c1-abd8-9721-085d-36d61ea90033",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2020-02-13T10:29:53+01:00",
"end": "2020-02-13T10:46:28+01:00"
},
"created": "2020-02-13T10:46:28+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:67d5a1c9-9fc7-b1a0-a88b-c2076c7b6b30"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:c2038d21-8f7f-ad62-54a1-5804e23e2003"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 3405.19,
"currency": "USD"
}
} ],
"total": {
"value": 3547.77,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:8bf8fdd3-b6f8-c8e0-a141-82de589b5652",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "8bf8fdd3-b6f8-c8e0-a141-82de589b5652",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "45a4f3c1-abd8-9721-085d-36d61ea90033"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2020-02-13T10:46:28+01:00",
"end": "2021-02-13T10:46:28+01:00"
},
"created": "2020-02-13T10:46:28+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:45a4f3c1-abd8-9721-085d-36d61ea90033"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2020-02-13T10:29:53+01:00",
"end": "2020-02-13T10:46:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:c2038d21-8f7f-ad62-54a1-5804e23e2003"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2020-02-13T10:29:53+01:00",
"end": "2020-02-13T10:46:28+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 3405.19,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 681.038,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2724.152,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 3405.19,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 3405.19,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 3547.77,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2724.152,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:918b7f0c-1a75-f3fc-4bfb-5f08ce51f173",
"resource": {
"resourceType": "Encounter",
"id": "918b7f0c-1a75-f3fc-4bfb-5f08ce51f173",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "918b7f0c-1a75-f3fc-4bfb-5f08ce51f173"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2020-05-14T11:29:53+02:00",
"end": "2020-05-14T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2020-05-14T11:29:53+02:00",
"end": "2020-05-14T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:0c6d7863-6bb3-b7ec-113b-cc34c66dfb92",
"resource": {
"resourceType": "Condition",
"id": "0c6d7863-6bb3-b7ec-113b-cc34c66dfb92",
"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": "840544004",
"display": "Suspected COVID-19"
} ],
"text": "Suspected COVID-19"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:918b7f0c-1a75-f3fc-4bfb-5f08ce51f173"
},
"onsetDateTime": "2020-07-22T11:29:53+02:00",
"abatementDateTime": "2020-07-22T13:00:43+02:00",
"recordedDate": "2020-07-22T11:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:38b84891-43f0-7c1e-a0f0-02c8cf11f90a",
"resource": {
"resourceType": "Procedure",
"id": "38b84891-43f0-7c1e-a0f0-02c8cf11f90a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:918b7f0c-1a75-f3fc-4bfb-5f08ce51f173"
},
"performedPeriod": {
"start": "2020-05-14T11:29:53+02:00",
"end": "2020-05-14T11:40:42+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:e1c66ede-3f4a-9f7b-8a9a-595130d00b0c",
"resource": {
"resourceType": "DiagnosticReport",
"id": "e1c66ede-3f4a-9f7b-8a9a-595130d00b0c",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:918b7f0c-1a75-f3fc-4bfb-5f08ce51f173"
},
"effectiveDateTime": "2020-05-14T11:29:53+02:00",
"issued": "2020-05-14T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ab8b041a-c24e-0ced-dee7-896161a1a479",
"resource": {
"resourceType": "DocumentReference",
"id": "ab8b041a-c24e-0ced-dee7-896161a1a479",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:e1c66ede-3f4a-9f7b-8a9a-595130d00b0c"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2020-05-14T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:918b7f0c-1a75-f3fc-4bfb-5f08ce51f173"
} ],
"period": {
"start": "2020-05-14T11:29:53+02:00",
"end": "2020-05-14T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:c896a0a4-24bb-b2a0-c4dd-b9902ff721f5",
"resource": {
"resourceType": "Claim",
"id": "c896a0a4-24bb-b2a0-c4dd-b9902ff721f5",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2020-05-14T11:29:53+02:00",
"end": "2020-05-14T11:44:53+02:00"
},
"created": "2020-05-14T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:0c6d7863-6bb3-b7ec-113b-cc34c66dfb92"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:38b84891-43f0-7c1e-a0f0-02c8cf11f90a"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:918b7f0c-1a75-f3fc-4bfb-5f08ce51f173"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2742.60,
"currency": "USD"
}
}, {
"sequence": 3,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "840544004",
"display": "Suspected COVID-19"
} ],
"text": "Suspected COVID-19"
}
} ],
"total": {
"value": 2885.18,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:81a309a7-49a0-e8bd-96eb-c94641c3762f",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "81a309a7-49a0-e8bd-96eb-c94641c3762f",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "c896a0a4-24bb-b2a0-c4dd-b9902ff721f5"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2020-05-14T11:44:53+02:00",
"end": "2021-05-14T11:44:53+02:00"
},
"created": "2020-05-14T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:c896a0a4-24bb-b2a0-c4dd-b9902ff721f5"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:0c6d7863-6bb3-b7ec-113b-cc34c66dfb92"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2020-05-14T11:29:53+02:00",
"end": "2020-05-14T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:918b7f0c-1a75-f3fc-4bfb-5f08ce51f173"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2020-05-14T11:29:53+02:00",
"end": "2020-05-14T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2742.60,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 548.52,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2194.08,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2742.60,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2742.60,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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": "840544004",
"display": "Suspected COVID-19"
} ],
"text": "Suspected COVID-19"
},
"servicedPeriod": {
"start": "2020-05-14T11:29:53+02:00",
"end": "2020-05-14T11:44:53+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": 2885.18,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2194.08,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672",
"resource": {
"resourceType": "Encounter",
"id": "66e5d7d9-2eaf-0307-1dc8-fcaf60f57672",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
} ],
"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 (procedure)"
} ],
"text": "Encounter for symptom (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "840544004",
"display": "Suspected COVID-19"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:56a8b1b7-b582-a1d7-28f8-7948aeef12f9",
"resource": {
"resourceType": "Condition",
"id": "56a8b1b7-b582-a1d7-28f8-7948aeef12f9",
"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": "49727002",
"display": "Cough (finding)"
} ],
"text": "Cough (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"onsetDateTime": "2020-07-22T11:29:53+02:00",
"abatementDateTime": "2020-08-28T10:00:43+02:00",
"recordedDate": "2020-07-22T11:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:49fe7783-129f-17b7-c0ea-bc6167ecad2b",
"resource": {
"resourceType": "Condition",
"id": "49fe7783-129f-17b7-c0ea-bc6167ecad2b",
"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": "84229001",
"display": "Fatigue (finding)"
} ],
"text": "Fatigue (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"onsetDateTime": "2020-07-22T11:29:53+02:00",
"abatementDateTime": "2020-08-28T10:00:43+02:00",
"recordedDate": "2020-07-22T11:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:5f76eb19-c3a1-02a6-33d0-19d2a8e2664d",
"resource": {
"resourceType": "Condition",
"id": "5f76eb19-c3a1-02a6-33d0-19d2a8e2664d",
"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": "386661006",
"display": "Fever (finding)"
} ],
"text": "Fever (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"onsetDateTime": "2020-07-22T11:29:53+02:00",
"abatementDateTime": "2020-08-28T10:00:43+02:00",
"recordedDate": "2020-07-22T11:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:96dd3035-855d-ab7d-7f45-5e0e82b7bfa3",
"resource": {
"resourceType": "Condition",
"id": "96dd3035-855d-ab7d-7f45-5e0e82b7bfa3",
"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": "840539006",
"display": "COVID-19"
} ],
"text": "COVID-19"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"onsetDateTime": "2020-07-22T13:00:43+02:00",
"abatementDateTime": "2020-08-28T10:00:43+02:00",
"recordedDate": "2020-07-22T13:00:43+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:0197c8da-6cf6-f6f1-fcbf-c4057dd25dfd",
"resource": {
"resourceType": "Observation",
"id": "0197c8da-6cf6-f6f1-fcbf-c4057dd25dfd",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8310-5",
"display": "Body temperature"
}, {
"system": "http://loinc.org",
"code": "8331-1",
"display": "Oral temperature"
} ],
"text": "Body temperature"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T11:29:53+02:00",
"issued": "2020-07-22T11:29:53.294+02:00",
"valueQuantity": {
"value": 38.334,
"unit": "Cel",
"system": "http://unitsofmeasure.org",
"code": "Cel"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:351e976d-18be-aa73-bacb-0d2211dfb145",
"resource": {
"resourceType": "Observation",
"id": "351e976d-18be-aa73-bacb-0d2211dfb145",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T11:29:53+02:00",
"issued": "2020-07-22T11:29:53.294+02:00",
"valueQuantity": {
"value": 22.357,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a956ac99-b2ff-2d7b-51d1-f1da42fa7331",
"resource": {
"resourceType": "Observation",
"id": "a956ac99-b2ff-2d7b-51d1-f1da42fa7331",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T11:29:53+02:00",
"issued": "2020-07-22T11:29:53.294+02:00",
"valueQuantity": {
"value": 109.05,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0d44cf67-9246-8ea1-a6a3-02d50f3fdb0a",
"resource": {
"resourceType": "Observation",
"id": "0d44cf67-9246-8ea1-a6a3-02d50f3fdb0a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "2708-6",
"display": "Oxygen saturation in Arterial blood"
}, {
"system": "http://loinc.org",
"code": "59408-5",
"display": "Oxygen saturation in Arterial blood by Pulse oximetry"
} ],
"text": "Oxygen saturation in Arterial blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T11:29:53+02:00",
"issued": "2020-07-22T11:29:53.294+02:00",
"valueQuantity": {
"value": 81.34,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:af316b93-a2f0-1bd0-a19d-7005cebd7669",
"resource": {
"resourceType": "Observation",
"id": "af316b93-a2f0-1bd0-a19d-7005cebd7669",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T11:29:53+02:00",
"issued": "2020-07-22T11:29:53.294+02:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 87,
"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": 116,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:14c669aa-0949-0f18-790c-de0bc9ea56e3",
"resource": {
"resourceType": "Observation",
"id": "14c669aa-0949-0f18-790c-de0bc9ea56e3",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T11:29:53+02:00",
"issued": "2020-07-22T11:29:53.294+02:00",
"valueQuantity": {
"value": 79.7,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0c5f2459-c625-3ee4-dbf9-204c4576390f",
"resource": {
"resourceType": "Observation",
"id": "0c5f2459-c625-3ee4-dbf9-204c4576390f",
"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": "80382-5",
"display": "Influenza virus A Ag [Presence] in Upper respiratory specimen by Rapid immunoassay"
} ],
"text": "Influenza virus A Ag [Presence] in Upper respiratory specimen by Rapid immunoassay"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T11:43:15+02:00",
"issued": "2020-07-22T11:43:15.294+02:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "260415000",
"display": "Not detected (qualifier value)"
} ],
"text": "Not detected (qualifier value)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:42be55c2-4102-e961-889d-ab93b4cdacbc",
"resource": {
"resourceType": "Observation",
"id": "42be55c2-4102-e961-889d-ab93b4cdacbc",
"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": "80383-3",
"display": "Influenza virus B Ag [Presence] in Upper respiratory specimen by Rapid immunoassay"
} ],
"text": "Influenza virus B Ag [Presence] in Upper respiratory specimen by Rapid immunoassay"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T11:43:15+02:00",
"issued": "2020-07-22T11:43:15.294+02:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "260415000",
"display": "Not detected (qualifier value)"
} ],
"text": "Not detected (qualifier value)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0ad3637c-2b9b-70ef-9491-24bc65ba98b6",
"resource": {
"resourceType": "Observation",
"id": "0ad3637c-2b9b-70ef-9491-24bc65ba98b6",
"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": "94531-1",
"display": "SARS-CoV-2 RNA Pnl Resp NAA+probe"
} ],
"text": "SARS-CoV-2 RNA Pnl Resp NAA+probe"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T13:00:43+02:00",
"issued": "2020-07-22T13:00:43.294+02:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "260373001",
"display": "Detected (qualifier value)"
} ],
"text": "Detected (qualifier value)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:182baa86-b4cf-c46e-6861-6ba10bc2e791",
"resource": {
"resourceType": "Procedure",
"id": "182baa86-b4cf-c46e-6861-6ba10bc2e791",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "261352009",
"display": "Face mask (physical object)"
} ],
"text": "Face mask (physical object)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"performedPeriod": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T11:43:15+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"reasonReference": [ {
"reference": "urn:uuid:0c6d7863-6bb3-b7ec-113b-cc34c66dfb92",
"display": "Suspected COVID-19"
} ]
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:c5110a3d-a3f2-5fed-ed8d-c074fc92fae2",
"resource": {
"resourceType": "DiagnosticReport",
"id": "c5110a3d-a3f2-5fed-ed8d-c074fc92fae2",
"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": "80381-7",
"display": "Influenza virus A and B Ag panel - Upper respiratory specimen by Rapid immunoassay"
} ],
"text": "Influenza virus A and B Ag panel - Upper respiratory specimen by Rapid immunoassay"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T11:43:15+02:00",
"issued": "2020-07-22T11:43:15.294+02:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
} ],
"result": [ {
"reference": "urn:uuid:0c5f2459-c625-3ee4-dbf9-204c4576390f",
"display": "Influenza virus A Ag [Presence] in Upper respiratory specimen by Rapid immunoassay"
}, {
"reference": "urn:uuid:42be55c2-4102-e961-889d-ab93b4cdacbc",
"display": "Influenza virus B Ag [Presence] in Upper respiratory specimen by Rapid immunoassay"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ebf1e46d-c289-5f46-193a-17b13fb75e78",
"resource": {
"resourceType": "DiagnosticReport",
"id": "ebf1e46d-c289-5f46-193a-17b13fb75e78",
"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": "94531-1",
"display": "SARS-CoV-2 RNA Pnl Resp NAA+probe"
} ],
"text": "SARS-CoV-2 RNA Pnl Resp NAA+probe"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T13:00:43+02:00",
"issued": "2020-07-22T13:00:43.294+02:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
} ],
"result": [ {
"reference": "urn:uuid:0ad3637c-2b9b-70ef-9491-24bc65ba98b6",
"display": "SARS-CoV-2 RNA Pnl Resp NAA+probe"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:1cd39c5f-b510-5c5b-2778-126561ae9314",
"resource": {
"resourceType": "CareTeam",
"id": "1cd39c5f-b510-5c5b-2778-126561ae9314",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ]
},
"status": "inactive",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"period": {
"start": "2020-07-22T11:43:15+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"participant": [ {
"role": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "116154003",
"display": "Patient"
} ],
"text": "Patient"
} ],
"member": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
}
}, {
"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|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
}, {
"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|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"managingOrganization": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
} ]
},
"request": {
"method": "POST",
"url": "CareTeam"
}
}, {
"fullUrl": "urn:uuid:a697e074-0c0f-7b92-2c44-5e37c69e172c",
"resource": {
"resourceType": "CarePlan",
"id": "a697e074-0c0f-7b92-2c44-5e37c69e172c",
"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 Infectious disease care plan (record artifact).<br/>Activities: <ul><li>Infectious disease care plan (record artifact)</li><li>Infectious disease care plan (record artifact)</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": "736376001",
"display": "Infectious disease care plan (record artifact)"
} ],
"text": "Infectious disease care plan (record artifact)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"period": {
"start": "2020-07-22T11:43:15+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"careTeam": [ {
"reference": "urn:uuid:1cd39c5f-b510-5c5b-2778-126561ae9314"
} ],
"activity": [ {
"detail": {
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "409524006",
"display": "Airborne precautions (procedure)"
} ],
"text": "Airborne precautions (procedure)"
},
"status": "completed",
"location": {
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
}
}, {
"detail": {
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "409526008",
"display": "Personal protective equipment (physical object)"
} ],
"text": "Personal protective equipment (physical object)"
},
"status": "completed",
"location": {
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
}
} ]
},
"request": {
"method": "POST",
"url": "CarePlan"
}
}, {
"fullUrl": "urn:uuid:a0cc22aa-2d1f-5429-4282-4615bdc99b8a",
"resource": {
"resourceType": "CareTeam",
"id": "a0cc22aa-2d1f-5429-4282-4615bdc99b8a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam" ]
},
"status": "inactive",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"period": {
"start": "2020-07-22T13:00:43+02:00",
"end": "2020-08-28T10:00:43+02:00"
},
"participant": [ {
"role": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "116154003",
"display": "Patient"
} ],
"text": "Patient"
} ],
"member": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
}
}, {
"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|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
}, {
"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|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"managingOrganization": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
} ]
},
"request": {
"method": "POST",
"url": "CareTeam"
}
}, {
"fullUrl": "urn:uuid:da4039b3-b38e-ddb2-ae00-bdcb3a1838c5",
"resource": {
"resourceType": "CarePlan",
"id": "da4039b3-b38e-ddb2-ae00-bdcb3a1838c5",
"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 Infectious disease care plan (record artifact).<br/>Activities: <ul><li>Infectious disease care plan (record artifact)</li><li>Infectious disease care plan (record artifact)</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": "736376001",
"display": "Infectious disease care plan (record artifact)"
} ],
"text": "Infectious disease care plan (record artifact)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"period": {
"start": "2020-07-22T13:00:43+02:00",
"end": "2020-08-28T10:00:43+02:00"
},
"careTeam": [ {
"reference": "urn:uuid:a0cc22aa-2d1f-5429-4282-4615bdc99b8a"
} ],
"activity": [ {
"detail": {
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "409524006",
"display": "Airborne precautions (procedure)"
} ],
"text": "Airborne precautions (procedure)"
},
"status": "completed",
"location": {
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
}
}, {
"detail": {
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "361235007",
"display": "Isolation of infected patient (procedure)"
} ],
"text": "Isolation of infected patient (procedure)"
},
"status": "completed",
"location": {
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
}
} ]
},
"request": {
"method": "POST",
"url": "CarePlan"
}
}, {
"fullUrl": "urn:uuid:b2d9952d-a347-2fe2-0f5e-dbccf6debc16",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b2d9952d-a347-2fe2-0f5e-dbccf6debc16",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
},
"effectiveDateTime": "2020-07-22T11:29:53+02:00",
"issued": "2020-07-22T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:111a0307-1532-a3d3-cd7b-9deb3f679e6f",
"resource": {
"resourceType": "DocumentReference",
"id": "111a0307-1532-a3d3-cd7b-9deb3f679e6f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:b2d9952d-a347-2fe2-0f5e-dbccf6debc16"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2020-07-22T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
} ],
"period": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:d7526906-747f-96e1-b449-116ce169bbe5",
"resource": {
"resourceType": "Claim",
"id": "d7526906-747f-96e1-b449-116ce169bbe5",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"created": "2020-07-22T13:00:43+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:56a8b1b7-b582-a1d7-28f8-7948aeef12f9"
}
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:49fe7783-129f-17b7-c0ea-bc6167ecad2b"
}
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:5f76eb19-c3a1-02a6-33d0-19d2a8e2664d"
}
}, {
"sequence": 4,
"diagnosisReference": {
"reference": "urn:uuid:96dd3035-855d-ab7d-7f45-5e0e82b7bfa3"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:182baa86-b4cf-c46e-6861-6ba10bc2e791"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom (procedure)"
} ],
"text": "Encounter for symptom (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "49727002",
"display": "Cough (finding)"
} ],
"text": "Cough (finding)"
}
}, {
"sequence": 3,
"diagnosisSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "84229001",
"display": "Fatigue (finding)"
} ],
"text": "Fatigue (finding)"
}
}, {
"sequence": 4,
"diagnosisSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386661006",
"display": "Fever (finding)"
} ],
"text": "Fever (finding)"
}
}, {
"sequence": 5,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "261352009",
"display": "Face mask (physical object)"
} ],
"text": "Face mask (physical object)"
},
"net": {
"value": 1.74,
"currency": "USD"
}
}, {
"sequence": 6,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "80381-7",
"display": "Influenza virus A and B Ag panel - Upper respiratory specimen by Rapid immunoassay"
} ],
"text": "Influenza virus A and B Ag panel - Upper respiratory specimen by Rapid immunoassay"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 7,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "94531-1",
"display": "SARS-CoV-2 RNA Pnl Resp NAA+probe"
} ],
"text": "SARS-CoV-2 RNA Pnl Resp NAA+probe"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 8,
"diagnosisSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "840539006",
"display": "COVID-19"
} ],
"text": "COVID-19"
}
} ],
"total": {
"value": 236.45,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:f8c1b350-7c24-8ffe-82f7-7ba59fd4b745",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "f8c1b350-7c24-8ffe-82f7-7ba59fd4b745",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "d7526906-747f-96e1-b449-116ce169bbe5"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2020-07-22T13:00:43+02:00",
"end": "2021-07-22T13:00:43+02:00"
},
"created": "2020-07-22T13:00:43+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:d7526906-747f-96e1-b449-116ce169bbe5"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:56a8b1b7-b582-a1d7-28f8-7948aeef12f9"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:49fe7783-129f-17b7-c0ea-bc6167ecad2b"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:5f76eb19-c3a1-02a6-33d0-19d2a8e2664d"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 4,
"diagnosisReference": {
"reference": "urn:uuid:96dd3035-855d-ab7d-7f45-5e0e82b7bfa3"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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 (procedure)"
} ],
"text": "Encounter for symptom (procedure)"
},
"servicedPeriod": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
} ]
}, {
"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": "49727002",
"display": "Cough (finding)"
} ],
"text": "Cough (finding)"
},
"servicedPeriod": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
}
}, {
"sequence": 3,
"diagnosisSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "84229001",
"display": "Fatigue (finding)"
} ],
"text": "Fatigue (finding)"
},
"servicedPeriod": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
}
}, {
"sequence": 4,
"diagnosisSequence": [ 3 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "386661006",
"display": "Fever (finding)"
} ],
"text": "Fever (finding)"
},
"servicedPeriod": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "261352009",
"display": "Face mask (physical object)"
} ],
"text": "Face mask (physical object)"
},
"servicedPeriod": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1.74,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 0.34800000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1.3920000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 1.74,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 1.74,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"informationSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "80381-7",
"display": "Influenza virus A and B Ag panel - Upper respiratory specimen by Rapid immunoassay"
} ],
"text": "Influenza virus A and B Ag panel - Upper respiratory specimen by Rapid immunoassay"
},
"servicedPeriod": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"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": "94531-1",
"display": "SARS-CoV-2 RNA Pnl Resp NAA+probe"
} ],
"text": "SARS-CoV-2 RNA Pnl Resp NAA+probe"
},
"servicedPeriod": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"diagnosisSequence": [ 4 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "840539006",
"display": "COVID-19"
} ],
"text": "COVID-19"
},
"servicedPeriod": {
"start": "2020-07-22T11:29:53+02:00",
"end": "2020-07-22T13:00:43+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": 236.45,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 120.72,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:61fab5b9-e8a3-a7a4-4e52-4a653cd1595e",
"resource": {
"resourceType": "Encounter",
"id": "61fab5b9-e8a3-a7a4-4e52-4a653cd1595e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "61fab5b9-e8a3-a7a4-4e52-4a653cd1595e"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2020-08-13T11:29:53+02:00",
"end": "2020-08-13T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2020-08-13T11:29:53+02:00",
"end": "2020-08-13T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:7a7f860a-42ca-e303-fcb9-6a9843b693cb",
"resource": {
"resourceType": "Procedure",
"id": "7a7f860a-42ca-e303-fcb9-6a9843b693cb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:61fab5b9-e8a3-a7a4-4e52-4a653cd1595e"
},
"performedPeriod": {
"start": "2020-08-13T11:29:53+02:00",
"end": "2020-08-13T11:42:59+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:ab12da86-4c44-4260-ff7c-cfbfc5077828",
"resource": {
"resourceType": "DiagnosticReport",
"id": "ab12da86-4c44-4260-ff7c-cfbfc5077828",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:61fab5b9-e8a3-a7a4-4e52-4a653cd1595e"
},
"effectiveDateTime": "2020-08-13T11:29:53+02:00",
"issued": "2020-08-13T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:d3ca1a76-2a3f-bfdb-e978-5d1979e98ba1",
"resource": {
"resourceType": "DocumentReference",
"id": "d3ca1a76-2a3f-bfdb-e978-5d1979e98ba1",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:ab12da86-4c44-4260-ff7c-cfbfc5077828"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2020-08-13T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:61fab5b9-e8a3-a7a4-4e52-4a653cd1595e"
} ],
"period": {
"start": "2020-08-13T11:29:53+02:00",
"end": "2020-08-13T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:8022235f-bbb9-50eb-37b2-ebea56f412e7",
"resource": {
"resourceType": "Claim",
"id": "8022235f-bbb9-50eb-37b2-ebea56f412e7",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2020-08-13T11:29:53+02:00",
"end": "2020-08-13T11:44:53+02:00"
},
"created": "2020-08-13T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:7a7f860a-42ca-e303-fcb9-6a9843b693cb"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:61fab5b9-e8a3-a7a4-4e52-4a653cd1595e"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2386.82,
"currency": "USD"
}
} ],
"total": {
"value": 2529.40,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:045ab631-0bc3-bb6e-1f3e-e0c3002a58b3",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "045ab631-0bc3-bb6e-1f3e-e0c3002a58b3",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "8022235f-bbb9-50eb-37b2-ebea56f412e7"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2020-08-13T11:44:53+02:00",
"end": "2021-08-13T11:44:53+02:00"
},
"created": "2020-08-13T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:8022235f-bbb9-50eb-37b2-ebea56f412e7"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2020-08-13T11:29:53+02:00",
"end": "2020-08-13T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:61fab5b9-e8a3-a7a4-4e52-4a653cd1595e"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2020-08-13T11:29:53+02:00",
"end": "2020-08-13T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2386.82,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 477.36400000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1909.4560000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2386.82,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2386.82,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2529.40,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1909.4560000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:0242a675-2504-4067-7f0c-372c0f20a7b8",
"resource": {
"resourceType": "Encounter",
"id": "0242a675-2504-4067-7f0c-372c0f20a7b8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "0242a675-2504-4067-7f0c-372c0f20a7b8"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2020-09-19T07:29:53+02:00",
"end": "2020-09-19T07:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2020-09-19T07:29:53+02:00",
"end": "2020-09-19T07:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:9231e05f-bca9-3729-687e-fe7b88f97ea9",
"resource": {
"resourceType": "Condition",
"id": "9231e05f-bca9-3729-687e-fe7b88f97ea9",
"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": "195662009",
"display": "Acute viral pharyngitis (disorder)"
} ],
"text": "Acute viral pharyngitis (disorder)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:0242a675-2504-4067-7f0c-372c0f20a7b8"
},
"onsetDateTime": "2020-09-19T07:29:53+02:00",
"abatementDateTime": "2020-09-30T16:29:53+02:00",
"recordedDate": "2020-09-19T07:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:70c98937-f358-7063-fa67-cb7bb2a0e85b",
"resource": {
"resourceType": "Observation",
"id": "70c98937-f358-7063-fa67-cb7bb2a0e85b",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital signs"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8310-5",
"display": "Body temperature"
}, {
"system": "http://loinc.org",
"code": "8331-1",
"display": "Oral temperature"
} ],
"text": "Body temperature"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:0242a675-2504-4067-7f0c-372c0f20a7b8"
},
"effectiveDateTime": "2020-09-19T07:29:53+02:00",
"issued": "2020-09-19T07:29:53.294+02:00",
"valueQuantity": {
"value": 37.236,
"unit": "Cel",
"system": "http://unitsofmeasure.org",
"code": "Cel"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:fda0ae6a-91ac-a9db-d18b-215c17183a84",
"resource": {
"resourceType": "DiagnosticReport",
"id": "fda0ae6a-91ac-a9db-d18b-215c17183a84",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:0242a675-2504-4067-7f0c-372c0f20a7b8"
},
"effectiveDateTime": "2020-09-19T07:29:53+02:00",
"issued": "2020-09-19T07:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ae63bc93-dc8e-47ea-0ae9-03333025d41e",
"resource": {
"resourceType": "DocumentReference",
"id": "ae63bc93-dc8e-47ea-0ae9-03333025d41e",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:fda0ae6a-91ac-a9db-d18b-215c17183a84"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2020-09-19T07:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:0242a675-2504-4067-7f0c-372c0f20a7b8"
} ],
"period": {
"start": "2020-09-19T07:29:53+02:00",
"end": "2020-09-19T07:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:dd330f03-99d6-3973-2697-b498ed92e7d9",
"resource": {
"resourceType": "Claim",
"id": "dd330f03-99d6-3973-2697-b498ed92e7d9",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2020-09-19T07:29:53+02:00",
"end": "2020-09-19T07:44:53+02:00"
},
"created": "2020-09-19T07:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:9231e05f-bca9-3729-687e-fe7b88f97ea9"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:0242a675-2504-4067-7f0c-372c0f20a7b8"
} ]
}, {
"sequence": 2,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "195662009",
"display": "Acute viral pharyngitis (disorder)"
} ],
"text": "Acute viral pharyngitis (disorder)"
}
} ],
"total": {
"value": 85.55,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:813528ea-cec7-8421-fb85-618e2b4cd665",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "813528ea-cec7-8421-fb85-618e2b4cd665",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "dd330f03-99d6-3973-2697-b498ed92e7d9"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2020-09-19T07:44:53+02:00",
"end": "2021-09-19T07:44:53+02:00"
},
"created": "2020-09-19T07:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:dd330f03-99d6-3973-2697-b498ed92e7d9"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:9231e05f-bca9-3729-687e-fe7b88f97ea9"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "2020-09-19T07:29:53+02:00",
"end": "2020-09-19T07:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:0242a675-2504-4067-7f0c-372c0f20a7b8"
} ]
}, {
"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": "195662009",
"display": "Acute viral pharyngitis (disorder)"
} ],
"text": "Acute viral pharyngitis (disorder)"
},
"servicedPeriod": {
"start": "2020-09-19T07:29:53+02:00",
"end": "2020-09-19T07:44:53+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:3750ec72-d5e3-2fd1-e9f5-291ccfa705b2",
"resource": {
"resourceType": "Encounter",
"id": "3750ec72-d5e3-2fd1-e9f5-291ccfa705b2",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "3750ec72-d5e3-2fd1-e9f5-291ccfa705b2"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2020-11-12T10:29:53+01:00",
"end": "2020-11-12T10:44:53+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2020-11-12T10:29:53+01:00",
"end": "2020-11-12T10:44:53+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:15e1b358-94e3-fd7a-6d77-1c791fd590ed",
"resource": {
"resourceType": "Procedure",
"id": "15e1b358-94e3-fd7a-6d77-1c791fd590ed",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:3750ec72-d5e3-2fd1-e9f5-291ccfa705b2"
},
"performedPeriod": {
"start": "2020-11-12T10:29:53+01:00",
"end": "2020-11-12T10:40:28+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:9fd5c524-4fb7-2dfc-ef7f-90ea6565709f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "9fd5c524-4fb7-2dfc-ef7f-90ea6565709f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:3750ec72-d5e3-2fd1-e9f5-291ccfa705b2"
},
"effectiveDateTime": "2020-11-12T10:29:53+01:00",
"issued": "2020-11-12T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:a127513a-0a94-efc6-133c-6bb758f32094",
"resource": {
"resourceType": "DocumentReference",
"id": "a127513a-0a94-efc6-133c-6bb758f32094",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:9fd5c524-4fb7-2dfc-ef7f-90ea6565709f"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2020-11-12T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:3750ec72-d5e3-2fd1-e9f5-291ccfa705b2"
} ],
"period": {
"start": "2020-11-12T10:29:53+01:00",
"end": "2020-11-12T10:44:53+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:3601019c-68e0-40af-257f-30a87d4cdc69",
"resource": {
"resourceType": "Claim",
"id": "3601019c-68e0-40af-257f-30a87d4cdc69",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2020-11-12T10:29:53+01:00",
"end": "2020-11-12T10:44:53+01:00"
},
"created": "2020-11-12T10:44:53+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:15e1b358-94e3-fd7a-6d77-1c791fd590ed"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:3750ec72-d5e3-2fd1-e9f5-291ccfa705b2"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2708.11,
"currency": "USD"
}
} ],
"total": {
"value": 2850.69,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:3854445a-fd44-e829-ccde-7a235269bb47",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "3854445a-fd44-e829-ccde-7a235269bb47",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "3601019c-68e0-40af-257f-30a87d4cdc69"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2020-11-12T10:44:53+01:00",
"end": "2021-11-12T10:44:53+01:00"
},
"created": "2020-11-12T10:44:53+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:3601019c-68e0-40af-257f-30a87d4cdc69"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2020-11-12T10:29:53+01:00",
"end": "2020-11-12T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:3750ec72-d5e3-2fd1-e9f5-291ccfa705b2"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2020-11-12T10:29:53+01:00",
"end": "2020-11-12T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2708.11,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 541.6220000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2166.4880000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2708.11,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2708.11,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2850.69,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2166.4880000000003,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb",
"resource": {
"resourceType": "Encounter",
"id": "c3c72647-0027-8d7d-4f04-1c5163effbcb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "c3c72647-0027-8d7d-4f04-1c5163effbcb"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:d90ba52a-4dc6-a66f-ac9e-5639f1992cce",
"resource": {
"resourceType": "Condition",
"id": "d90ba52a-4dc6-a66f-ac9e-5639f1992cce",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"onsetDateTime": "2020-12-03T10:29:53+01:00",
"abatementDateTime": "2022-12-15T10:29:53+01:00",
"recordedDate": "2020-12-03T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:4ee3f291-b296-a41a-0930-dd810e39912f",
"resource": {
"resourceType": "Condition",
"id": "4ee3f291-b296-a41a-0930-dd810e39912f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"onsetDateTime": "2020-12-03T11:01:18+01:00",
"abatementDateTime": "2021-12-09T11:06:08+01:00",
"recordedDate": "2020-12-03T11:01:18+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:f294fa55-4e73-d8f2-447f-edda4380eb06",
"resource": {
"resourceType": "Condition",
"id": "f294fa55-4e73-d8f2-447f-edda4380eb06",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "resolved"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "424393004",
"display": "Reports of violence in the environment (finding)"
} ],
"text": "Reports of violence in the environment (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"onsetDateTime": "2020-12-03T11:01:18+01:00",
"abatementDateTime": "2021-12-09T11:06:08+01:00",
"recordedDate": "2020-12-03T11:01:18+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:7d6b5fc7-6229-3a23-5845-bd3e83635580",
"resource": {
"resourceType": "Condition",
"id": "7d6b5fc7-6229-3a23-5845-bd3e83635580",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "10939881000119105",
"display": "Unhealthy alcohol drinking behavior (finding)"
} ],
"text": "Unhealthy alcohol drinking behavior (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"onsetDateTime": "2020-12-03T12:34:43+01:00",
"recordedDate": "2020-12-03T12:34:43+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:a69579ed-bb87-6e99-8af3-6f22690a23ce",
"resource": {
"resourceType": "Observation",
"id": "a69579ed-bb87-6e99-8af3-6f22690a23ce",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
} ],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 6.36,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ab89ef60-b06b-64c1-a8d0-296ef72ee17d",
"resource": {
"resourceType": "Observation",
"id": "ab89ef60-b06b-64c1-a8d0-296ef72ee17d",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 170.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0f5c59ba-0567-d102-6fe0-ab197f13afc3",
"resource": {
"resourceType": "Observation",
"id": "0f5c59ba-0567-d102-6fe0-ab197f13afc3",
"status": "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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e3667cff-58ee-06cf-ac81-14b48f5ff015",
"resource": {
"resourceType": "Observation",
"id": "e3667cff-58ee-06cf-ac81-14b48f5ff015",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 79.7,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7e412771-703c-1230-3d37-067392fe06e6",
"resource": {
"resourceType": "Observation",
"id": "7e412771-703c-1230-3d37-067392fe06e6",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 27.48,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:14ce6f44-23de-bc1c-d175-90a9b33db858",
"resource": {
"resourceType": "Observation",
"id": "14ce6f44-23de-bc1c-d175-90a9b33db858",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+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": 123,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e87be79f-9274-665e-76cc-6c9dc7592185",
"resource": {
"resourceType": "Observation",
"id": "e87be79f-9274-665e-76cc-6c9dc7592185",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 60,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7de08142-82e9-3ff9-d613-c85b903a64e5",
"resource": {
"resourceType": "Observation",
"id": "7de08142-82e9-3ff9-d613-c85b903a64e5",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 15,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:38448745-92d7-db1a-99ac-b7dd3abab520",
"resource": {
"resourceType": "Observation",
"id": "38448745-92d7-db1a-99ac-b7dd3abab520",
"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": "2339-0",
"display": "Glucose [Mass/volume] in Blood"
} ],
"text": "Glucose [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 93.46,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:a619df41-3a1b-803c-2513-c853401f2347",
"resource": {
"resourceType": "Observation",
"id": "a619df41-3a1b-803c-2513-c853401f2347",
"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": "6299-2",
"display": "Urea nitrogen [Mass/volume] in Blood"
} ],
"text": "Urea nitrogen [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 16.97,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:8943df10-6efe-6344-e307-523d92d56b18",
"resource": {
"resourceType": "Observation",
"id": "8943df10-6efe-6344-e307-523d92d56b18",
"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": "38483-4",
"display": "Creatinine [Mass/volume] in Blood"
} ],
"text": "Creatinine [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 0.96,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:daab62fa-d95b-68d5-23a1-f634f8832a70",
"resource": {
"resourceType": "Observation",
"id": "daab62fa-d95b-68d5-23a1-f634f8832a70",
"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": "49765-1",
"display": "Calcium [Mass/volume] in Blood"
} ],
"text": "Calcium [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 10,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:857ba216-b686-6ce2-3e19-a1e51e8c9bfe",
"resource": {
"resourceType": "Observation",
"id": "857ba216-b686-6ce2-3e19-a1e51e8c9bfe",
"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": "2947-0",
"display": "Sodium [Moles/volume] in Blood"
} ],
"text": "Sodium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 141.3,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:662d64eb-1b59-de84-69fb-6159b93fc939",
"resource": {
"resourceType": "Observation",
"id": "662d64eb-1b59-de84-69fb-6159b93fc939",
"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": "6298-4",
"display": "Potassium [Moles/volume] in Blood"
} ],
"text": "Potassium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 4.24,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:03bc8254-b861-c50d-f27c-807c9f2c6793",
"resource": {
"resourceType": "Observation",
"id": "03bc8254-b861-c50d-f27c-807c9f2c6793",
"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": "2069-3",
"display": "Chloride [Moles/volume] in Blood"
} ],
"text": "Chloride [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 104.28,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:28bdc6ae-0309-825c-d8fd-c0dd65ffd4ee",
"resource": {
"resourceType": "Observation",
"id": "28bdc6ae-0309-825c-d8fd-c0dd65ffd4ee",
"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": "20565-8",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ],
"text": "Carbon dioxide, total [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueQuantity": {
"value": 28.77,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:67127388-1bf2-6845-71c3-281cddb683d0",
"resource": {
"resourceType": "Observation",
"id": "67127388-1bf2-6845-71c3-281cddb683d0",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Ex-smoker (finding)"
} ],
"text": "Ex-smoker (finding)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:de9b9a38-c34c-301b-8fb3-b79b5118fd85",
"resource": {
"resourceType": "Observation",
"id": "de9b9a38-c34c-301b-8fb3-b79b5118fd85",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93025-5",
"display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T11:01:18+01:00",
"issued": "2020-12-03T11:01:18.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76501-6",
"display": "Within the last year, have you been afraid of your partner or ex-partner?"
} ],
"text": "Within the last year, have you been afraid of your partner or ex-partner?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA33-6",
"display": "Yes"
} ],
"text": "Yes"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93026-3",
"display": "Do you feel physically and emotionally safe where you currently live?"
} ],
"text": "Do you feel physically and emotionally safe where you currently live?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93027-1",
"display": "Are you a refugee?"
} ],
"text": "Are you a refugee?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93028-9",
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93038-8",
"display": "Stress level"
} ],
"text": "Stress level"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA13909-9",
"display": "Somewhat"
} ],
"text": "Somewhat"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93029-7",
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30132-7",
"display": "5 or more times a week"
} ],
"text": "5 or more times a week"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93030-5",
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
} ],
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93031-3",
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30126-9",
"display": "Clothing"
} ],
"text": "Clothing"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63586-2",
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
},
"valueQuantity": {
"value": 90472,
"unit": "/a",
"system": "http://unitsofmeasure.org",
"code": "/a"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76437-3",
"display": "Primary insurance"
} ],
"text": "Primary insurance"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6350-8",
"display": "Private insurance"
} ],
"text": "Private insurance"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "67875-5",
"display": "Employment status - current"
} ],
"text": "Employment status - current"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30138-4",
"display": "Part-time or temporary work"
} ],
"text": "Part-time or temporary work"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82589-3",
"display": "Highest level of education"
} ],
"text": "Highest level of education"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30191-3",
"display": "Less than high school degree"
} ],
"text": "Less than high school degree"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56799-0",
"display": "Address"
} ],
"text": "Address"
},
"valueString": "217 Bayer Drive Unit 35"
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93033-9",
"display": "Are you worried about losing your housing?"
} ],
"text": "Are you worried about losing your housing?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "71802-3",
"display": "Housing status"
} ],
"text": "Housing status"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30189-7",
"display": "I have housing"
} ],
"text": "I have housing"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63512-8",
"display": "How many people are living or staying at this address?"
} ],
"text": "How many people are living or staying at this address?"
},
"valueQuantity": {
"value": 5,
"unit": "{#}",
"system": "http://unitsofmeasure.org",
"code": "{#}"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "54899-0",
"display": "Preferred language"
} ],
"text": "Preferred language"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA43-5",
"display": "English"
} ],
"text": "English"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93034-7",
"display": "Have you been discharged from the armed forces of the United States?"
} ],
"text": "Have you been discharged from the armed forces of the United States?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93035-4",
"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "32624-9",
"display": "Race"
} ],
"text": "Race"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA4457-3",
"display": "White"
} ],
"text": "White"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56051-6",
"display": "Do you consider yourself Hispanic/Latino?"
} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ec08bc1d-1a88-bb3e-87d8-10810cb6e111",
"resource": {
"resourceType": "Observation",
"id": "ec08bc1d-1a88-bb3e-87d8-10810cb6e111",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T11:20:41+01:00",
"issued": "2020-12-03T11:20:41.294+01:00",
"valueQuantity": {
"value": 9,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2c512f79-f5ce-291d-05d1-70991fab3d28",
"resource": {
"resourceType": "Observation",
"id": "2c512f79-f5ce-291d-05d1-70991fab3d28",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55758-7",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T12:00:22+01:00",
"issued": "2020-12-03T12:00:22.294+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5bd862d4-b26d-6578-2771-da8609d76e28",
"resource": {
"resourceType": "Observation",
"id": "5bd862d4-b26d-6578-2771-da8609d76e28",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "75626-2",
"display": "Total score [AUDIT-C]"
} ],
"text": "Total score [AUDIT-C]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T12:34:43+01:00",
"issued": "2020-12-03T12:34:43.294+01:00",
"valueQuantity": {
"value": 3,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0742bfe0-6595-97d4-11fa-2db3cd0b30db",
"resource": {
"resourceType": "Procedure",
"id": "0742bfe0-6595-97d4-11fa-2db3cd0b30db",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"performedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:b574afbb-c955-dc88-2f85-9b7e13232e80",
"resource": {
"resourceType": "Procedure",
"id": "b574afbb-c955-dc88-2f85-9b7e13232e80",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"performedPeriod": {
"start": "2020-12-03T11:01:18+01:00",
"end": "2020-12-03T11:20:41+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:cd64bb22-279e-9d24-1a45-239a485ded03",
"resource": {
"resourceType": "Procedure",
"id": "cd64bb22-279e-9d24-1a45-239a485ded03",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"performedPeriod": {
"start": "2020-12-03T11:20:41+01:00",
"end": "2020-12-03T11:32:33+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:2c05103d-c8d0-cec9-d6dd-ad713dfc15fc",
"resource": {
"resourceType": "Procedure",
"id": "2c05103d-c8d0-cec9-d6dd-ad713dfc15fc",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"performedPeriod": {
"start": "2020-12-03T11:32:33+01:00",
"end": "2020-12-03T12:00:22+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:777ced4e-e09d-3ff5-3250-b27127e7ed51",
"resource": {
"resourceType": "Procedure",
"id": "777ced4e-e09d-3ff5-3250-b27127e7ed51",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"performedPeriod": {
"start": "2020-12-03T12:00:22+01:00",
"end": "2020-12-03T12:14:35+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:cb4fd9e5-5e06-9543-6356-d6b793ed1517",
"resource": {
"resourceType": "Procedure",
"id": "cb4fd9e5-5e06-9543-6356-d6b793ed1517",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"performedPeriod": {
"start": "2020-12-03T12:14:35+01:00",
"end": "2020-12-03T12:34:43+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:161e9c76-eeb8-1da4-7321-e219c1d5dd12",
"resource": {
"resourceType": "SupplyDelivery",
"id": "161e9c76-eeb8-1da4-7321-e219c1d5dd12",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2020-12-03T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:a25823a1-4be3-4dd5-723e-4a246be34eca",
"resource": {
"resourceType": "SupplyDelivery",
"id": "a25823a1-4be3-4dd5-723e-4a246be34eca",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 100
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
}
},
"occurrenceDateTime": "2020-12-03T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:04dffa0d-b994-f2f5-67b1-f00fbbb54e5d",
"resource": {
"resourceType": "Immunization",
"id": "04dffa0d-b994-f2f5-67b1-f00fbbb54e5d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "121",
"display": "zoster vaccine, live"
} ],
"text": "zoster vaccine, live"
},
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"occurrenceDateTime": "2020-12-03T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:2c9dcf8d-5ccf-9dd4-c849-9ecda4c70ab4",
"resource": {
"resourceType": "Immunization",
"id": "2c9dcf8d-5ccf-9dd4-c849-9ecda4c70ab4",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"occurrenceDateTime": "2020-12-03T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:2b3244d0-0df5-c692-5b53-540cbd822268",
"resource": {
"resourceType": "Immunization",
"id": "2b3244d0-0df5-c692-5b53-540cbd822268",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ]
},
"status": "completed",
"vaccineCode": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "113",
"display": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed"
} ],
"text": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed"
},
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"occurrenceDateTime": "2020-12-03T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:a4c9a92c-5f32-e672-aa65-a7b0bfbfe74f",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a4c9a92c-5f32-e672-aa65-a7b0bfbfe74f",
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:38448745-92d7-db1a-99ac-b7dd3abab520",
"display": "Glucose [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:a619df41-3a1b-803c-2513-c853401f2347",
"display": "Urea nitrogen [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:8943df10-6efe-6344-e307-523d92d56b18",
"display": "Creatinine [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:daab62fa-d95b-68d5-23a1-f634f8832a70",
"display": "Calcium [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:857ba216-b686-6ce2-3e19-a1e51e8c9bfe",
"display": "Sodium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:662d64eb-1b59-de84-69fb-6159b93fc939",
"display": "Potassium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:03bc8254-b861-c50d-f27c-807c9f2c6793",
"display": "Chloride [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:28bdc6ae-0309-825c-d8fd-c0dd65ffd4ee",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:16465af2-5155-575f-cf4d-e392da5db757",
"resource": {
"resourceType": "DiagnosticReport",
"id": "16465af2-5155-575f-cf4d-e392da5db757",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T11:20:41+01:00",
"issued": "2020-12-03T11:20:41.294+01:00",
"result": [ {
"reference": "urn:uuid:ec08bc1d-1a88-bb3e-87d8-10810cb6e111",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ad769cca-ff95-86fb-7f9e-51b97cd71d6b",
"resource": {
"resourceType": "DiagnosticReport",
"id": "ad769cca-ff95-86fb-7f9e-51b97cd71d6b",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T12:00:22+01:00",
"issued": "2020-12-03T12:00:22.294+01:00",
"result": [ {
"reference": "urn:uuid:2c512f79-f5ce-291d-05d1-70991fab3d28",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:4ceaf4aa-f711-e15f-7150-aae11892bb2b",
"resource": {
"resourceType": "DiagnosticReport",
"id": "4ceaf4aa-f711-e15f-7150-aae11892bb2b",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T12:34:43+01:00",
"issued": "2020-12-03T12:34:43.294+01:00",
"result": [ {
"reference": "urn:uuid:5bd862d4-b26d-6578-2771-da8609d76e28",
"display": "Total score [AUDIT-C]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:854d5ab4-c2bc-5c72-8fda-995bf1d4b32b",
"resource": {
"resourceType": "DiagnosticReport",
"id": "854d5ab4-c2bc-5c72-8fda-995bf1d4b32b",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
},
"effectiveDateTime": "2020-12-03T10:29:53+01:00",
"issued": "2020-12-03T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:18c126ce-1d43-17c5-dbf6-ef228738513d",
"resource": {
"resourceType": "DocumentReference",
"id": "18c126ce-1d43-17c5-dbf6-ef228738513d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:854d5ab4-c2bc-5c72-8fda-995bf1d4b32b"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2020-12-03T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
} ],
"period": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:3e72d559-5e20-ef65-2b50-f839cb1724c0",
"resource": {
"resourceType": "Claim",
"id": "3e72d559-5e20-ef65-2b50-f839cb1724c0",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"created": "2020-12-03T11:01:18+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:04dffa0d-b994-f2f5-67b1-f00fbbb54e5d"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:2c9dcf8d-5ccf-9dd4-c849-9ecda4c70ab4"
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:2b3244d0-0df5-c692-5b53-540cbd822268"
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 8,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 9,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:d90ba52a-4dc6-a66f-ac9e-5639f1992cce"
}
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:4ee3f291-b296-a41a-0930-dd810e39912f"
}
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:f294fa55-4e73-d8f2-447f-edda4380eb06"
}
}, {
"sequence": 4,
"diagnosisReference": {
"reference": "urn:uuid:7d6b5fc7-6229-3a23-5845-bd3e83635580"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:0742bfe0-6595-97d4-11fa-2db3cd0b30db"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:b574afbb-c955-dc88-2f85-9b7e13232e80"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:cd64bb22-279e-9d24-1a45-239a485ded03"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:2c05103d-c8d0-cec9-d6dd-ad713dfc15fc"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:777ced4e-e09d-3ff5-3250-b27127e7ed51"
}
}, {
"sequence": 6,
"procedureReference": {
"reference": "urn:uuid:cb4fd9e5-5e06-9543-6356-d6b793ed1517"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "121",
"display": "zoster vaccine, live"
} ],
"text": "zoster vaccine, live"
},
"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": "113",
"display": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed"
} ],
"text": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 5,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
}
}, {
"sequence": 6,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
}, {
"sequence": 7,
"informationSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
},
"net": {
"value": 0.00,
"currency": "USD"
}
}, {
"sequence": 8,
"informationSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 9,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 10,
"diagnosisSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
}
}, {
"sequence": 11,
"diagnosisSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "424393004",
"display": "Reports of violence in the environment (finding)"
} ],
"text": "Reports of violence in the environment (finding)"
}
}, {
"sequence": 12,
"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": 13,
"informationSequence": [ 7 ],
"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": 14,
"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": 15,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 16,
"informationSequence": [ 8 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 17,
"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": 18,
"procedureSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 19,
"diagnosisSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "10939881000119105",
"display": "Unhealthy alcohol drinking behavior (finding)"
} ],
"text": "Unhealthy alcohol drinking behavior (finding)"
}
}, {
"sequence": 20,
"informationSequence": [ 9 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
} ],
"total": {
"value": 1057.58,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:179e7136-3187-3335-3c63-db5f08a887c9",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "179e7136-3187-3335-3c63-db5f08a887c9",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "3e72d559-5e20-ef65-2b50-f839cb1724c0"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2020-12-03T11:01:18+01:00",
"end": "2021-12-03T11:01:18+01:00"
},
"created": "2020-12-03T11:01:18+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:3e72d559-5e20-ef65-2b50-f839cb1724c0"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:d90ba52a-4dc6-a66f-ac9e-5639f1992cce"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 2,
"diagnosisReference": {
"reference": "urn:uuid:4ee3f291-b296-a41a-0930-dd810e39912f"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 3,
"diagnosisReference": {
"reference": "urn:uuid:f294fa55-4e73-d8f2-447f-edda4380eb06"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
}, {
"sequence": 4,
"diagnosisReference": {
"reference": "urn:uuid:7d6b5fc7-6229-3a23-5845-bd3e83635580"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
} ]
}, {
"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": "121",
"display": "zoster vaccine, live"
} ],
"text": "zoster vaccine, live"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"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": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 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": "113",
"display": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed"
} ],
"text": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 5,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "314529007",
"display": "Medication review due (situation)"
} ],
"text": "Medication review due (situation)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 6,
"informationSequence": [ 4 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 0.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 0.0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 0.0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 0.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 0.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 8,
"informationSequence": [ 6 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 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": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 10,
"diagnosisSequence": [ 2 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 11,
"diagnosisSequence": [ 3 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "424393004",
"display": "Reports of violence in the environment (finding)"
} ],
"text": "Reports of violence in the environment (finding)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"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": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 13,
"informationSequence": [ 7 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 14,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 15,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 16,
"informationSequence": [ 8 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 17,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 18,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "763302001",
"display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
} ],
"text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 19,
"diagnosisSequence": [ 4 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "10939881000119105",
"display": "Unhealthy alcohol drinking behavior (finding)"
} ],
"text": "Unhealthy alcohol drinking behavior (finding)"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 20,
"informationSequence": [ 9 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "72109-2",
"display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
} ],
"text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]"
},
"servicedPeriod": {
"start": "2020-12-03T10:29:53+01:00",
"end": "2020-12-03T11:01:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 1057.58,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2641.2160000000003,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:ccf1014a-84fe-a9a9-8712-34e51adfaff1",
"resource": {
"resourceType": "Encounter",
"id": "ccf1014a-84fe-a9a9-8712-34e51adfaff1",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "ccf1014a-84fe-a9a9-8712-34e51adfaff1"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-02-11T10:29:53+01:00",
"end": "2021-02-11T10:44:53+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2021-02-11T10:29:53+01:00",
"end": "2021-02-11T10:44:53+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:70f15847-a9eb-f8fd-70bf-5d8886a308ce",
"resource": {
"resourceType": "Procedure",
"id": "70f15847-a9eb-f8fd-70bf-5d8886a308ce",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:ccf1014a-84fe-a9a9-8712-34e51adfaff1"
},
"performedPeriod": {
"start": "2021-02-11T10:29:53+01:00",
"end": "2021-02-11T10:43:43+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:ca8a4901-b393-8ace-97fc-5e1c30e1e8ff",
"resource": {
"resourceType": "DiagnosticReport",
"id": "ca8a4901-b393-8ace-97fc-5e1c30e1e8ff",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:ccf1014a-84fe-a9a9-8712-34e51adfaff1"
},
"effectiveDateTime": "2021-02-11T10:29:53+01:00",
"issued": "2021-02-11T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:7fb4e2aa-d4a6-b277-f2a6-6816654f8661",
"resource": {
"resourceType": "DocumentReference",
"id": "7fb4e2aa-d4a6-b277-f2a6-6816654f8661",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:ca8a4901-b393-8ace-97fc-5e1c30e1e8ff"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2021-02-11T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:ccf1014a-84fe-a9a9-8712-34e51adfaff1"
} ],
"period": {
"start": "2021-02-11T10:29:53+01:00",
"end": "2021-02-11T10:44:53+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:565c2146-3c83-81bb-1c0b-58b2cdbd351d",
"resource": {
"resourceType": "Claim",
"id": "565c2146-3c83-81bb-1c0b-58b2cdbd351d",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2021-02-11T10:29:53+01:00",
"end": "2021-02-11T10:44:53+01:00"
},
"created": "2021-02-11T10:44:53+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:70f15847-a9eb-f8fd-70bf-5d8886a308ce"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:ccf1014a-84fe-a9a9-8712-34e51adfaff1"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 1539.80,
"currency": "USD"
}
} ],
"total": {
"value": 1682.38,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:e154416d-9818-2177-9b7d-188eecaf1737",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "e154416d-9818-2177-9b7d-188eecaf1737",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "565c2146-3c83-81bb-1c0b-58b2cdbd351d"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2021-02-11T10:44:53+01:00",
"end": "2022-02-11T10:44:53+01:00"
},
"created": "2021-02-11T10:44:53+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:565c2146-3c83-81bb-1c0b-58b2cdbd351d"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2021-02-11T10:29:53+01:00",
"end": "2021-02-11T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:ccf1014a-84fe-a9a9-8712-34e51adfaff1"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2021-02-11T10:29:53+01:00",
"end": "2021-02-11T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1539.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 307.96000000000004,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1231.8400000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 1539.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 1539.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 1682.38,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1231.8400000000001,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:eee25e11-db1a-f3d2-f67d-cb40cbb72be1",
"resource": {
"resourceType": "Encounter",
"id": "eee25e11-db1a-f3d2-f67d-cb40cbb72be1",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "eee25e11-db1a-f3d2-f67d-cb40cbb72be1"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-05-13T11:29:53+02:00",
"end": "2021-05-13T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2021-05-13T11:29:53+02:00",
"end": "2021-05-13T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:904f520d-00e4-c898-598e-d72f6192362f",
"resource": {
"resourceType": "Procedure",
"id": "904f520d-00e4-c898-598e-d72f6192362f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:eee25e11-db1a-f3d2-f67d-cb40cbb72be1"
},
"performedPeriod": {
"start": "2021-05-13T11:29:53+02:00",
"end": "2021-05-13T11:42:47+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:cffe12e7-2cdb-e95d-5d3c-ba164532a268",
"resource": {
"resourceType": "DiagnosticReport",
"id": "cffe12e7-2cdb-e95d-5d3c-ba164532a268",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:eee25e11-db1a-f3d2-f67d-cb40cbb72be1"
},
"effectiveDateTime": "2021-05-13T11:29:53+02:00",
"issued": "2021-05-13T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:48d93c48-de08-e89c-7ea1-90b2d342615f",
"resource": {
"resourceType": "DocumentReference",
"id": "48d93c48-de08-e89c-7ea1-90b2d342615f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:cffe12e7-2cdb-e95d-5d3c-ba164532a268"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2021-05-13T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:eee25e11-db1a-f3d2-f67d-cb40cbb72be1"
} ],
"period": {
"start": "2021-05-13T11:29:53+02:00",
"end": "2021-05-13T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:6a074935-2e4e-3a2b-77de-7ddd69fa172b",
"resource": {
"resourceType": "Claim",
"id": "6a074935-2e4e-3a2b-77de-7ddd69fa172b",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2021-05-13T11:29:53+02:00",
"end": "2021-05-13T11:44:53+02:00"
},
"created": "2021-05-13T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:904f520d-00e4-c898-598e-d72f6192362f"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:eee25e11-db1a-f3d2-f67d-cb40cbb72be1"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 3591.35,
"currency": "USD"
}
} ],
"total": {
"value": 3733.93,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c9dd5082-188f-f0bc-ffa5-a5a8c0513946",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c9dd5082-188f-f0bc-ffa5-a5a8c0513946",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "6a074935-2e4e-3a2b-77de-7ddd69fa172b"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2021-05-13T11:44:53+02:00",
"end": "2022-05-13T11:44:53+02:00"
},
"created": "2021-05-13T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:6a074935-2e4e-3a2b-77de-7ddd69fa172b"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2021-05-13T11:29:53+02:00",
"end": "2021-05-13T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:eee25e11-db1a-f3d2-f67d-cb40cbb72be1"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2021-05-13T11:29:53+02:00",
"end": "2021-05-13T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 3591.35,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 718.27,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2873.08,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 3591.35,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 3591.35,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 3733.93,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2873.08,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:371cd60f-c20f-449b-7aef-f3cb1bbf67ca",
"resource": {
"resourceType": "Encounter",
"id": "371cd60f-c20f-449b-7aef-f3cb1bbf67ca",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "371cd60f-c20f-449b-7aef-f3cb1bbf67ca"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-08-12T11:29:53+02:00",
"end": "2021-08-12T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2021-08-12T11:29:53+02:00",
"end": "2021-08-12T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:44d93356-ff3f-25a4-95ca-45f5cfdc19f0",
"resource": {
"resourceType": "Procedure",
"id": "44d93356-ff3f-25a4-95ca-45f5cfdc19f0",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:371cd60f-c20f-449b-7aef-f3cb1bbf67ca"
},
"performedPeriod": {
"start": "2021-08-12T11:29:53+02:00",
"end": "2021-08-12T11:43:20+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:0f6319d8-1dec-f617-9b96-765d648c49ae",
"resource": {
"resourceType": "DiagnosticReport",
"id": "0f6319d8-1dec-f617-9b96-765d648c49ae",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:371cd60f-c20f-449b-7aef-f3cb1bbf67ca"
},
"effectiveDateTime": "2021-08-12T11:29:53+02:00",
"issued": "2021-08-12T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:9e699016-03fe-fbd4-9906-4c779ee32609",
"resource": {
"resourceType": "DocumentReference",
"id": "9e699016-03fe-fbd4-9906-4c779ee32609",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:0f6319d8-1dec-f617-9b96-765d648c49ae"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2021-08-12T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:371cd60f-c20f-449b-7aef-f3cb1bbf67ca"
} ],
"period": {
"start": "2021-08-12T11:29:53+02:00",
"end": "2021-08-12T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:e16fe330-18ad-0ff6-f8fb-b95c430ee91d",
"resource": {
"resourceType": "Claim",
"id": "e16fe330-18ad-0ff6-f8fb-b95c430ee91d",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2021-08-12T11:29:53+02:00",
"end": "2021-08-12T11:44:53+02:00"
},
"created": "2021-08-12T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:44d93356-ff3f-25a4-95ca-45f5cfdc19f0"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:371cd60f-c20f-449b-7aef-f3cb1bbf67ca"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 3312.83,
"currency": "USD"
}
} ],
"total": {
"value": 3455.41,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:a462b534-3142-f8d3-ecad-3f5d08644d71",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "a462b534-3142-f8d3-ecad-3f5d08644d71",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "e16fe330-18ad-0ff6-f8fb-b95c430ee91d"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2021-08-12T11:44:53+02:00",
"end": "2022-08-12T11:44:53+02:00"
},
"created": "2021-08-12T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:e16fe330-18ad-0ff6-f8fb-b95c430ee91d"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2021-08-12T11:29:53+02:00",
"end": "2021-08-12T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:371cd60f-c20f-449b-7aef-f3cb1bbf67ca"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2021-08-12T11:29:53+02:00",
"end": "2021-08-12T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 3312.83,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 662.566,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2650.264,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 3312.83,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 3312.83,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 3455.41,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2650.264,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:467c839b-ac61-30c8-63b6-e8e880dec480",
"resource": {
"resourceType": "Encounter",
"id": "467c839b-ac61-30c8-63b6-e8e880dec480",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "467c839b-ac61-30c8-63b6-e8e880dec480"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-11-11T10:29:53+01:00",
"end": "2021-11-11T10:46:35+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2021-11-11T10:29:53+01:00",
"end": "2021-11-11T10:46:35+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:1a5fc886-528d-a295-f8db-f62547abb751",
"resource": {
"resourceType": "Procedure",
"id": "1a5fc886-528d-a295-f8db-f62547abb751",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:467c839b-ac61-30c8-63b6-e8e880dec480"
},
"performedPeriod": {
"start": "2021-11-11T10:29:53+01:00",
"end": "2021-11-11T10:46:35+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:1fbb8829-4fc1-3a07-6f65-53ef656f7caa",
"resource": {
"resourceType": "DiagnosticReport",
"id": "1fbb8829-4fc1-3a07-6f65-53ef656f7caa",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:467c839b-ac61-30c8-63b6-e8e880dec480"
},
"effectiveDateTime": "2021-11-11T10:29:53+01:00",
"issued": "2021-11-11T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMjEtMTEtMTEKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzClBldHJvbmlsYTcyNAogaXMgYSA1MSB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBhY3V0ZSBiYWN0ZXJpYWwgc2ludXNpdGlzIChkaXNvcmRlciksIGZhdGlndWUgKGZpbmRpbmcpLCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIGFjdXRlIHZpcmFsIHBoYXJ5bmdpdGlzIChkaXNvcmRlciksIHZpY3RpbSBvZiBpbnRpbWF0ZSBwYXJ0bmVyIGFidXNlIChmaW5kaW5nKSwgdmlyYWwgc2ludXNpdGlzIChkaXNvcmRlciksIHN1c3BlY3RlZCBjb3ZpZC0xOSwgY292aWQtMTksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgYWN1dGUgYnJvbmNoaXRpcyAoZGlzb3JkZXIpLCBmZXZlciAoZmluZGluZyksIHVuaGVhbHRoeSBhbGNvaG9sIGRyaW5raW5nIGJlaGF2aW9yIChmaW5kaW5nKSwgcmVwb3J0cyBvZiB2aW9sZW5jZSBpbiB0aGUgZW52aXJvbm1lbnQgKGZpbmRpbmcpLCBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIGNvdWdoIChmaW5kaW5nKSwgc3RyZXNzIChmaW5kaW5nKSwgc29jaWFsIGlzb2xhdGlvbiAoZmluZGluZykuCgojIFNvY2lhbCBIaXN0b3J5ClBhdGllbnQgaXMgc2luZ2xlLiBQYXRpZW50IHF1aXQgc21va2luZyBhdCBhZ2UgMTcuCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KIFBhdGllbnQgZGlkIG5vdCBmaW5pc2ggaGlnaCBzY2hvb2wuClBhdGllbnQgY3VycmVudGx5IGhhcyBVbml0ZWRIZWFsdGhjYXJlLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwphY2V0YW1pbm9waGVuIDMyNSBtZyBvcmFsIHRhYmxldAoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgoKVGhlIGZvbGxvd2luZyBwcm9jZWR1cmVzIHdlcmUgY29uZHVjdGVkOgotIGludHJhbXVzY3VsYXIgaW5qZWN0aW9uCg=="
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:d92e6b39-38ad-17c6-4b43-85b6870b4894",
"resource": {
"resourceType": "DocumentReference",
"id": "d92e6b39-38ad-17c6-4b43-85b6870b4894",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:1fbb8829-4fc1-3a07-6f65-53ef656f7caa"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2021-11-11T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMjEtMTEtMTEKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzClBldHJvbmlsYTcyNAogaXMgYSA1MSB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBhY3V0ZSBiYWN0ZXJpYWwgc2ludXNpdGlzIChkaXNvcmRlciksIGZhdGlndWUgKGZpbmRpbmcpLCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIGFjdXRlIHZpcmFsIHBoYXJ5bmdpdGlzIChkaXNvcmRlciksIHZpY3RpbSBvZiBpbnRpbWF0ZSBwYXJ0bmVyIGFidXNlIChmaW5kaW5nKSwgdmlyYWwgc2ludXNpdGlzIChkaXNvcmRlciksIHN1c3BlY3RlZCBjb3ZpZC0xOSwgY292aWQtMTksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgYWN1dGUgYnJvbmNoaXRpcyAoZGlzb3JkZXIpLCBmZXZlciAoZmluZGluZyksIHVuaGVhbHRoeSBhbGNvaG9sIGRyaW5raW5nIGJlaGF2aW9yIChmaW5kaW5nKSwgcmVwb3J0cyBvZiB2aW9sZW5jZSBpbiB0aGUgZW52aXJvbm1lbnQgKGZpbmRpbmcpLCBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIGNvdWdoIChmaW5kaW5nKSwgc3RyZXNzIChmaW5kaW5nKSwgc29jaWFsIGlzb2xhdGlvbiAoZmluZGluZykuCgojIFNvY2lhbCBIaXN0b3J5ClBhdGllbnQgaXMgc2luZ2xlLiBQYXRpZW50IHF1aXQgc21va2luZyBhdCBhZ2UgMTcuCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KIFBhdGllbnQgZGlkIG5vdCBmaW5pc2ggaGlnaCBzY2hvb2wuClBhdGllbnQgY3VycmVudGx5IGhhcyBVbml0ZWRIZWFsdGhjYXJlLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwphY2V0YW1pbm9waGVuIDMyNSBtZyBvcmFsIHRhYmxldAoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgoKVGhlIGZvbGxvd2luZyBwcm9jZWR1cmVzIHdlcmUgY29uZHVjdGVkOgotIGludHJhbXVzY3VsYXIgaW5qZWN0aW9uCg=="
},
"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:467c839b-ac61-30c8-63b6-e8e880dec480"
} ],
"period": {
"start": "2021-11-11T10:29:53+01:00",
"end": "2021-11-11T10:46:35+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:4dd4ab5d-2297-cc80-9c5a-7452e13a8a2f",
"resource": {
"resourceType": "Claim",
"id": "4dd4ab5d-2297-cc80-9c5a-7452e13a8a2f",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2021-11-11T10:29:53+01:00",
"end": "2021-11-11T10:46:35+01:00"
},
"created": "2021-11-11T10:46:35+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:1a5fc886-528d-a295-f8db-f62547abb751"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:467c839b-ac61-30c8-63b6-e8e880dec480"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 3044.58,
"currency": "USD"
}
} ],
"total": {
"value": 3187.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:71351828-9a96-3fd8-c5d7-09b88cbf16f9",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "71351828-9a96-3fd8-c5d7-09b88cbf16f9",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "4dd4ab5d-2297-cc80-9c5a-7452e13a8a2f"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2021-11-11T10:46:35+01:00",
"end": "2022-11-11T10:46:35+01:00"
},
"created": "2021-11-11T10:46:35+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:4dd4ab5d-2297-cc80-9c5a-7452e13a8a2f"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2021-11-11T10:29:53+01:00",
"end": "2021-11-11T10:46:35+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:467c839b-ac61-30c8-63b6-e8e880dec480"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2021-11-11T10:29:53+01:00",
"end": "2021-11-11T10:46:35+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 3044.58,
"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": 608.916,
"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": 2435.664,
"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": 3044.58,
"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": 3044.58,
"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": 3187.16,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2435.664,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d",
"resource": {
"resourceType": "Encounter",
"id": "2c22dc82-7190-f2ff-6927-b27f8540600d",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "2c22dc82-7190-f2ff-6927-b27f8540600d"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:e84ac9c1-9e35-644c-b96b-0f4f69f321cb",
"resource": {
"resourceType": "Condition",
"id": "e84ac9c1-9e35-644c-b96b-0f4f69f321cb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"onsetDateTime": "2021-12-09T11:06:08+01:00",
"recordedDate": "2021-12-09T11:06:08+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:b20f6722-c493-3bae-3d68-d39140e0e1e4",
"resource": {
"resourceType": "Observation",
"id": "b20f6722-c493-3bae-3d68-d39140e0e1e4",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
} ],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 6.34,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:bac72860-b815-6443-5896-37aa2b17ffb1",
"resource": {
"resourceType": "Observation",
"id": "bac72860-b815-6443-5896-37aa2b17ffb1",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 170.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f9412bed-5dcc-7464-6fd5-25584358a645",
"resource": {
"resourceType": "Observation",
"id": "f9412bed-5dcc-7464-6fd5-25584358a645",
"status": "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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0bb32d85-7038-c387-65f7-f4697a7a8a79",
"resource": {
"resourceType": "Observation",
"id": "0bb32d85-7038-c387-65f7-f4697a7a8a79",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 79.7,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:07e4121f-d2a2-5c8a-89a5-8bcac2803aff",
"resource": {
"resourceType": "Observation",
"id": "07e4121f-d2a2-5c8a-89a5-8bcac2803aff",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 27.48,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:cbb8b993-2ea7-3f53-3c4e-a09be8bdcb82",
"resource": {
"resourceType": "Observation",
"id": "cbb8b993-2ea7-3f53-3c4e-a09be8bdcb82",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 94,
"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": 121,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7a25d230-d58b-bb45-032e-30677fd63d48",
"resource": {
"resourceType": "Observation",
"id": "7a25d230-d58b-bb45-032e-30677fd63d48",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 89,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9c7d4b89-4654-022b-c767-e0977275a910",
"resource": {
"resourceType": "Observation",
"id": "9c7d4b89-4654-022b-c767-e0977275a910",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 15,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7bf1f0cf-ebdd-eb08-bdd8-0ab4dc6391aa",
"resource": {
"resourceType": "Observation",
"id": "7bf1f0cf-ebdd-eb08-bdd8-0ab4dc6391aa",
"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": "2339-0",
"display": "Glucose [Mass/volume] in Blood"
} ],
"text": "Glucose [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 86.54,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1d84a5b4-4e5f-81ce-0c61-655c278ba0cd",
"resource": {
"resourceType": "Observation",
"id": "1d84a5b4-4e5f-81ce-0c61-655c278ba0cd",
"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": "6299-2",
"display": "Urea nitrogen [Mass/volume] in Blood"
} ],
"text": "Urea nitrogen [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 17.16,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:58e7ec43-294f-bac5-2741-353817165f53",
"resource": {
"resourceType": "Observation",
"id": "58e7ec43-294f-bac5-2741-353817165f53",
"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": "38483-4",
"display": "Creatinine [Mass/volume] in Blood"
} ],
"text": "Creatinine [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 0.83,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e3f92db1-1866-b98f-1ced-4a9b0e7a295f",
"resource": {
"resourceType": "Observation",
"id": "e3f92db1-1866-b98f-1ced-4a9b0e7a295f",
"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": "49765-1",
"display": "Calcium [Mass/volume] in Blood"
} ],
"text": "Calcium [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 8.66,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2e9398e9-3e01-2755-3dc2-6da3151791b1",
"resource": {
"resourceType": "Observation",
"id": "2e9398e9-3e01-2755-3dc2-6da3151791b1",
"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": "2947-0",
"display": "Sodium [Moles/volume] in Blood"
} ],
"text": "Sodium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 142.05,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d6d3e544-29a6-3843-4aea-e89b3ae8263b",
"resource": {
"resourceType": "Observation",
"id": "d6d3e544-29a6-3843-4aea-e89b3ae8263b",
"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": "6298-4",
"display": "Potassium [Moles/volume] in Blood"
} ],
"text": "Potassium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 4.53,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1c8efd96-bee4-1435-6638-d4a0b87c69f5",
"resource": {
"resourceType": "Observation",
"id": "1c8efd96-bee4-1435-6638-d4a0b87c69f5",
"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": "2069-3",
"display": "Chloride [Moles/volume] in Blood"
} ],
"text": "Chloride [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 101.29,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d659d772-ffbd-96b2-6a46-0c88caff17ed",
"resource": {
"resourceType": "Observation",
"id": "d659d772-ffbd-96b2-6a46-0c88caff17ed",
"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": "20565-8",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ],
"text": "Carbon dioxide, total [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 25.02,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:501330f5-7732-2a90-0a85-76756e45f965",
"resource": {
"resourceType": "Observation",
"id": "501330f5-7732-2a90-0a85-76756e45f965",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 8.3726,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d1363115-db97-16a8-66ca-465355689458",
"resource": {
"resourceType": "Observation",
"id": "d1363115-db97-16a8-66ca-465355689458",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 4.3705,
"unit": "10*6/uL",
"system": "http://unitsofmeasure.org",
"code": "10*6/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7a630dd0-bfbd-43e7-63e6-b56c5cbdca05",
"resource": {
"resourceType": "Observation",
"id": "7a630dd0-bfbd-43e7-63e6-b56c5cbdca05",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 15.907,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:71611cd6-aca4-6b5b-3cf5-0c124af81fac",
"resource": {
"resourceType": "Observation",
"id": "71611cd6-aca4-6b5b-3cf5-0c124af81fac",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 46.653,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:294df629-af85-df7c-088d-a2b7003fabd5",
"resource": {
"resourceType": "Observation",
"id": "294df629-af85-df7c-088d-a2b7003fabd5",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 86.021,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6dedc318-5a41-11fd-77a0-ab7edd331221",
"resource": {
"resourceType": "Observation",
"id": "6dedc318-5a41-11fd-77a0-ab7edd331221",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 28.572,
"unit": "pg",
"system": "http://unitsofmeasure.org",
"code": "pg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2b17089b-4df6-621c-2fc8-5a665b996fa5",
"resource": {
"resourceType": "Observation",
"id": "2b17089b-4df6-621c-2fc8-5a665b996fa5",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 34.565,
"unit": "g/dL",
"system": "http://unitsofmeasure.org",
"code": "g/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:4ce6797b-9ee2-3758-7653-1f0b4c4f3b6a",
"resource": {
"resourceType": "Observation",
"id": "4ce6797b-9ee2-3758-7653-1f0b4c4f3b6a",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 43.917,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6fffba91-3b18-0d97-5572-cb44d25bc1eb",
"resource": {
"resourceType": "Observation",
"id": "6fffba91-3b18-0d97-5572-cb44d25bc1eb",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 160.03,
"unit": "10*3/uL",
"system": "http://unitsofmeasure.org",
"code": "10*3/uL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3d0f6fe5-30ef-af14-146b-680264c56ba7",
"resource": {
"resourceType": "Observation",
"id": "3d0f6fe5-30ef-af14-146b-680264c56ba7",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 186.5,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0c80f3b6-e016-b5c0-96f5-2e2842713e21",
"resource": {
"resourceType": "Observation",
"id": "0c80f3b6-e016-b5c0-96f5-2e2842713e21",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueQuantity": {
"value": 9.9816,
"unit": "fL",
"system": "http://unitsofmeasure.org",
"code": "fL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:75222b73-3a20-4be4-1163-e0eb7233fe2c",
"resource": {
"resourceType": "Observation",
"id": "75222b73-3a20-4be4-1163-e0eb7233fe2c",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Ex-smoker (finding)"
} ],
"text": "Ex-smoker (finding)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:2ea2c547-ac68-4826-1934-970848537fe8",
"resource": {
"resourceType": "Observation",
"id": "2ea2c547-ac68-4826-1934-970848537fe8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93025-5",
"display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T11:06:08+01:00",
"issued": "2021-12-09T11:06:08.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76501-6",
"display": "Within the last year, have you been afraid of your partner or ex-partner?"
} ],
"text": "Within the last year, have you been afraid of your partner or ex-partner?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93026-3",
"display": "Do you feel physically and emotionally safe where you currently live?"
} ],
"text": "Do you feel physically and emotionally safe where you currently live?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA33-6",
"display": "Yes"
} ],
"text": "Yes"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93027-1",
"display": "Are you a refugee?"
} ],
"text": "Are you a refugee?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93028-9",
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93038-8",
"display": "Stress level"
} ],
"text": "Stress level"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6568-5",
"display": "Not at all"
} ],
"text": "Not at all"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93029-7",
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30132-7",
"display": "5 or more times a week"
} ],
"text": "5 or more times a week"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93030-5",
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
} ],
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93031-3",
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30122-8",
"display": "I choose not to answer this question"
} ],
"text": "I choose not to answer this question"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63586-2",
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
},
"valueQuantity": {
"value": 90472,
"unit": "/a",
"system": "http://unitsofmeasure.org",
"code": "/a"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76437-3",
"display": "Primary insurance"
} ],
"text": "Primary insurance"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6350-8",
"display": "Private insurance"
} ],
"text": "Private insurance"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "67875-5",
"display": "Employment status - current"
} ],
"text": "Employment status - current"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30136-8",
"display": "Full-time work"
} ],
"text": "Full-time work"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82589-3",
"display": "Highest level of education"
} ],
"text": "Highest level of education"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30191-3",
"display": "Less than high school degree"
} ],
"text": "Less than high school degree"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56799-0",
"display": "Address"
} ],
"text": "Address"
},
"valueString": "217 Bayer Drive Unit 35"
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93033-9",
"display": "Are you worried about losing your housing?"
} ],
"text": "Are you worried about losing your housing?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "71802-3",
"display": "Housing status"
} ],
"text": "Housing status"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30189-7",
"display": "I have housing"
} ],
"text": "I have housing"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63512-8",
"display": "How many people are living or staying at this address?"
} ],
"text": "How many people are living or staying at this address?"
},
"valueQuantity": {
"value": 5,
"unit": "{#}",
"system": "http://unitsofmeasure.org",
"code": "{#}"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "54899-0",
"display": "Preferred language"
} ],
"text": "Preferred language"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA43-5",
"display": "English"
} ],
"text": "English"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93034-7",
"display": "Have you been discharged from the armed forces of the United States?"
} ],
"text": "Have you been discharged from the armed forces of the United States?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93035-4",
"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "32624-9",
"display": "Race"
} ],
"text": "Race"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA4457-3",
"display": "White"
} ],
"text": "White"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56051-6",
"display": "Do you consider yourself Hispanic/Latino?"
} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1515a571-295d-59de-be5d-b38597ce7e74",
"resource": {
"resourceType": "Observation",
"id": "1515a571-295d-59de-be5d-b38597ce7e74",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T11:34:54+01:00",
"issued": "2021-12-09T11:34:54.294+01:00",
"valueQuantity": {
"value": 10,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ac210da4-72a3-24a7-f986-9b7905e3e362",
"resource": {
"resourceType": "Procedure",
"id": "ac210da4-72a3-24a7-f986-9b7905e3e362",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"performedPeriod": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:bb951178-1c13-b50f-d3ff-c83325b4cdaa",
"resource": {
"resourceType": "Procedure",
"id": "bb951178-1c13-b50f-d3ff-c83325b4cdaa",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"performedPeriod": {
"start": "2021-12-09T11:06:08+01:00",
"end": "2021-12-09T11:34:54+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:830d0b9e-776d-89d2-2cd1-c4abbfad7049",
"resource": {
"resourceType": "SupplyDelivery",
"id": "830d0b9e-776d-89d2-2cd1-c4abbfad7049",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2021-12-09T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:429d31bc-a773-4da5-fd12-56c4db699c7f",
"resource": {
"resourceType": "Immunization",
"id": "429d31bc-a773-4da5-fd12-56c4db699c7f",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"occurrenceDateTime": "2021-12-09T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:3ba0faa6-a21f-9a18-5ae5-ea0159c103a1",
"resource": {
"resourceType": "DiagnosticReport",
"id": "3ba0faa6-a21f-9a18-5ae5-ea0159c103a1",
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:7bf1f0cf-ebdd-eb08-bdd8-0ab4dc6391aa",
"display": "Glucose [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:1d84a5b4-4e5f-81ce-0c61-655c278ba0cd",
"display": "Urea nitrogen [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:58e7ec43-294f-bac5-2741-353817165f53",
"display": "Creatinine [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:e3f92db1-1866-b98f-1ced-4a9b0e7a295f",
"display": "Calcium [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:2e9398e9-3e01-2755-3dc2-6da3151791b1",
"display": "Sodium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:d6d3e544-29a6-3843-4aea-e89b3ae8263b",
"display": "Potassium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:1c8efd96-bee4-1435-6638-d4a0b87c69f5",
"display": "Chloride [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:d659d772-ffbd-96b2-6a46-0c88caff17ed",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:c0e16881-4e44-5867-8621-d0839dcb60cf",
"resource": {
"resourceType": "DiagnosticReport",
"id": "c0e16881-4e44-5867-8621-d0839dcb60cf",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:501330f5-7732-2a90-0a85-76756e45f965",
"display": "Leukocytes [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:d1363115-db97-16a8-66ca-465355689458",
"display": "Erythrocytes [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:7a630dd0-bfbd-43e7-63e6-b56c5cbdca05",
"display": "Hemoglobin [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:71611cd6-aca4-6b5b-3cf5-0c124af81fac",
"display": "Hematocrit [Volume Fraction] of Blood by Automated count"
}, {
"reference": "urn:uuid:294df629-af85-df7c-088d-a2b7003fabd5",
"display": "MCV [Entitic volume] by Automated count"
}, {
"reference": "urn:uuid:6dedc318-5a41-11fd-77a0-ab7edd331221",
"display": "MCH [Entitic mass] by Automated count"
}, {
"reference": "urn:uuid:2b17089b-4df6-621c-2fc8-5a665b996fa5",
"display": "MCHC [Mass/volume] by Automated count"
}, {
"reference": "urn:uuid:4ce6797b-9ee2-3758-7653-1f0b4c4f3b6a",
"display": "Erythrocyte distribution width [Entitic volume] by Automated count"
}, {
"reference": "urn:uuid:6fffba91-3b18-0d97-5572-cb44d25bc1eb",
"display": "Platelets [#/volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:3d0f6fe5-30ef-af14-146b-680264c56ba7",
"display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
}, {
"reference": "urn:uuid:0c80f3b6-e016-b5c0-96f5-2e2842713e21",
"display": "Platelet mean volume [Entitic volume] in Blood by Automated count"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:1cc0178c-04ab-2a86-f5a9-e28455c4c5c0",
"resource": {
"resourceType": "DiagnosticReport",
"id": "1cc0178c-04ab-2a86-f5a9-e28455c4c5c0",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T11:34:54+01:00",
"issued": "2021-12-09T11:34:54.294+01:00",
"result": [ {
"reference": "urn:uuid:1515a571-295d-59de-be5d-b38597ce7e74",
"display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:48fe8993-fab5-601c-7ec6-ddfdefeed8df",
"resource": {
"resourceType": "DiagnosticReport",
"id": "48fe8993-fab5-601c-7ec6-ddfdefeed8df",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
},
"effectiveDateTime": "2021-12-09T10:29:53+01:00",
"issued": "2021-12-09T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:387a8fa1-df6a-2741-0440-a550220d76eb",
"resource": {
"resourceType": "DocumentReference",
"id": "387a8fa1-df6a-2741-0440-a550220d76eb",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:48fe8993-fab5-601c-7ec6-ddfdefeed8df"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2021-12-09T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
} ],
"period": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:0ff3ba5a-3256-5d32-bbe2-e7a0e4582a07",
"resource": {
"resourceType": "Claim",
"id": "0ff3ba5a-3256-5d32-bbe2-e7a0e4582a07",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+01:00"
},
"created": "2021-12-09T11:06:08+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:429d31bc-a773-4da5-fd12-56c4db699c7f"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:e84ac9c1-9e35-644c-b96b-0f4f69f321cb"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:ac210da4-72a3-24a7-f986-9b7905e3e362"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:bb951178-1c13-b50f-d3ff-c83325b4cdaa"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
} ]
}, {
"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://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
}, {
"sequence": 4,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "58410-2",
"display": "CBC panel - Blood by Automated count"
} ],
"text": "CBC panel - Blood by Automated count"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 6,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 7,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
}
}, {
"sequence": 8,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 9,
"informationSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"net": {
"value": 74.58,
"currency": "USD"
}
} ],
"total": {
"value": 860.16,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:6f5123d9-e6aa-fbdb-285b-c8f2764b8d12",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "6f5123d9-e6aa-fbdb-285b-c8f2764b8d12",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "0ff3ba5a-3256-5d32-bbe2-e7a0e4582a07"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2021-12-09T11:06:08+01:00",
"end": "2022-12-09T11:06:08+01:00"
},
"created": "2021-12-09T11:06:08+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:0ff3ba5a-3256-5d32-bbe2-e7a0e4582a07"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:e84ac9c1-9e35-644c-b96b-0f4f69f321cb"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
} ]
}, {
"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": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+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://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"servicedPeriod": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+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": 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://loinc.org",
"code": "58410-2",
"display": "CBC panel - Blood by Automated count"
} ],
"text": "CBC panel - Blood by Automated count"
},
"servicedPeriod": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+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": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"servicedPeriod": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+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,
"diagnosisSequence": [ 1 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "160903007",
"display": "Full-time employment (finding)"
} ],
"text": "Full-time employment (finding)"
},
"servicedPeriod": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 8,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710841007",
"display": "Assessment of anxiety (procedure)"
} ],
"text": "Assessment of anxiety (procedure)"
},
"servicedPeriod": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 9,
"informationSequence": [ 5 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "69737-5",
"display": "Generalized anxiety disorder 7 item (GAD-7)"
} ],
"text": "Generalized anxiety disorder 7 item (GAD-7)"
},
"servicedPeriod": {
"start": "2021-12-09T10:29:53+01:00",
"end": "2021-12-09T11:06:08+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": 860.16,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 983.472,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:6730aa29-a6f9-1df4-24d1-25fe34f2d9c5",
"resource": {
"resourceType": "Encounter",
"id": "6730aa29-a6f9-1df4-24d1-25fe34f2d9c5",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "6730aa29-a6f9-1df4-24d1-25fe34f2d9c5"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-02-10T10:29:53+01:00",
"end": "2022-02-10T10:44:53+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2022-02-10T10:29:53+01:00",
"end": "2022-02-10T10:44:53+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:59e78251-d3ab-4974-92a2-f60b3b410bf8",
"resource": {
"resourceType": "Procedure",
"id": "59e78251-d3ab-4974-92a2-f60b3b410bf8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:6730aa29-a6f9-1df4-24d1-25fe34f2d9c5"
},
"performedPeriod": {
"start": "2022-02-10T10:29:53+01:00",
"end": "2022-02-10T10:42:06+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:306eb4cf-e49a-4474-0790-0677b9802781",
"resource": {
"resourceType": "DiagnosticReport",
"id": "306eb4cf-e49a-4474-0790-0677b9802781",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:6730aa29-a6f9-1df4-24d1-25fe34f2d9c5"
},
"effectiveDateTime": "2022-02-10T10:29:53+01:00",
"issued": "2022-02-10T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:080a5c8b-e1d1-9cd3-3722-b344ec5edb7a",
"resource": {
"resourceType": "DocumentReference",
"id": "080a5c8b-e1d1-9cd3-3722-b344ec5edb7a",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:306eb4cf-e49a-4474-0790-0677b9802781"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2022-02-10T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:6730aa29-a6f9-1df4-24d1-25fe34f2d9c5"
} ],
"period": {
"start": "2022-02-10T10:29:53+01:00",
"end": "2022-02-10T10:44:53+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:9bc4a9b8-ad02-8b7a-bb03-a17dd5392494",
"resource": {
"resourceType": "Claim",
"id": "9bc4a9b8-ad02-8b7a-bb03-a17dd5392494",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2022-02-10T10:29:53+01:00",
"end": "2022-02-10T10:44:53+01:00"
},
"created": "2022-02-10T10:44:53+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:59e78251-d3ab-4974-92a2-f60b3b410bf8"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:6730aa29-a6f9-1df4-24d1-25fe34f2d9c5"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2939.48,
"currency": "USD"
}
} ],
"total": {
"value": 3082.06,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:06d82386-0a14-3bbe-5b7d-be5b643d12df",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "06d82386-0a14-3bbe-5b7d-be5b643d12df",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "9bc4a9b8-ad02-8b7a-bb03-a17dd5392494"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2022-02-10T10:44:53+01:00",
"end": "2023-02-10T10:44:53+01:00"
},
"created": "2022-02-10T10:44:53+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:9bc4a9b8-ad02-8b7a-bb03-a17dd5392494"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2022-02-10T10:29:53+01:00",
"end": "2022-02-10T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:6730aa29-a6f9-1df4-24d1-25fe34f2d9c5"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2022-02-10T10:29:53+01:00",
"end": "2022-02-10T10:44:53+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2939.48,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 587.8960000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2351.5840000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2939.48,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2939.48,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 3082.06,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2351.5840000000003,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:db3d8953-deca-5736-e60a-84aecf43572f",
"resource": {
"resourceType": "Encounter",
"id": "db3d8953-deca-5736-e60a-84aecf43572f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "db3d8953-deca-5736-e60a-84aecf43572f"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-05-12T11:29:53+02:00",
"end": "2022-05-12T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2022-05-12T11:29:53+02:00",
"end": "2022-05-12T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:a5171ef9-061a-82e4-c89e-eff78240829b",
"resource": {
"resourceType": "Procedure",
"id": "a5171ef9-061a-82e4-c89e-eff78240829b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:db3d8953-deca-5736-e60a-84aecf43572f"
},
"performedPeriod": {
"start": "2022-05-12T11:29:53+02:00",
"end": "2022-05-12T11:41:02+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:9f97c703-5b7f-affd-83c1-fbfdf83c1158",
"resource": {
"resourceType": "DiagnosticReport",
"id": "9f97c703-5b7f-affd-83c1-fbfdf83c1158",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:db3d8953-deca-5736-e60a-84aecf43572f"
},
"effectiveDateTime": "2022-05-12T11:29:53+02:00",
"issued": "2022-05-12T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:ba5443c2-f4ef-d0a2-9d61-1ae44697a588",
"resource": {
"resourceType": "DocumentReference",
"id": "ba5443c2-f4ef-d0a2-9d61-1ae44697a588",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:9f97c703-5b7f-affd-83c1-fbfdf83c1158"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2022-05-12T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:db3d8953-deca-5736-e60a-84aecf43572f"
} ],
"period": {
"start": "2022-05-12T11:29:53+02:00",
"end": "2022-05-12T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:530c7cb9-37eb-f45c-5ab9-3eef0a453e94",
"resource": {
"resourceType": "Claim",
"id": "530c7cb9-37eb-f45c-5ab9-3eef0a453e94",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2022-05-12T11:29:53+02:00",
"end": "2022-05-12T11:44:53+02:00"
},
"created": "2022-05-12T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:a5171ef9-061a-82e4-c89e-eff78240829b"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:db3d8953-deca-5736-e60a-84aecf43572f"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 1434.75,
"currency": "USD"
}
} ],
"total": {
"value": 1577.33,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c5728fa3-85f4-1fc4-faf6-dd51c89d724c",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c5728fa3-85f4-1fc4-faf6-dd51c89d724c",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "530c7cb9-37eb-f45c-5ab9-3eef0a453e94"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2022-05-12T11:44:53+02:00",
"end": "2023-05-12T11:44:53+02:00"
},
"created": "2022-05-12T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:530c7cb9-37eb-f45c-5ab9-3eef0a453e94"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2022-05-12T11:29:53+02:00",
"end": "2022-05-12T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:db3d8953-deca-5736-e60a-84aecf43572f"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2022-05-12T11:29:53+02:00",
"end": "2022-05-12T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 1434.75,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 286.95,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1147.8,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 1434.75,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 1434.75,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 1577.33,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1147.8,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:7da4c5dc-dcd4-855a-7ec1-c9669de82484",
"resource": {
"resourceType": "Encounter",
"id": "7da4c5dc-dcd4-855a-7ec1-c9669de82484",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "7da4c5dc-dcd4-855a-7ec1-c9669de82484"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-06-20T20:29:53+02:00",
"end": "2022-06-20T20:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2022-06-20T20:29:53+02:00",
"end": "2022-06-20T20:44:53+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:785b1476-fcfa-e49f-ad7b-5ab77de355c1",
"resource": {
"resourceType": "Condition",
"id": "785b1476-fcfa-e49f-ad7b-5ab77de355c1",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7da4c5dc-dcd4-855a-7ec1-c9669de82484"
},
"onsetDateTime": "2022-06-20T20:29:53+02:00",
"abatementDateTime": "2022-07-10T20:29:53+02:00",
"recordedDate": "2022-06-20T20:29:53+02:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:51ba46d2-e990-7f29-cf08-a503b7029443",
"resource": {
"resourceType": "DiagnosticReport",
"id": "51ba46d2-e990-7f29-cf08-a503b7029443",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:7da4c5dc-dcd4-855a-7ec1-c9669de82484"
},
"effectiveDateTime": "2022-06-20T20:29:53+02:00",
"issued": "2022-06-20T20:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:d06bf668-b595-02a5-6114-ca5328868811",
"resource": {
"resourceType": "DocumentReference",
"id": "d06bf668-b595-02a5-6114-ca5328868811",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:51ba46d2-e990-7f29-cf08-a503b7029443"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2022-06-20T20:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:7da4c5dc-dcd4-855a-7ec1-c9669de82484"
} ],
"period": {
"start": "2022-06-20T20:29:53+02:00",
"end": "2022-06-20T20:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:94758826-da20-cbaa-3f9e-50077590eb9b",
"resource": {
"resourceType": "Claim",
"id": "94758826-da20-cbaa-3f9e-50077590eb9b",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2022-06-20T20:29:53+02:00",
"end": "2022-06-20T20:44:53+02:00"
},
"created": "2022-06-20T20:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:785b1476-fcfa-e49f-ad7b-5ab77de355c1"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"encounter": [ {
"reference": "urn:uuid:7da4c5dc-dcd4-855a-7ec1-c9669de82484"
} ]
}, {
"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:4022ad52-1140-2330-c575-58b8af7cc68c",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "4022ad52-1140-2330-c575-58b8af7cc68c",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "94758826-da20-cbaa-3f9e-50077590eb9b"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2022-06-20T20:44:53+02:00",
"end": "2023-06-20T20:44:53+02:00"
},
"created": "2022-06-20T20:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:94758826-da20-cbaa-3f9e-50077590eb9b"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:785b1476-fcfa-e49f-ad7b-5ab77de355c1"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "185345009",
"display": "Encounter for symptom"
} ],
"text": "Encounter for symptom"
},
"servicedPeriod": {
"start": "2022-06-20T20:29:53+02:00",
"end": "2022-06-20T20:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:7da4c5dc-dcd4-855a-7ec1-c9669de82484"
} ]
}, {
"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": "2022-06-20T20:29:53+02:00",
"end": "2022-06-20T20:44:53+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:37225ce5-17fc-62ef-3da6-ec44c8f1c46b",
"resource": {
"resourceType": "Encounter",
"id": "37225ce5-17fc-62ef-3da6-ec44c8f1c46b",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "37225ce5-17fc-62ef-3da6-ec44c8f1c46b"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-08-11T11:29:53+02:00",
"end": "2022-08-11T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2022-08-11T11:29:53+02:00",
"end": "2022-08-11T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:26a20bb1-819f-856b-fc01-f2c415348b47",
"resource": {
"resourceType": "Procedure",
"id": "26a20bb1-819f-856b-fc01-f2c415348b47",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:37225ce5-17fc-62ef-3da6-ec44c8f1c46b"
},
"performedPeriod": {
"start": "2022-08-11T11:29:53+02:00",
"end": "2022-08-11T11:44:03+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:b1f58275-3140-c8c9-c70f-ffc38f71963b",
"resource": {
"resourceType": "DiagnosticReport",
"id": "b1f58275-3140-c8c9-c70f-ffc38f71963b",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:37225ce5-17fc-62ef-3da6-ec44c8f1c46b"
},
"effectiveDateTime": "2022-08-11T11:29:53+02:00",
"issued": "2022-08-11T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMjItMDgtMTEKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzClBldHJvbmlsYTcyNAogaXMgYSA1MiB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBhY3V0ZSBiYWN0ZXJpYWwgc2ludXNpdGlzIChkaXNvcmRlciksIGZhdGlndWUgKGZpbmRpbmcpLCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIGFjdXRlIHZpcmFsIHBoYXJ5bmdpdGlzIChkaXNvcmRlciksIHZpY3RpbSBvZiBpbnRpbWF0ZSBwYXJ0bmVyIGFidXNlIChmaW5kaW5nKSwgdmlyYWwgc2ludXNpdGlzIChkaXNvcmRlciksIHN1c3BlY3RlZCBjb3ZpZC0xOSwgY292aWQtMTksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgYWN1dGUgYnJvbmNoaXRpcyAoZGlzb3JkZXIpLCBmZXZlciAoZmluZGluZyksIHVuaGVhbHRoeSBhbGNvaG9sIGRyaW5raW5nIGJlaGF2aW9yIChmaW5kaW5nKSwgcmVwb3J0cyBvZiB2aW9sZW5jZSBpbiB0aGUgZW52aXJvbm1lbnQgKGZpbmRpbmcpLCBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIGNvdWdoIChmaW5kaW5nKSwgc3RyZXNzIChmaW5kaW5nKSwgc29jaWFsIGlzb2xhdGlvbiAoZmluZGluZykuCgojIFNvY2lhbCBIaXN0b3J5ClBhdGllbnQgaXMgc2luZ2xlLiBQYXRpZW50IHF1aXQgc21va2luZyBhdCBhZ2UgMTcuCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KIFBhdGllbnQgZGlkIG5vdCBmaW5pc2ggaGlnaCBzY2hvb2wuClBhdGllbnQgY3VycmVudGx5IGhhcyBVbml0ZWRIZWFsdGhjYXJlLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwphY2V0YW1pbm9waGVuIDMyNSBtZyBvcmFsIHRhYmxldAoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgoKVGhlIGZvbGxvd2luZyBwcm9jZWR1cmVzIHdlcmUgY29uZHVjdGVkOgotIGludHJhbXVzY3VsYXIgaW5qZWN0aW9uCg=="
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:71b40b56-47ee-8ce8-f71f-9bff1bd8ffd9",
"resource": {
"resourceType": "DocumentReference",
"id": "71b40b56-47ee-8ce8-f71f-9bff1bd8ffd9",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:b1f58275-3140-c8c9-c70f-ffc38f71963b"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2022-08-11T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:37225ce5-17fc-62ef-3da6-ec44c8f1c46b"
} ],
"period": {
"start": "2022-08-11T11:29:53+02:00",
"end": "2022-08-11T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:534b7e52-c8e8-215d-9b3d-5fc038580a02",
"resource": {
"resourceType": "Claim",
"id": "534b7e52-c8e8-215d-9b3d-5fc038580a02",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2022-08-11T11:29:53+02:00",
"end": "2022-08-11T11:44:53+02:00"
},
"created": "2022-08-11T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:26a20bb1-819f-856b-fc01-f2c415348b47"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:37225ce5-17fc-62ef-3da6-ec44c8f1c46b"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 4390.48,
"currency": "USD"
}
} ],
"total": {
"value": 4533.06,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:ba94a1a8-d10b-cfda-6aa9-b51461b62651",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "ba94a1a8-d10b-cfda-6aa9-b51461b62651",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "534b7e52-c8e8-215d-9b3d-5fc038580a02"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2022-08-11T11:44:53+02:00",
"end": "2023-08-11T11:44:53+02:00"
},
"created": "2022-08-11T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:534b7e52-c8e8-215d-9b3d-5fc038580a02"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2022-08-11T11:29:53+02:00",
"end": "2022-08-11T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:37225ce5-17fc-62ef-3da6-ec44c8f1c46b"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2022-08-11T11:29:53+02:00",
"end": "2022-08-11T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 4390.48,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 878.096,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 3512.384,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 4390.48,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 4390.48,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 4533.06,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 3512.384,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:dc2722b2-52bf-729a-e2cd-e76bfc83b898",
"resource": {
"resourceType": "Encounter",
"id": "dc2722b2-52bf-729a-e2cd-e76bfc83b898",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "dc2722b2-52bf-729a-e2cd-e76bfc83b898"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-11-10T10:29:53+01:00",
"end": "2022-11-10T10:48:04+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2022-11-10T10:29:53+01:00",
"end": "2022-11-10T10:48:04+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:805510a5-a194-f1e5-e2ad-022d1da38cf0",
"resource": {
"resourceType": "Procedure",
"id": "805510a5-a194-f1e5-e2ad-022d1da38cf0",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:dc2722b2-52bf-729a-e2cd-e76bfc83b898"
},
"performedPeriod": {
"start": "2022-11-10T10:29:53+01:00",
"end": "2022-11-10T10:48:04+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:2be54746-e7a4-c3b9-804f-3c806067f981",
"resource": {
"resourceType": "DiagnosticReport",
"id": "2be54746-e7a4-c3b9-804f-3c806067f981",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:dc2722b2-52bf-729a-e2cd-e76bfc83b898"
},
"effectiveDateTime": "2022-11-10T10:29:53+01:00",
"issued": "2022-11-10T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:d3c59dfb-d9a5-c4b6-e973-e09f294f907c",
"resource": {
"resourceType": "DocumentReference",
"id": "d3c59dfb-d9a5-c4b6-e973-e09f294f907c",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:2be54746-e7a4-c3b9-804f-3c806067f981"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2022-11-10T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "CjIwMjItMTEtMTAKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzClBldHJvbmlsYTcyNAogaXMgYSA1MiB5ZWFyLW9sZCBub25oaXNwYW5pYyB3aGl0ZSBmZW1hbGUuIFBhdGllbnQgaGFzIGEgaGlzdG9yeSBvZiBhY3V0ZSBiYWN0ZXJpYWwgc2ludXNpdGlzIChkaXNvcmRlciksIGZhdGlndWUgKGZpbmRpbmcpLCBtZWRpY2F0aW9uIHJldmlldyBkdWUgKHNpdHVhdGlvbiksIGFjdXRlIHZpcmFsIHBoYXJ5bmdpdGlzIChkaXNvcmRlciksIHZpY3RpbSBvZiBpbnRpbWF0ZSBwYXJ0bmVyIGFidXNlIChmaW5kaW5nKSwgdmlyYWwgc2ludXNpdGlzIChkaXNvcmRlciksIHN1c3BlY3RlZCBjb3ZpZC0xOSwgY292aWQtMTksIHBhcnQtdGltZSBlbXBsb3ltZW50IChmaW5kaW5nKSwgYWN1dGUgYnJvbmNoaXRpcyAoZGlzb3JkZXIpLCBmZXZlciAoZmluZGluZyksIHVuaGVhbHRoeSBhbGNvaG9sIGRyaW5raW5nIGJlaGF2aW9yIChmaW5kaW5nKSwgcmVwb3J0cyBvZiB2aW9sZW5jZSBpbiB0aGUgZW52aXJvbm1lbnQgKGZpbmRpbmcpLCBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIGNvdWdoIChmaW5kaW5nKSwgc3RyZXNzIChmaW5kaW5nKSwgc29jaWFsIGlzb2xhdGlvbiAoZmluZGluZykuCgojIFNvY2lhbCBIaXN0b3J5ClBhdGllbnQgaXMgc2luZ2xlLiBQYXRpZW50IHF1aXQgc21va2luZyBhdCBhZ2UgMTcuCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KIFBhdGllbnQgZGlkIG5vdCBmaW5pc2ggaGlnaCBzY2hvb2wuClBhdGllbnQgY3VycmVudGx5IGhhcyBVbml0ZWRIZWFsdGhjYXJlLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwphY2V0YW1pbm9waGVuIDMyNSBtZyBvcmFsIHRhYmxldAoKIyBBc3Nlc3NtZW50IGFuZCBQbGFuCgoKIyMgUGxhbgoKVGhlIGZvbGxvd2luZyBwcm9jZWR1cmVzIHdlcmUgY29uZHVjdGVkOgotIGludHJhbXVzY3VsYXIgaW5qZWN0aW9uCg=="
},
"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:dc2722b2-52bf-729a-e2cd-e76bfc83b898"
} ],
"period": {
"start": "2022-11-10T10:29:53+01:00",
"end": "2022-11-10T10:48:04+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:27caf04d-63af-16f3-598d-cb07cdb1bb83",
"resource": {
"resourceType": "Claim",
"id": "27caf04d-63af-16f3-598d-cb07cdb1bb83",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2022-11-10T10:29:53+01:00",
"end": "2022-11-10T10:48:04+01:00"
},
"created": "2022-11-10T10:48:04+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:805510a5-a194-f1e5-e2ad-022d1da38cf0"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:dc2722b2-52bf-729a-e2cd-e76bfc83b898"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2478.05,
"currency": "USD"
}
} ],
"total": {
"value": 2620.63,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:702fd7e8-4fb9-19b6-d15d-230c9d675c5f",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "702fd7e8-4fb9-19b6-d15d-230c9d675c5f",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "27caf04d-63af-16f3-598d-cb07cdb1bb83"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2022-11-10T10:48:04+01:00",
"end": "2023-11-10T10:48:04+01:00"
},
"created": "2022-11-10T10:48:04+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:27caf04d-63af-16f3-598d-cb07cdb1bb83"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2022-11-10T10:29:53+01:00",
"end": "2022-11-10T10:48:04+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:dc2722b2-52bf-729a-e2cd-e76bfc83b898"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2022-11-10T10:29:53+01:00",
"end": "2022-11-10T10:48:04+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2478.05,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 495.61000000000007,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1982.4400000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2478.05,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2478.05,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2620.63,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1982.4400000000003,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5",
"resource": {
"resourceType": "Encounter",
"id": "445d3a1f-9c95-87bf-c8d4-9b93def3f8f5",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
}
} ],
"period": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:ae06a544-f839-c138-20d0-44fa07bc7f73",
"resource": {
"resourceType": "Condition",
"id": "ae06a544-f839-c138-20d0-44fa07bc7f73",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
},
"clinicalStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
} ]
},
"verificationStatus": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
} ]
},
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "encounter-diagnosis",
"display": "Encounter Diagnosis"
} ]
} ],
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"onsetDateTime": "2022-12-15T11:15:39+01:00",
"recordedDate": "2022-12-15T11:15:39+01:00"
},
"request": {
"method": "POST",
"url": "Condition"
}
}, {
"fullUrl": "urn:uuid:ab6f117c-1639-a1a6-567d-f2d97d34cb87",
"resource": {
"resourceType": "Observation",
"id": "ab6f117c-1639-a1a6-567d-f2d97d34cb87",
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "4548-4",
"display": "Hemoglobin A1c/Hemoglobin.total in Blood"
} ],
"text": "Hemoglobin A1c/Hemoglobin.total in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 6.33,
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:122d9950-9b77-f094-e59c-af74e59ef320",
"resource": {
"resourceType": "Observation",
"id": "122d9950-9b77-f094-e59c-af74e59ef320",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 170.3,
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0aa87c85-b6b6-94ad-a4f0-ddc1b34831ca",
"resource": {
"resourceType": "Observation",
"id": "0aa87c85-b6b6-94ad-a4f0-ddc1b34831ca",
"status": "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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 1,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:3b6033db-7516-334f-7d67-734a191d2725",
"resource": {
"resourceType": "Observation",
"id": "3b6033db-7516-334f-7d67-734a191d2725",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 79.7,
"unit": "kg",
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:1f2735be-24bc-594f-bbfe-9be8edc97602",
"resource": {
"resourceType": "Observation",
"id": "1f2735be-24bc-594f-bbfe-9be8edc97602",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 27.48,
"unit": "kg/m2",
"system": "http://unitsofmeasure.org",
"code": "kg/m2"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:5cb8e31d-8f5a-6967-36ed-dba887369c3d",
"resource": {
"resourceType": "Observation",
"id": "5cb8e31d-8f5a-6967-36ed-dba887369c3d",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure"
},
"valueQuantity": {
"value": 89,
"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": 121,
"unit": "mm[Hg]",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:732d2930-1f71-5a6a-53cf-ec21c81816f0",
"resource": {
"resourceType": "Observation",
"id": "732d2930-1f71-5a6a-53cf-ec21c81816f0",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 95,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9701da0d-9625-fa95-5525-f736bfa4ceb9",
"resource": {
"resourceType": "Observation",
"id": "9701da0d-9625-fa95-5525-f736bfa4ceb9",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 13,
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:4bdb5293-ba6b-ebc9-4b4b-e524d68231a2",
"resource": {
"resourceType": "Observation",
"id": "4bdb5293-ba6b-ebc9-4b4b-e524d68231a2",
"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": "2339-0",
"display": "Glucose [Mass/volume] in Blood"
} ],
"text": "Glucose [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 99.44,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:6f0b8989-38dd-1fff-70e3-469310f1c5f8",
"resource": {
"resourceType": "Observation",
"id": "6f0b8989-38dd-1fff-70e3-469310f1c5f8",
"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": "6299-2",
"display": "Urea nitrogen [Mass/volume] in Blood"
} ],
"text": "Urea nitrogen [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 8.62,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7ea8d8f1-011e-3813-1372-9b239e838e83",
"resource": {
"resourceType": "Observation",
"id": "7ea8d8f1-011e-3813-1372-9b239e838e83",
"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": "38483-4",
"display": "Creatinine [Mass/volume] in Blood"
} ],
"text": "Creatinine [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 1.44,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:f13d705a-79b9-a983-5452-7de7a7f22feb",
"resource": {
"resourceType": "Observation",
"id": "f13d705a-79b9-a983-5452-7de7a7f22feb",
"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": "49765-1",
"display": "Calcium [Mass/volume] in Blood"
} ],
"text": "Calcium [Mass/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 9.43,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d64b1874-de60-fc76-8bdc-a51495d18857",
"resource": {
"resourceType": "Observation",
"id": "d64b1874-de60-fc76-8bdc-a51495d18857",
"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": "2947-0",
"display": "Sodium [Moles/volume] in Blood"
} ],
"text": "Sodium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 142.41,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:ce0f1be7-3cf5-6600-ef5e-a8f5d89c9d56",
"resource": {
"resourceType": "Observation",
"id": "ce0f1be7-3cf5-6600-ef5e-a8f5d89c9d56",
"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": "6298-4",
"display": "Potassium [Moles/volume] in Blood"
} ],
"text": "Potassium [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 4.46,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:c15b6960-9409-42a4-4bfd-c6223c1a0402",
"resource": {
"resourceType": "Observation",
"id": "c15b6960-9409-42a4-4bfd-c6223c1a0402",
"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": "2069-3",
"display": "Chloride [Moles/volume] in Blood"
} ],
"text": "Chloride [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 103.9,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d21742ed-50a0-3519-81d8-0ef155dc2762",
"resource": {
"resourceType": "Observation",
"id": "d21742ed-50a0-3519-81d8-0ef155dc2762",
"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": "20565-8",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ],
"text": "Carbon dioxide, total [Moles/volume] in Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 27.88,
"unit": "mmol/L",
"system": "http://unitsofmeasure.org",
"code": "mmol/L"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:e9c01bfb-c41f-dbb6-9bcc-ad02c34b981b",
"resource": {
"resourceType": "Observation",
"id": "e9c01bfb-c41f-dbb6-9bcc-ad02c34b981b",
"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": "2093-3",
"display": "Cholesterol [Mass/volume] in Serum or Plasma"
} ],
"text": "Cholesterol [Mass/volume] in Serum or Plasma"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 138.41,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:7d7673dc-9ed6-54b6-faa6-f6430dfa1a2e",
"resource": {
"resourceType": "Observation",
"id": "7d7673dc-9ed6-54b6-faa6-f6430dfa1a2e",
"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": "2571-8",
"display": "Triglycerides"
} ],
"text": "Triglycerides"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 106.72,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:9dc003f5-cb25-e881-5185-80c816fd22f1",
"resource": {
"resourceType": "Observation",
"id": "9dc003f5-cb25-e881-5185-80c816fd22f1",
"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": "18262-6",
"display": "Low Density Lipoprotein Cholesterol"
} ],
"text": "Low Density Lipoprotein Cholesterol"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 63.36,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:d6f1bcd3-296d-f311-a4ab-df2eb33aa5af",
"resource": {
"resourceType": "Observation",
"id": "d6f1bcd3-296d-f311-a4ab-df2eb33aa5af",
"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": "2085-9",
"display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
} ],
"text": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueQuantity": {
"value": 53.71,
"unit": "mg/dL",
"system": "http://unitsofmeasure.org",
"code": "mg/dL"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:42e8a301-4629-2123-d9dc-47eb25a4a608",
"resource": {
"resourceType": "Observation",
"id": "42e8a301-4629-2123-d9dc-47eb25a4a608",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"valueCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "8517006",
"display": "Ex-smoker (finding)"
} ],
"text": "Ex-smoker (finding)"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:cf281600-d53a-9922-75fe-e68e4e54bae0",
"resource": {
"resourceType": "Observation",
"id": "cf281600-d53a-9922-75fe-e68e4e54bae0",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93025-5",
"display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T11:15:39+01:00",
"issued": "2022-12-15T11:15:39.294+01:00",
"component": [ {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76501-6",
"display": "Within the last year, have you been afraid of your partner or ex-partner?"
} ],
"text": "Within the last year, have you been afraid of your partner or ex-partner?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93026-3",
"display": "Do you feel physically and emotionally safe where you currently live?"
} ],
"text": "Do you feel physically and emotionally safe where you currently live?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA33-6",
"display": "Yes"
} ],
"text": "Yes"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93027-1",
"display": "Are you a refugee?"
} ],
"text": "Are you a refugee?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93028-9",
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93038-8",
"display": "Stress level"
} ],
"text": "Stress level"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA13863-8",
"display": "A little bit"
} ],
"text": "A little bit"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93029-7",
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30122-8",
"display": "I choose not to answer this question"
} ],
"text": "I choose not to answer this question"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93030-5",
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
} ],
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93031-3",
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30122-8",
"display": "I choose not to answer this question"
} ],
"text": "I choose not to answer this question"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63586-2",
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
},
"valueQuantity": {
"value": 90472,
"unit": "/a",
"system": "http://unitsofmeasure.org",
"code": "/a"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "76437-3",
"display": "Primary insurance"
} ],
"text": "Primary insurance"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA6350-8",
"display": "Private insurance"
} ],
"text": "Private insurance"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "67875-5",
"display": "Employment status - current"
} ],
"text": "Employment status - current"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30136-8",
"display": "Full-time work"
} ],
"text": "Full-time work"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82589-3",
"display": "Highest level of education"
} ],
"text": "Highest level of education"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30191-3",
"display": "Less than high school degree"
} ],
"text": "Less than high school degree"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56799-0",
"display": "Address"
} ],
"text": "Address"
},
"valueString": "217 Bayer Drive Unit 35"
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93033-9",
"display": "Are you worried about losing your housing?"
} ],
"text": "Are you worried about losing your housing?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "71802-3",
"display": "Housing status"
} ],
"text": "Housing status"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA30189-7",
"display": "I have housing"
} ],
"text": "I have housing"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "63512-8",
"display": "How many people are living or staying at this address?"
} ],
"text": "How many people are living or staying at this address?"
},
"valueQuantity": {
"value": 5,
"unit": "{#}",
"system": "http://unitsofmeasure.org",
"code": "{#}"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "54899-0",
"display": "Preferred language"
} ],
"text": "Preferred language"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA43-5",
"display": "English"
} ],
"text": "English"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93034-7",
"display": "Have you been discharged from the armed forces of the United States?"
} ],
"text": "Have you been discharged from the armed forces of the United States?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "93035-4",
"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "32624-9",
"display": "Race"
} ],
"text": "Race"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA4457-3",
"display": "White"
} ],
"text": "White"
}
}, {
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "56051-6",
"display": "Do you consider yourself Hispanic/Latino?"
} ],
"text": "Do you consider yourself Hispanic/Latino?"
},
"valueCodeableConcept": {
"coding": [ {
"system": "http://loinc.org",
"code": "LA32-8",
"display": "No"
} ],
"text": "No"
}
} ]
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:900856b0-3fe2-ebc8-1b85-135e335f2d71",
"resource": {
"resourceType": "Observation",
"id": "900856b0-3fe2-ebc8-1b85-135e335f2d71",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55758-7",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T11:55:54+01:00",
"issued": "2022-12-15T11:55:54.294+01:00",
"valueQuantity": {
"value": 0,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:49cece6d-61a4-7c4e-fdbe-d5640fd1dec0",
"resource": {
"resourceType": "Observation",
"id": "49cece6d-61a4-7c4e-fdbe-d5640fd1dec0",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
},
"status": "final",
"category": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "Survey"
} ]
} ],
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82667-7",
"display": "Total score [DAST-10]"
} ],
"text": "Total score [DAST-10]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T12:30:11+01:00",
"issued": "2022-12-15T12:30:11.294+01:00",
"valueQuantity": {
"value": 2,
"unit": "{score}",
"system": "http://unitsofmeasure.org",
"code": "{score}"
}
},
"request": {
"method": "POST",
"url": "Observation"
}
}, {
"fullUrl": "urn:uuid:0db8c0de-8d62-b81a-c3e9-6c48a71246b1",
"resource": {
"resourceType": "Procedure",
"id": "0db8c0de-8d62-b81a-c3e9-6c48a71246b1",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"performedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T10:44:53+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:c25d4ae0-b3d4-2b24-d590-311ff71aa6a8",
"resource": {
"resourceType": "Procedure",
"id": "c25d4ae0-b3d4-2b24-d590-311ff71aa6a8",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"performedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a312afeb-243f-c76b-1d9e-6ae807ac28ac",
"resource": {
"resourceType": "Procedure",
"id": "a312afeb-243f-c76b-1d9e-6ae807ac28ac",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"performedPeriod": {
"start": "2022-12-15T11:15:39+01:00",
"end": "2022-12-15T11:27:15+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:d4b1359b-2a39-666b-38c7-49df1727bd82",
"resource": {
"resourceType": "Procedure",
"id": "d4b1359b-2a39-666b-38c7-49df1727bd82",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"performedPeriod": {
"start": "2022-12-15T11:27:15+01:00",
"end": "2022-12-15T11:55:54+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:372e8b81-788e-7128-a0d3-b4b4671794f2",
"resource": {
"resourceType": "Procedure",
"id": "372e8b81-788e-7128-a0d3-b4b4671794f2",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"performedPeriod": {
"start": "2022-12-15T11:55:54+01:00",
"end": "2022-12-15T12:08:12+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:af6d0d46-1773-30f3-a82d-6f23a28e51ff",
"resource": {
"resourceType": "Procedure",
"id": "af6d0d46-1773-30f3-a82d-6f23a28e51ff",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "713106006",
"display": "Screening for drug abuse (procedure)"
} ],
"text": "Screening for drug abuse (procedure)"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"performedPeriod": {
"start": "2022-12-15T12:08:12+01:00",
"end": "2022-12-15T12:30:11+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:e8488080-f73d-1f1d-d19f-11222dfeb51d",
"resource": {
"resourceType": "SupplyDelivery",
"id": "e8488080-f73d-1f1d-d19f-11222dfeb51d",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 50
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
}
},
"occurrenceDateTime": "2022-12-15T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:c042c1d0-82c7-a26d-42e8-5324613d20a8",
"resource": {
"resourceType": "SupplyDelivery",
"id": "c042c1d0-82c7-a26d-42e8-5324613d20a8",
"status": "completed",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/supply-item-type",
"code": "device",
"display": "Device"
} ]
},
"suppliedItem": {
"quantity": {
"value": 100
},
"itemCodeableConcept": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
}
},
"occurrenceDateTime": "2022-12-15T10:29:53+01:00"
},
"request": {
"method": "POST",
"url": "SupplyDelivery"
}
}, {
"fullUrl": "urn:uuid:033ece28-ff44-c2fd-a342-6202a777fe80",
"resource": {
"resourceType": "Immunization",
"id": "033ece28-ff44-c2fd-a342-6202a777fe80",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"occurrenceDateTime": "2022-12-15T10:29:53+01:00",
"primarySource": true,
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
}
},
"request": {
"method": "POST",
"url": "Immunization"
}
}, {
"fullUrl": "urn:uuid:434b0e8b-590b-ed51-6e82-c02c0b151110",
"resource": {
"resourceType": "DiagnosticReport",
"id": "434b0e8b-590b-ed51-6e82-c02c0b151110",
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:4bdb5293-ba6b-ebc9-4b4b-e524d68231a2",
"display": "Glucose [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:6f0b8989-38dd-1fff-70e3-469310f1c5f8",
"display": "Urea nitrogen [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:7ea8d8f1-011e-3813-1372-9b239e838e83",
"display": "Creatinine [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:f13d705a-79b9-a983-5452-7de7a7f22feb",
"display": "Calcium [Mass/volume] in Blood"
}, {
"reference": "urn:uuid:d64b1874-de60-fc76-8bdc-a51495d18857",
"display": "Sodium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:ce0f1be7-3cf5-6600-ef5e-a8f5d89c9d56",
"display": "Potassium [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:c15b6960-9409-42a4-4bfd-c6223c1a0402",
"display": "Chloride [Moles/volume] in Blood"
}, {
"reference": "urn:uuid:d21742ed-50a0-3519-81d8-0ef155dc2762",
"display": "Carbon dioxide, total [Moles/volume] in Blood"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:9e907494-3ecd-a86a-84f2-a2d06a50ad38",
"resource": {
"resourceType": "DiagnosticReport",
"id": "9e907494-3ecd-a86a-84f2-a2d06a50ad38",
"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": "57698-3",
"display": "Lipid panel with direct LDL - Serum or Plasma"
} ],
"text": "Lipid panel with direct LDL - Serum or Plasma"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"performer": [ {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
} ],
"result": [ {
"reference": "urn:uuid:e9c01bfb-c41f-dbb6-9bcc-ad02c34b981b",
"display": "Cholesterol [Mass/volume] in Serum or Plasma"
}, {
"reference": "urn:uuid:7d7673dc-9ed6-54b6-faa6-f6430dfa1a2e",
"display": "Triglycerides"
}, {
"reference": "urn:uuid:9dc003f5-cb25-e881-5185-80c816fd22f1",
"display": "Low Density Lipoprotein Cholesterol"
}, {
"reference": "urn:uuid:d6f1bcd3-296d-f311-a4ab-df2eb33aa5af",
"display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:9e2a22e2-041e-e7b7-d018-5c4ee906f34d",
"resource": {
"resourceType": "DiagnosticReport",
"id": "9e2a22e2-041e-e7b7-d018-5c4ee906f34d",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T11:55:54+01:00",
"issued": "2022-12-15T11:55:54.294+01:00",
"result": [ {
"reference": "urn:uuid:900856b0-3fe2-ebc8-1b85-135e335f2d71",
"display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:e465106a-b4e2-248f-e770-2904993cac33",
"resource": {
"resourceType": "DiagnosticReport",
"id": "e465106a-b4e2-248f-e770-2904993cac33",
"status": "final",
"code": {
"coding": [ {
"system": "http://loinc.org",
"code": "82666-9",
"display": "Drug Abuse Screening Test-10 [DAST-10]"
} ],
"text": "Drug Abuse Screening Test-10 [DAST-10]"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T12:30:11+01:00",
"issued": "2022-12-15T12:30:11.294+01:00",
"result": [ {
"reference": "urn:uuid:49cece6d-61a4-7c4e-fdbe-d5640fd1dec0",
"display": "Total score [DAST-10]"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:f3f8f9b8-91ac-c48d-c7e3-6caa17185536",
"resource": {
"resourceType": "DiagnosticReport",
"id": "f3f8f9b8-91ac-c48d-c7e3-6caa17185536",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
},
"effectiveDateTime": "2022-12-15T10:29:53+01:00",
"issued": "2022-12-15T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:abfb0d4e-9ee8-b7e2-0880-53edf2804416",
"resource": {
"resourceType": "DocumentReference",
"id": "abfb0d4e-9ee8-b7e2-0880-53edf2804416",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:f3f8f9b8-91ac-c48d-c7e3-6caa17185536"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2022-12-15T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690",
"display": "Dr. Mao115 Bednar518"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"content": [ {
"attachment": {
"contentType": "text/plain; charset=utf-8",
"data": "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"
},
"format": {
"system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
"display": "mimeType Sufficient"
}
} ],
"context": {
"encounter": [ {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
} ],
"period": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:1ecb486d-c427-7b5d-daad-f9a19fac68ae",
"resource": {
"resourceType": "Claim",
"id": "1ecb486d-c427-7b5d-daad-f9a19fac68ae",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"created": "2022-12-15T11:15:39+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|4e880cb9-1ca0-3582-b8cf-8a59b0d2b878",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"supportingInfo": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
},
"valueReference": {
"reference": "urn:uuid:033ece28-ff44-c2fd-a342-6202a777fe80"
}
}, {
"sequence": 2,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 4,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 5,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 6,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
}, {
"sequence": 7,
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code": "info"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:ae06a544-f839-c138-20d0-44fa07bc7f73"
}
} ],
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:0db8c0de-8d62-b81a-c3e9-6c48a71246b1"
}
}, {
"sequence": 2,
"procedureReference": {
"reference": "urn:uuid:c25d4ae0-b3d4-2b24-d590-311ff71aa6a8"
}
}, {
"sequence": 3,
"procedureReference": {
"reference": "urn:uuid:a312afeb-243f-c76b-1d9e-6ae807ac28ac"
}
}, {
"sequence": 4,
"procedureReference": {
"reference": "urn:uuid:d4b1359b-2a39-666b-38c7-49df1727bd82"
}
}, {
"sequence": 5,
"procedureReference": {
"reference": "urn:uuid:372e8b81-788e-7128-a0d3-b4b4671794f2"
}
}, {
"sequence": 6,
"procedureReference": {
"reference": "urn:uuid:af6d0d46-1773-30f3-a82d-6f23a28e51ff"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"encounter": [ {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
} ]
}, {
"sequence": 2,
"informationSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://hl7.org/fhir/sid/cvx",
"code": "140",
"display": "Influenza, seasonal, injectable, preservative free"
} ],
"text": "Influenza, seasonal, injectable, preservative free"
},
"net": {
"value": 136.00,
"currency": "USD"
}
}, {
"sequence": 3,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "430193006",
"display": "Medication Reconciliation (procedure)"
} ],
"text": "Medication Reconciliation (procedure)"
},
"net": {
"value": 466.21,
"currency": "USD"
}
}, {
"sequence": 4,
"informationSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"net": {
"value": 6.80,
"currency": "USD"
}
}, {
"sequence": 5,
"informationSequence": [ 3 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
},
"net": {
"value": 0.00,
"currency": "USD"
}
}, {
"sequence": 6,
"informationSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 7,
"informationSequence": [ 5 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "57698-3",
"display": "Lipid panel with direct LDL - Serum or Plasma"
} ],
"text": "Lipid panel with direct LDL - Serum or Plasma"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 8,
"procedureSequence": [ 2 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 9,
"diagnosisSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
}
}, {
"sequence": 10,
"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": 11,
"procedureSequence": [ 4 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 12,
"informationSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
}, {
"sequence": 13,
"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": 14,
"procedureSequence": [ 6 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "713106006",
"display": "Screening for drug abuse (procedure)"
} ],
"text": "Screening for drug abuse (procedure)"
},
"net": {
"value": 431.40,
"currency": "USD"
}
}, {
"sequence": 15,
"informationSequence": [ 7 ],
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "82666-9",
"display": "Drug Abuse Screening Test-10 [DAST-10]"
} ],
"text": "Drug Abuse Screening Test-10 [DAST-10]"
},
"net": {
"value": 74.58,
"currency": "USD"
}
} ],
"total": {
"value": 1326.37,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:c8bcc96b-7ae7-fbb1-f45f-56dd90331ba3",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "c8bcc96b-7ae7-fbb1-f45f-56dd90331ba3",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "1ecb486d-c427-7b5d-daad-f9a19fac68ae"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2022-12-15T11:15:39+01:00",
"end": "2023-12-15T11:15:39+01:00"
},
"created": "2022-12-15T11:15:39+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|675f6865-0e31-3731-8cef-233165fa6a6a",
"display": "BERKSHIRE INTERNAL MEDICINE LLC"
},
"claim": {
"reference": "urn:uuid:1ecb486d-c427-7b5d-daad-f9a19fac68ae"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999960690"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"diagnosis": [ {
"sequence": 1,
"diagnosisReference": {
"reference": "urn:uuid:ae06a544-f839-c138-20d0-44fa07bc7f73"
},
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code": "principal"
} ]
} ]
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "162673000",
"display": "General examination of patient (procedure)"
} ],
"text": "General examination of patient (procedure)"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
} ]
}, {
"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": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 136.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 27.200000000000003,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 108.80000000000001,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 136.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 3,
"category": {
"coding": [ {
"system": "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": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 466.21,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 93.242,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 372.968,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 466.21,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 466.21,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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": [ 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": "337388004",
"display": "Blood glucose testing strips (physical object)"
} ],
"text": "Blood glucose testing strips (physical object)"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 6.80,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 1.36,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 5.44,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 6.80,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "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://snomed.info/sct",
"code": "1137596000",
"display": "Blood lancet (physical object)"
} ],
"text": "Blood lancet (physical object)"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 0.00,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 0.0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 0.0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 0.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 0.00,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 6,
"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": "51990-0",
"display": "Basic metabolic panel - Blood"
} ],
"text": "Basic metabolic panel - Blood"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 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": "57698-3",
"display": "Lipid panel with direct LDL - Serum or Plasma"
} ],
"text": "Lipid panel with direct LDL - Serum or Plasma"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 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": "710824005",
"display": "Assessment of health and social care needs (procedure)"
} ],
"text": "Assessment of health and social care needs (procedure)"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 9,
"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": "73595000",
"display": "Stress (finding)"
} ],
"text": "Stress (finding)"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
}
}, {
"sequence": 10,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "171207006",
"display": "Depression screening (procedure)"
} ],
"text": "Depression screening (procedure)"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 11,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "454711000124102",
"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
} ],
"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 12,
"informationSequence": [ 6 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "55757-9",
"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
} ],
"text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 13,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "428211000124100",
"display": "Assessment of substance use (procedure)"
} ],
"text": "Assessment of substance use (procedure)"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 14,
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "713106006",
"display": "Screening for drug abuse (procedure)"
} ],
"text": "Screening for drug abuse (procedure)"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 431.40,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 86.28,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 345.12,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 431.40,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
}, {
"sequence": 15,
"informationSequence": [ 7 ],
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
"code": "1",
"display": "Medical care"
} ]
},
"productOrService": {
"coding": [ {
"system": "http://loinc.org",
"code": "82666-9",
"display": "Drug Abuse Screening Test-10 [DAST-10]"
} ],
"text": "Drug Abuse Screening Test-10 [DAST-10]"
},
"servicedPeriod": {
"start": "2022-12-15T10:29:53+01:00",
"end": "2022-12-15T11:15:39+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "19",
"display": "Off Campus-Outpatient Hospital"
} ]
},
"net": {
"value": 74.58,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 14.916,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 59.664,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 74.58,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
} ]
}
} ]
} ],
"total": [ {
"category": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
} ],
"text": "Submitted Amount"
},
"amount": {
"value": 1326.37,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2451.4640000000004,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:87de3c1b-0ff8-17b1-7167-aec0eec460cf",
"resource": {
"resourceType": "Encounter",
"id": "87de3c1b-0ff8-17b1-7167-aec0eec460cf",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "87de3c1b-0ff8-17b1-7167-aec0eec460cf"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2023-02-09T10:29:53+01:00",
"end": "2023-02-09T10:46:18+01:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2023-02-09T10:29:53+01:00",
"end": "2023-02-09T10:46:18+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|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:588aa9bd-0977-39eb-c90d-d2ac77295b3f",
"resource": {
"resourceType": "Procedure",
"id": "588aa9bd-0977-39eb-c90d-d2ac77295b3f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:87de3c1b-0ff8-17b1-7167-aec0eec460cf"
},
"performedPeriod": {
"start": "2023-02-09T10:29:53+01:00",
"end": "2023-02-09T10:46:18+01:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:378a0298-d492-139b-f3eb-9d7cfec70e37",
"resource": {
"resourceType": "DiagnosticReport",
"id": "378a0298-d492-139b-f3eb-9d7cfec70e37",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:87de3c1b-0ff8-17b1-7167-aec0eec460cf"
},
"effectiveDateTime": "2023-02-09T10:29:53+01:00",
"issued": "2023-02-09T10:29:53.294+01:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:e852a079-2659-c835-9027-865c3330e987",
"resource": {
"resourceType": "DocumentReference",
"id": "e852a079-2659-c835-9027-865c3330e987",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:378a0298-d492-139b-f3eb-9d7cfec70e37"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2023-02-09T10:29:53.294+01:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:87de3c1b-0ff8-17b1-7167-aec0eec460cf"
} ],
"period": {
"start": "2023-02-09T10:29:53+01:00",
"end": "2023-02-09T10:46:18+01:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:9f949093-8a36-14ba-2875-6fb1e43adf0e",
"resource": {
"resourceType": "Claim",
"id": "9f949093-8a36-14ba-2875-6fb1e43adf0e",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2023-02-09T10:29:53+01:00",
"end": "2023-02-09T10:46:18+01:00"
},
"created": "2023-02-09T10:46:18+01:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:588aa9bd-0977-39eb-c90d-d2ac77295b3f"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:87de3c1b-0ff8-17b1-7167-aec0eec460cf"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2456.16,
"currency": "USD"
}
} ],
"total": {
"value": 2598.74,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:272393ab-325b-612e-fd17-e1597504c9ad",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "272393ab-325b-612e-fd17-e1597504c9ad",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "9f949093-8a36-14ba-2875-6fb1e43adf0e"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2023-02-09T10:46:18+01:00",
"end": "2024-02-09T10:46:18+01:00"
},
"created": "2023-02-09T10:46:18+01:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:9f949093-8a36-14ba-2875-6fb1e43adf0e"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2023-02-09T10:29:53+01:00",
"end": "2023-02-09T10:46:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:87de3c1b-0ff8-17b1-7167-aec0eec460cf"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2023-02-09T10:29:53+01:00",
"end": "2023-02-09T10:46:18+01:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2456.16,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 491.23199999999997,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1964.9279999999999,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2456.16,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2456.16,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2598.74,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1964.9279999999999,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:1eab82ee-9cd6-0784-8a0d-6d3545e60f98",
"resource": {
"resourceType": "Encounter",
"id": "1eab82ee-9cd6-0784-8a0d-6d3545e60f98",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "1eab82ee-9cd6-0784-8a0d-6d3545e60f98"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2023-05-11T11:29:53+02:00",
"end": "2023-05-11T11:46:21+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2023-05-11T11:29:53+02:00",
"end": "2023-05-11T11:46:21+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:2d68f693-1b52-8a26-9508-e0266e8011b7",
"resource": {
"resourceType": "Procedure",
"id": "2d68f693-1b52-8a26-9508-e0266e8011b7",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:1eab82ee-9cd6-0784-8a0d-6d3545e60f98"
},
"performedPeriod": {
"start": "2023-05-11T11:29:53+02:00",
"end": "2023-05-11T11:46:21+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a00a6c8b-e922-434e-cf22-c344f3af81f5",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a00a6c8b-e922-434e-cf22-c344f3af81f5",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:1eab82ee-9cd6-0784-8a0d-6d3545e60f98"
},
"effectiveDateTime": "2023-05-11T11:29:53+02:00",
"issued": "2023-05-11T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:c607e6af-883e-bcac-2ffd-20284b748501",
"resource": {
"resourceType": "DocumentReference",
"id": "c607e6af-883e-bcac-2ffd-20284b748501",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:a00a6c8b-e922-434e-cf22-c344f3af81f5"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2023-05-11T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:1eab82ee-9cd6-0784-8a0d-6d3545e60f98"
} ],
"period": {
"start": "2023-05-11T11:29:53+02:00",
"end": "2023-05-11T11:46:21+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:44032919-5dd7-c111-9d90-f5f51649c782",
"resource": {
"resourceType": "Claim",
"id": "44032919-5dd7-c111-9d90-f5f51649c782",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2023-05-11T11:29:53+02:00",
"end": "2023-05-11T11:46:21+02:00"
},
"created": "2023-05-11T11:46:21+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:2d68f693-1b52-8a26-9508-e0266e8011b7"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:1eab82ee-9cd6-0784-8a0d-6d3545e60f98"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 3157.30,
"currency": "USD"
}
} ],
"total": {
"value": 3299.88,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:7180bca5-c325-c14e-6ea6-c8eade09ebe5",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "7180bca5-c325-c14e-6ea6-c8eade09ebe5",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "44032919-5dd7-c111-9d90-f5f51649c782"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2023-05-11T11:46:21+02:00",
"end": "2024-05-11T11:46:21+02:00"
},
"created": "2023-05-11T11:46:21+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:44032919-5dd7-c111-9d90-f5f51649c782"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2023-05-11T11:29:53+02:00",
"end": "2023-05-11T11:46:21+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:1eab82ee-9cd6-0784-8a0d-6d3545e60f98"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2023-05-11T11:29:53+02:00",
"end": "2023-05-11T11:46:21+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 3157.30,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 631.46,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 2525.84,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 3157.30,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 3157.30,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 3299.88,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 2525.84,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:cf0328ac-8c8d-250a-11d9-28581b9aa7f5",
"resource": {
"resourceType": "Encounter",
"id": "cf0328ac-8c8d-250a-11d9-28581b9aa7f5",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
},
"identifier": [ {
"use": "official",
"system": "https://github.com/synthetichealth/synthea",
"value": "cf0328ac-8c8d-250a-11d9-28581b9aa7f5"
} ],
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB"
},
"type": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
} ],
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Ms. Petronila724 Kristeen693 Rutherford999"
},
"participant": [ {
"type": [ {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "PPRF",
"display": "primary performer"
} ],
"text": "primary performer"
} ],
"period": {
"start": "2023-08-10T11:29:53+02:00",
"end": "2023-08-10T11:44:53+02:00"
},
"individual": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
}
} ],
"period": {
"start": "2023-08-10T11:29:53+02:00",
"end": "2023-08-10T11:44:53+02:00"
},
"reasonCode": [ {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "389095005",
"display": "Contraception care (regime/therapy)"
} ]
} ],
"location": [ {
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ],
"serviceProvider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
}, {
"fullUrl": "urn:uuid:a0b43f8e-d38e-52d0-7160-88a5e25780d7",
"resource": {
"resourceType": "Procedure",
"id": "a0b43f8e-d38e-52d0-7160-88a5e25780d7",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
},
"status": "completed",
"code": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cf0328ac-8c8d-250a-11d9-28581b9aa7f5"
},
"performedPeriod": {
"start": "2023-08-10T11:29:53+02:00",
"end": "2023-08-10T11:39:54+02:00"
},
"location": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
},
"request": {
"method": "POST",
"url": "Procedure"
}
}, {
"fullUrl": "urn:uuid:a07347ef-265a-0d7e-4848-2dd233312ed0",
"resource": {
"resourceType": "DiagnosticReport",
"id": "a07347ef-265a-0d7e-4848-2dd233312ed0",
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"encounter": {
"reference": "urn:uuid:cf0328ac-8c8d-250a-11d9-28581b9aa7f5"
},
"effectiveDateTime": "2023-08-10T11:29:53+02:00",
"issued": "2023-08-10T11:29:53.294+02:00",
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"presentedForm": [ {
"contentType": "text/plain; charset=utf-8",
"data": "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"
} ]
},
"request": {
"method": "POST",
"url": "DiagnosticReport"
}
}, {
"fullUrl": "urn:uuid:651b6ac1-4875-5fdb-1e25-f7ffefa47832",
"resource": {
"resourceType": "DocumentReference",
"id": "651b6ac1-4875-5fdb-1e25-f7ffefa47832",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
},
"identifier": [ {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:a07347ef-265a-0d7e-4848-2dd233312ed0"
} ],
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"date": "2023-08-10T11:29:53.294+02:00",
"author": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790",
"display": "Dr. Maryann106 Hintz995"
} ],
"custodian": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"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:cf0328ac-8c8d-250a-11d9-28581b9aa7f5"
} ],
"period": {
"start": "2023-08-10T11:29:53+02:00",
"end": "2023-08-10T11:44:53+02:00"
}
}
},
"request": {
"method": "POST",
"url": "DocumentReference"
}
}, {
"fullUrl": "urn:uuid:1faa8b4a-17ea-bdef-22b9-8a73fcf58a03",
"resource": {
"resourceType": "Claim",
"id": "1faa8b4a-17ea-bdef-22b9-8a73fcf58a03",
"status": "active",
"type": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
} ]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2",
"display": "Petronila724 Rutherford999"
},
"billablePeriod": {
"start": "2023-08-10T11:29:53+02:00",
"end": "2023-08-10T11:44:53+02:00"
},
"created": "2023-08-10T11:44:53+02:00",
"provider": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"priority": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
} ]
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"procedure": [ {
"sequence": 1,
"procedureReference": {
"reference": "urn:uuid:a0b43f8e-d38e-52d0-7160-88a5e25780d7"
}
} ],
"insurance": [ {
"sequence": 1,
"focal": true,
"coverage": {
"display": "UnitedHealthcare"
}
} ],
"item": [ {
"sequence": 1,
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"encounter": [ {
"reference": "urn:uuid:cf0328ac-8c8d-250a-11d9-28581b9aa7f5"
} ]
}, {
"sequence": 2,
"procedureSequence": [ 1 ],
"productOrService": {
"coding": [ {
"system": "http://snomed.info/sct",
"code": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"net": {
"value": 2205.02,
"currency": "USD"
}
} ],
"total": {
"value": 2347.60,
"currency": "USD"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}, {
"fullUrl": "urn:uuid:3cdd7acc-c6ab-85a9-217a-ed56fc73dad8",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "3cdd7acc-c6ab-85a9-217a-ed56fc73dad8",
"contained": [ {
"resourceType": "ServiceRequest",
"id": "referral",
"status": "completed",
"intent": "order",
"subject": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"requester": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"performer": [ {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
} ]
}, {
"resourceType": "Coverage",
"id": "coverage",
"status": "active",
"type": {
"text": "UnitedHealthcare"
},
"beneficiary": {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"payor": [ {
"display": "UnitedHealthcare"
} ]
} ],
"identifier": [ {
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
"value": "1faa8b4a-17ea-bdef-22b9-8a73fcf58a03"
}, {
"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:ec8f677e-0e42-d13a-b292-ff50216121b2"
},
"billablePeriod": {
"start": "2023-08-10T11:44:53+02:00",
"end": "2024-08-10T11:44:53+02:00"
},
"created": "2023-08-10T11:44:53+02:00",
"insurer": {
"display": "UnitedHealthcare"
},
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"referral": {
"reference": "#referral"
},
"facility": {
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d9dd2699-ec1b-3b77-8b83-33d437131ded",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
},
"claim": {
"reference": "urn:uuid:1faa8b4a-17ea-bdef-22b9-8a73fcf58a03"
},
"outcome": "complete",
"careTeam": [ {
"sequence": 1,
"provider": {
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999993790"
},
"role": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code": "primary",
"display": "Primary provider"
} ]
}
} ],
"insurance": [ {
"focal": true,
"coverage": {
"reference": "#coverage",
"display": "UnitedHealthcare"
}
} ],
"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": "308335008",
"display": "Patient encounter procedure"
} ],
"text": "Patient encounter procedure"
},
"servicedPeriod": {
"start": "2023-08-10T11:29:53+02:00",
"end": "2023-08-10T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"encounter": [ {
"reference": "urn:uuid:cf0328ac-8c8d-250a-11d9-28581b9aa7f5"
} ]
}, {
"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": "76601001",
"display": "Intramuscular injection"
} ],
"text": "Intramuscular injection"
},
"servicedPeriod": {
"start": "2023-08-10T11:29:53+02:00",
"end": "2023-08-10T11:44:53+02:00"
},
"locationCodeableConcept": {
"coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
"code": "21",
"display": "Inpatient Hospital"
} ]
},
"net": {
"value": 2205.02,
"currency": "USD"
},
"adjudication": [ {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display": "Line Beneficiary Coinsurance Amount"
} ]
},
"amount": {
"value": 441.004,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display": "Line Provider Payment Amount"
} ]
},
"amount": {
"value": 1764.016,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
"display": "Line Submitted Charge Amount"
} ]
},
"amount": {
"value": 2205.02,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
} ]
},
"amount": {
"value": 2205.02,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
} ]
},
"amount": {
"value": 0,
"currency": "USD"
}
}, {
"category": {
"coding": [ {
"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": 2347.60,
"currency": "USD"
}
} ],
"payment": {
"amount": {
"value": 1764.016,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}, {
"fullUrl": "urn:uuid:2dd634d5-24a1-d976-04f7-867b951e139f",
"resource": {
"resourceType": "Provenance",
"id": "2dd634d5-24a1-d976-04f7-867b951e139f",
"meta": {
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance" ]
},
"target": [ {
"reference": "urn:uuid:ec8f677e-0e42-d13a-b292-ff50216121b2"
}, {
"reference": "urn:uuid:542f1d85-16b5-41ee-03f9-933814c47b1e"
}, {
"reference": "urn:uuid:e4163046-f4fa-093b-2bc4-3ae612dde7a6"
}, {
"reference": "urn:uuid:fcf38ece-1223-8661-7d06-6606c18de9fe"
}, {
"reference": "urn:uuid:ef15b4ed-b144-aad4-5b30-d9ce87ab8079"
}, {
"reference": "urn:uuid:94a73384-2fc8-fa7a-0037-dc581a3bec00"
}, {
"reference": "urn:uuid:62c72356-127e-e055-fa53-56b297c57fa8"
}, {
"reference": "urn:uuid:cf6498c0-cd2b-a7d8-fc16-0554c3d8a9e1"
}, {
"reference": "urn:uuid:c15aa811-6cdb-e0f2-4a83-4ea2a394eb88"
}, {
"reference": "urn:uuid:6672acfc-bea6-6700-269a-a503e4efd22b"
}, {
"reference": "urn:uuid:23535997-219f-fe13-6709-1d63cd71f8c7"
}, {
"reference": "urn:uuid:d42a93cc-92ac-ecb7-a815-06be18187d60"
}, {
"reference": "urn:uuid:ad3d7920-2bb9-57e2-09c2-bfbf7f50e416"
}, {
"reference": "urn:uuid:81b69655-e04a-541e-3aee-d8638ac1b933"
}, {
"reference": "urn:uuid:59728c07-057f-17ef-07b5-31872a060c3d"
}, {
"reference": "urn:uuid:342af48a-cdc0-e22f-300b-9ee633531b02"
}, {
"reference": "urn:uuid:50d48740-f857-33a2-c69e-c95f0f94019a"
}, {
"reference": "urn:uuid:0a074369-09e8-0179-2484-91c73ab5738e"
}, {
"reference": "urn:uuid:9688e62c-14fe-a6b9-0219-8effff71983f"
}, {
"reference": "urn:uuid:b83a8b20-834e-6fd4-297a-94b72f1b32e2"
}, {
"reference": "urn:uuid:42d1b265-6d05-7c91-a51e-9d76a3be8728"
}, {
"reference": "urn:uuid:3ec42747-ec75-893d-4ffe-92466cb44749"
}, {
"reference": "urn:uuid:2a0a3a8d-2b8d-d155-8b00-5c1b229fcef9"
}, {
"reference": "urn:uuid:3ae19bed-afa2-011f-6516-968a6c039c03"
}, {
"reference": "urn:uuid:e665c00f-b095-3439-f33c-e161586a1a1c"
}, {
"reference": "urn:uuid:46ec95d0-6240-1052-a0b9-021cc90edc5b"
}, {
"reference": "urn:uuid:ca0f3f46-fcca-4bd6-5781-547b484f5ef9"
}, {
"reference": "urn:uuid:d21cb741-2eba-67fb-b17e-2374740e9a84"
}, {
"reference": "urn:uuid:c578a377-574d-fe04-5bf4-524d8e696909"
}, {
"reference": "urn:uuid:6b291db6-d596-b44c-7662-758cd21f6e7b"
}, {
"reference": "urn:uuid:6d142d35-feca-9e7e-15e8-17a8f0500a0f"
}, {
"reference": "urn:uuid:a38f0c43-e040-cae9-d6eb-918a7f946275"
}, {
"reference": "urn:uuid:bd76649c-5384-be8e-b9cc-4df5fa2443bc"
}, {
"reference": "urn:uuid:0ea5b47a-aac9-9ea9-b874-47fd2bdd0a39"
}, {
"reference": "urn:uuid:e170bf6b-6454-c66e-81c4-faa669e7f2cd"
}, {
"reference": "urn:uuid:bbdc312f-4f95-abcf-f0d1-7f9a2675580e"
}, {
"reference": "urn:uuid:9b7eaeb6-03a9-4351-961b-6b179e8d6d86"
}, {
"reference": "urn:uuid:7fc3f091-bc32-864f-a115-9866a2159326"
}, {
"reference": "urn:uuid:bae55e60-89ed-1ee3-a2d7-a6e3c933192c"
}, {
"reference": "urn:uuid:0f0901fe-69e7-f2d3-49fd-cd53457564e8"
}, {
"reference": "urn:uuid:15372171-ed67-5fec-d21c-860c6a8c7d21"
}, {
"reference": "urn:uuid:4e3eb0c5-d8c9-0b33-fe38-46e5742909e8"
}, {
"reference": "urn:uuid:c976e5ce-11dd-c67c-ff3f-3a3807173f3f"
}, {
"reference": "urn:uuid:7bad8fae-ab7f-0ffa-4773-a55cee225fa4"
}, {
"reference": "urn:uuid:8c2e6962-f589-c7fe-401a-d936837cf2e8"
}, {
"reference": "urn:uuid:f9e0ad85-c395-41ad-5278-7dcade796c2c"
}, {
"reference": "urn:uuid:65d3e421-112b-6657-9a1c-ab12aafb721c"
}, {
"reference": "urn:uuid:2cd554ee-5403-3e6d-2d97-e2e4c40f815f"
}, {
"reference": "urn:uuid:c24fe6ae-dde9-8275-6da4-22195d93d950"
}, {
"reference": "urn:uuid:f485d323-7154-ef72-07da-8f0974b72926"
}, {
"reference": "urn:uuid:0519b6e6-714b-3741-8ba8-39f91b5327fe"
}, {
"reference": "urn:uuid:69c1e663-0b0a-a95a-2474-d42783a6ee7f"
}, {
"reference": "urn:uuid:4eca683a-e9e7-7746-543a-94dd77598c87"
}, {
"reference": "urn:uuid:002aebf5-cb8c-89c6-aeea-cfefa23f01e7"
}, {
"reference": "urn:uuid:a14877ea-ab7f-36c7-409c-0f76dedbbc0e"
}, {
"reference": "urn:uuid:c87f6900-fc96-effd-aca9-9dfb99535158"
}, {
"reference": "urn:uuid:6edf1f66-bff5-c81a-4661-76890a0bfb64"
}, {
"reference": "urn:uuid:c2e5d1eb-9e1d-c8e5-7afc-232257286968"
}, {
"reference": "urn:uuid:f6ad31a4-b371-dcc2-d0c0-062e5dfd5a84"
}, {
"reference": "urn:uuid:87ff4f1e-9a8d-12fa-5798-461ddad17ec0"
}, {
"reference": "urn:uuid:71b3d37b-87ef-b135-f71f-64245bda2426"
}, {
"reference": "urn:uuid:54a49ee2-d889-bece-a83c-2b16350f056d"
}, {
"reference": "urn:uuid:2de81fdc-7bdb-2df9-2105-cc4713c411aa"
}, {
"reference": "urn:uuid:6b6b1f41-52e1-12c1-340e-7bc6a394364d"
}, {
"reference": "urn:uuid:12669957-dd6f-68ac-804e-6efb4f49ca5c"
}, {
"reference": "urn:uuid:9e82bf06-a43c-05bc-7913-027fe3f10ab8"
}, {
"reference": "urn:uuid:5908382d-903a-735e-bad1-966eadddd5c4"
}, {
"reference": "urn:uuid:4a5229f8-c191-2d50-89e6-3b9c2e39e96b"
}, {
"reference": "urn:uuid:d36c6e33-1749-9db9-a03f-332c22ca7d51"
}, {
"reference": "urn:uuid:9b8d3ba8-3cd4-42f5-984e-8f66f9e42138"
}, {
"reference": "urn:uuid:b7bfc038-5a0a-ba54-a718-32df0fe99123"
}, {
"reference": "urn:uuid:70dc93b9-4b7e-e1e9-0639-7373a4fee1b2"
}, {
"reference": "urn:uuid:cf4605db-8a43-c12d-33d9-e70733080cfa"
}, {
"reference": "urn:uuid:d2be5b61-73cd-a70c-1ea3-7ba886855224"
}, {
"reference": "urn:uuid:c4a6cae0-619f-a1f4-ae26-877a9e9ed62a"
}, {
"reference": "urn:uuid:eff5d42b-e3a3-f797-4c15-4868a87f888b"
}, {
"reference": "urn:uuid:94279922-7d59-54a5-755d-c4426f6eb99b"
}, {
"reference": "urn:uuid:33e40deb-e8a2-71ca-63b6-3c9b4bec4a97"
}, {
"reference": "urn:uuid:61a16984-59b6-93db-5622-7cf309d74af8"
}, {
"reference": "urn:uuid:50de9a77-769d-5b4b-03fd-67169bd0970b"
}, {
"reference": "urn:uuid:5a09c3eb-4c53-96e3-68e4-61c7ab104bc1"
}, {
"reference": "urn:uuid:9de306e3-235e-0db2-ed98-8d99cefe23c3"
}, {
"reference": "urn:uuid:8d79800a-0aee-010b-50ce-a542a943ac2c"
}, {
"reference": "urn:uuid:1598fa50-fd5e-30c4-bda9-5c451878a60b"
}, {
"reference": "urn:uuid:deb2b64d-401f-ab33-4f8e-62eb4c8f93fb"
}, {
"reference": "urn:uuid:87f9599c-2114-b085-c276-bb9206689582"
}, {
"reference": "urn:uuid:dab95344-2278-f6f9-bcb5-f701cdec055f"
}, {
"reference": "urn:uuid:3445ae02-f504-8918-f00d-f02988410b5f"
}, {
"reference": "urn:uuid:9b023c6f-deb4-542b-63d3-b6f80a043db9"
}, {
"reference": "urn:uuid:df9871ec-b18a-87fc-e433-f71f21b7f8e2"
}, {
"reference": "urn:uuid:e2ecd6e7-c7ae-b2dd-c8a2-0dc0ff8c6c44"
}, {
"reference": "urn:uuid:1b03f71a-3947-170d-c2f0-52268f67ec25"
}, {
"reference": "urn:uuid:337040a4-f598-e894-1bcc-2bd538ab9300"
}, {
"reference": "urn:uuid:5bcaa08a-7b27-318f-2043-9e096db0a4ef"
}, {
"reference": "urn:uuid:468e1e02-3ea3-9f37-3d2c-1f4289a8544c"
}, {
"reference": "urn:uuid:3e7452e8-9f7a-dd90-8f43-6525eeef8b2f"
}, {
"reference": "urn:uuid:bb6c1bc0-386a-7441-c4c3-e41e144a11c9"
}, {
"reference": "urn:uuid:4ae7a33d-4176-772f-c518-a0c7a97ca8a6"
}, {
"reference": "urn:uuid:e2c90d27-75ca-5e05-7f64-2b15c8a1884c"
}, {
"reference": "urn:uuid:7c11becc-0db2-bb90-b224-a50185052452"
}, {
"reference": "urn:uuid:f1b34493-59c9-c9b9-771e-d53c2db43cab"
}, {
"reference": "urn:uuid:2568c2e2-dffa-e0ed-7900-4f163c80278c"
}, {
"reference": "urn:uuid:2cc07577-be07-1f67-9d47-479777d02fc8"
}, {
"reference": "urn:uuid:5d2363a1-da4d-4723-93dc-6e4349977fb4"
}, {
"reference": "urn:uuid:84374611-b7be-90f0-0d74-4f1e42725364"
}, {
"reference": "urn:uuid:a1d06ac2-b01f-3b4a-ad9d-cca7e69b900a"
}, {
"reference": "urn:uuid:2856441e-d58c-deaa-0b63-1b402734b390"
}, {
"reference": "urn:uuid:84a38729-6cc9-62c5-c34a-b641c3826d52"
}, {
"reference": "urn:uuid:69bc9db8-afda-a1a0-16ae-6a3f697f7c4b"
}, {
"reference": "urn:uuid:19d4c489-f501-406b-305e-fa524a0d5cf5"
}, {
"reference": "urn:uuid:cbb7ba6e-d6a0-c447-62db-5dc10b24c13b"
}, {
"reference": "urn:uuid:49734b9c-b61d-6637-7efd-aedc9bf4da40"
}, {
"reference": "urn:uuid:b35753cc-8a7c-5fe6-256c-6e49d8da90b4"
}, {
"reference": "urn:uuid:416aa3bb-acc0-3f37-32f0-0f4c559429aa"
}, {
"reference": "urn:uuid:3772ade0-c028-4e25-4c65-9230bdc9d6f4"
}, {
"reference": "urn:uuid:cfcdf8d7-5fac-21fd-1d7c-3b7fc7e2fd82"
}, {
"reference": "urn:uuid:bf6a228f-ea45-982c-c0e7-d2e77a6fa149"
}, {
"reference": "urn:uuid:07c3a5e3-06bb-c5e0-04fb-813eb1577931"
}, {
"reference": "urn:uuid:6d0bcc2a-a946-3c0b-c3c4-d6b7e7ed6b23"
}, {
"reference": "urn:uuid:a38f90bc-bbda-6337-dd08-53f2842ecd2c"
}, {
"reference": "urn:uuid:5960e88d-cbd2-e56d-e7fb-470c54648db3"
}, {
"reference": "urn:uuid:66d0cd91-6cdc-3561-1688-3fc2a3954003"
}, {
"reference": "urn:uuid:819d6f7f-74cf-f5f6-10b1-28c4fe260256"
}, {
"reference": "urn:uuid:9dbab15b-7a41-e722-9b2b-e0db1b1ffe74"
}, {
"reference": "urn:uuid:c0784213-1307-60f7-196a-6a4a1a92828c"
}, {
"reference": "urn:uuid:5e64e932-e20e-8505-bc95-b6a4f7290253"
}, {
"reference": "urn:uuid:e4030e51-91ad-31d8-b7ed-81431718c281"
}, {
"reference": "urn:uuid:efa27ded-d610-3bfe-b8a1-fe8f62cbe038"
}, {
"reference": "urn:uuid:e6679a6b-cce6-1192-0f3e-bbc0043b3049"
}, {
"reference": "urn:uuid:c4be8af1-7a2d-7ca2-60cc-fba57e403277"
}, {
"reference": "urn:uuid:01e7cb29-e006-b9f5-3344-1652329b53d2"
}, {
"reference": "urn:uuid:bd75b9db-921a-997e-64a4-d2324b2526bd"
}, {
"reference": "urn:uuid:85dce35d-5d04-4322-da46-d896d5c778ea"
}, {
"reference": "urn:uuid:3c4614f9-2294-2edb-df0b-67dada65f888"
}, {
"reference": "urn:uuid:5edc60f0-7843-c4f3-0d1f-096001aa1941"
}, {
"reference": "urn:uuid:05eb8859-8bcf-4b5f-813b-eefe3351c6ef"
}, {
"reference": "urn:uuid:216d41d4-ab65-217a-c0c0-d960dec1a6c0"
}, {
"reference": "urn:uuid:70359f02-22e6-3ffd-545f-d3fcbfa2a158"
}, {
"reference": "urn:uuid:67f5a8e9-df6a-eb11-6325-11493e56c590"
}, {
"reference": "urn:uuid:72b45a54-3276-4c66-861f-eafe4e68f4c9"
}, {
"reference": "urn:uuid:7015ad16-1388-572c-2fc9-8fbc5709a5ab"
}, {
"reference": "urn:uuid:36d51e2f-c19f-f34b-d869-79f64ef5079a"
}, {
"reference": "urn:uuid:93fab213-2840-2c21-fdef-eb8beb75f475"
}, {
"reference": "urn:uuid:5b76d227-411e-12ef-09b9-7576eae9d905"
}, {
"reference": "urn:uuid:74e9a9cd-2c5a-bc07-7930-5225b1431c30"
}, {
"reference": "urn:uuid:c8c5ed33-3927-239c-fe8e-424214a54826"
}, {
"reference": "urn:uuid:2aa17fcf-7960-8ccc-6cfc-17426b81e3de"
}, {
"reference": "urn:uuid:e3b26b84-de59-ad6c-7271-9da53b882db2"
}, {
"reference": "urn:uuid:13d593af-5d0e-f97b-df9b-a95d9fb24924"
}, {
"reference": "urn:uuid:ea07350a-79e7-e245-0484-8368aab5545b"
}, {
"reference": "urn:uuid:8671f354-f4ea-cd4f-5ba9-669438157169"
}, {
"reference": "urn:uuid:6de8754a-b750-e18d-1075-e75ffb42556d"
}, {
"reference": "urn:uuid:2c852c44-bec3-73a8-d37a-9e8cb6e86f22"
}, {
"reference": "urn:uuid:b387a419-cb66-c074-4bdb-c7843160fd1f"
}, {
"reference": "urn:uuid:d2eaa292-9e2e-566f-c470-0e23470240e2"
}, {
"reference": "urn:uuid:218a998a-ab7d-9dd8-c0de-3116deda231e"
}, {
"reference": "urn:uuid:22025c4c-d1fa-f7ca-0e34-0f4fd6b371e7"
}, {
"reference": "urn:uuid:5a6ccdc4-3462-e471-ab77-cfd1bd0640f6"
}, {
"reference": "urn:uuid:681af50c-e2c9-dfc0-ab2b-add080085190"
}, {
"reference": "urn:uuid:65a4ac71-5784-54ee-165e-1b0a6d50cd19"
}, {
"reference": "urn:uuid:c58d8307-1078-e8e3-daa8-00556ea9b655"
}, {
"reference": "urn:uuid:31b23ac8-e7f3-1be2-b71d-cb71bbdd8ed3"
}, {
"reference": "urn:uuid:abc8c494-9f36-a076-beca-c850f866ef1a"
}, {
"reference": "urn:uuid:c42597af-f7db-7cad-df09-c23899a0edb2"
}, {
"reference": "urn:uuid:86fa2fa3-eea1-8763-e817-9a5c2c8f47f3"
}, {
"reference": "urn:uuid:ece7b7e8-aa21-4304-a903-cd04b8e4845a"
}, {
"reference": "urn:uuid:9f6b1897-0ea1-56f6-2b9e-751c5540aa8e"
}, {
"reference": "urn:uuid:01708c95-c40d-00cf-fc0d-48f75ef12b03"
}, {
"reference": "urn:uuid:dc5aa22d-bc0e-191f-9cf2-de50ae2bb4fd"
}, {
"reference": "urn:uuid:4c39bf2c-cb6a-233f-d18a-d8d3ee92c69b"
}, {
"reference": "urn:uuid:c850c9cc-0803-9443-df71-b4cf407c6767"
}, {
"reference": "urn:uuid:92ccf087-a00d-4c0a-0535-bdc337d9626c"
}, {
"reference": "urn:uuid:e5fe277b-8cdb-ec4a-733c-ceaaa532a555"
}, {
"reference": "urn:uuid:48bfe588-dead-8b9c-7e88-39f2d3e7045f"
}, {
"reference": "urn:uuid:07864dfb-2619-08ec-86c2-1c08db844698"
}, {
"reference": "urn:uuid:c9738b9e-0ec8-7e7c-ff3b-e0afcd7e2386"
}, {
"reference": "urn:uuid:5734d894-23ae-85f8-675a-c38f785781ac"
}, {
"reference": "urn:uuid:5ffe550d-46f3-0d60-5cdc-ad2d94219517"
}, {
"reference": "urn:uuid:534670bd-76f7-e547-8cbf-33f33f4c4f3c"
}, {
"reference": "urn:uuid:5bd9a627-ad33-7eaa-ff29-4ff373492cec"
}, {
"reference": "urn:uuid:daaf9457-a385-2499-183e-cb3ac2f182b3"
}, {
"reference": "urn:uuid:78c13ead-272d-26bf-02f7-070239b1ea4c"
}, {
"reference": "urn:uuid:cd5e7dfe-93ca-4cfa-8878-dbdc2979d639"
}, {
"reference": "urn:uuid:9a665041-0c35-85e7-8df5-a5b1aac70733"
}, {
"reference": "urn:uuid:c6c0c521-ed43-659b-242b-08c0ac818803"
}, {
"reference": "urn:uuid:a1c950ae-e65d-4f1a-2d37-3f8eda4281a4"
}, {
"reference": "urn:uuid:d1b20e3d-f335-bc66-4519-9c0bd81a60b4"
}, {
"reference": "urn:uuid:5011cd6e-3127-d505-9639-16417d37bfe8"
}, {
"reference": "urn:uuid:7b5d7215-111c-d63c-4035-4b26d9fda165"
}, {
"reference": "urn:uuid:492c3d22-19a6-59ea-2eb8-648e114bfe62"
}, {
"reference": "urn:uuid:8ea5b49b-d263-b757-cf31-ebab8daea9eb"
}, {
"reference": "urn:uuid:a92951aa-6c7d-1104-a563-802a037042f1"
}, {
"reference": "urn:uuid:e31e9e6f-1caf-c399-ed52-9b0a22654d01"
}, {
"reference": "urn:uuid:dfa98345-7da9-d638-9501-4eee10a8e32d"
}, {
"reference": "urn:uuid:96d24315-ae2a-b14f-c483-af9eef04794a"
}, {
"reference": "urn:uuid:9a1596f5-959d-cb65-f018-33060457d9bd"
}, {
"reference": "urn:uuid:6e1ee22a-50dc-f0df-b840-c682d15b3d24"
}, {
"reference": "urn:uuid:998fac68-e421-1844-28b8-c0ce736c99e8"
}, {
"reference": "urn:uuid:3b4b4ec2-50bf-d757-77bf-b381ed57716a"
}, {
"reference": "urn:uuid:cdd60abb-c0a2-9568-dc81-50de92afbc7c"
}, {
"reference": "urn:uuid:206befbe-574e-0ee6-f3ef-69cb768aab13"
}, {
"reference": "urn:uuid:49d632b1-46a5-fe39-dd2f-4819f3d72b3a"
}, {
"reference": "urn:uuid:404bdbe3-5c01-fdce-d10b-e90e33436b48"
}, {
"reference": "urn:uuid:54757257-d501-b4e4-7619-ca009a62f1e9"
}, {
"reference": "urn:uuid:8ad7f5bc-c940-65a4-9ec6-e7dae0a9f7f6"
}, {
"reference": "urn:uuid:e585832a-beea-2e11-9696-dadc662ae008"
}, {
"reference": "urn:uuid:65b3170c-4567-13b2-b73e-cff42f56ccba"
}, {
"reference": "urn:uuid:f67c775a-7c44-4032-4a75-6b8a36ea82bc"
}, {
"reference": "urn:uuid:b2df8759-3995-f194-2c40-43c0ce9e0e61"
}, {
"reference": "urn:uuid:8ebff455-fbcc-289f-85af-93e5be5f7153"
}, {
"reference": "urn:uuid:6d645a32-b154-f7ae-8504-e6dd8b684f01"
}, {
"reference": "urn:uuid:ed5afb32-42a1-b540-4c3e-61b6ca8e34bd"
}, {
"reference": "urn:uuid:d9b34185-cd5f-82f1-25f0-47f60edb7fbc"
}, {
"reference": "urn:uuid:7dde8f84-bacb-5bc4-3030-b07ff09c6a32"
}, {
"reference": "urn:uuid:0a1b1114-7d9f-76f2-7789-4e4abf7c4e6f"
}, {
"reference": "urn:uuid:388c6ce5-9299-2375-8c58-d660eac47816"
}, {
"reference": "urn:uuid:76a7fe9c-3b8e-de08-8730-00e37aeadab7"
}, {
"reference": "urn:uuid:e707baf7-20b4-1655-8c4e-f4ff57960a78"
}, {
"reference": "urn:uuid:1b74301b-d02c-ae92-0628-dfaae85065b4"
}, {
"reference": "urn:uuid:5706cab4-423e-563b-a02e-d55f1250c1f6"
}, {
"reference": "urn:uuid:962d2c80-8e07-f536-4c1b-a129b3760ded"
}, {
"reference": "urn:uuid:117921ea-5341-4356-2bdb-f089cde1ef19"
}, {
"reference": "urn:uuid:df1143b4-7519-a77a-ea42-36b01592a6cb"
}, {
"reference": "urn:uuid:d154287c-ff53-a94d-bf13-cc77760c3e72"
}, {
"reference": "urn:uuid:bd2304d1-1b77-ba70-7e2b-e47011e0106d"
}, {
"reference": "urn:uuid:a4b4160b-9aa8-4f51-13e0-cc0e207ca245"
}, {
"reference": "urn:uuid:27588a92-8a27-39ad-2777-8889e90e27ab"
}, {
"reference": "urn:uuid:23e0fad1-015d-a1b1-e052-c729a147c906"
}, {
"reference": "urn:uuid:2f14ef2e-45e5-f772-fef2-dc20c7bbcb55"
}, {
"reference": "urn:uuid:8e8b07ca-6253-dad3-c1f1-cbdc352caa6b"
}, {
"reference": "urn:uuid:ea516937-2e10-3b82-fde2-9588b5023187"
}, {
"reference": "urn:uuid:08b0c0d8-7b04-f15c-000b-785edb9301a6"
}, {
"reference": "urn:uuid:322e753e-c30d-02a0-a5c5-c8b44b2a215b"
}, {
"reference": "urn:uuid:c5b5e2ab-5473-fe60-38a7-6816e51cd24b"
}, {
"reference": "urn:uuid:7c81dd48-a26b-007c-c321-30e02e9e5d01"
}, {
"reference": "urn:uuid:313cc8cb-b296-1eec-a9ca-ad074e4c1950"
}, {
"reference": "urn:uuid:59257687-71d7-0f9d-9bce-0d7e888b5d4b"
}, {
"reference": "urn:uuid:d9ad4cdb-db53-ba65-f1d2-b62c52f3f72c"
}, {
"reference": "urn:uuid:d405b88a-3622-faf0-baaf-d3ba75f96ad1"
}, {
"reference": "urn:uuid:a16a8862-ab81-78d8-40be-1feededdfe1f"
}, {
"reference": "urn:uuid:aa8f1f02-0d1a-affd-8eb9-53fca9d71158"
}, {
"reference": "urn:uuid:c0c68bb5-be7c-6a18-4f15-3c8a19398472"
}, {
"reference": "urn:uuid:fedc2f26-71fe-57dc-d012-e831146c3a79"
}, {
"reference": "urn:uuid:ff049f5d-1b48-3e40-2eef-ebf38a3a832b"
}, {
"reference": "urn:uuid:48dcbfdb-7db5-34b4-89e3-bb229a8e91e5"
}, {
"reference": "urn:uuid:0466ccb8-02e0-e8b0-1981-4a066111b622"
}, {
"reference": "urn:uuid:72b3d5c0-0040-a375-f81f-6668d42b1666"
}, {
"reference": "urn:uuid:7df58aff-b099-ce96-394f-de6cec37040b"
}, {
"reference": "urn:uuid:e15da1de-d149-9fb2-8b86-54ab525d0b43"
}, {
"reference": "urn:uuid:b2b46933-cdf5-b71d-d01d-2398be4d39ef"
}, {
"reference": "urn:uuid:e1254f76-4354-e73b-8fe9-97417c1f3133"
}, {
"reference": "urn:uuid:a6dc441c-fa40-3ab5-bf32-fd27877ee1e4"
}, {
"reference": "urn:uuid:ef475c6c-4762-6bdf-e480-d52f7d2ac049"
}, {
"reference": "urn:uuid:6ffebfbd-d7f0-c1d7-abe5-e331ce7799bc"
}, {
"reference": "urn:uuid:ee7a54ea-c55c-c9f2-29f3-fd8e21e21b47"
}, {
"reference": "urn:uuid:834321df-c050-2e9e-b058-5412c10714e2"
}, {
"reference": "urn:uuid:050f9895-f222-60bb-7919-d29b49c10758"
}, {
"reference": "urn:uuid:60d121b0-4870-c8ef-0f13-c4fff23c8f05"
}, {
"reference": "urn:uuid:f214c916-14c2-fd9f-5045-968829dd7aee"
}, {
"reference": "urn:uuid:7c16adf9-a8b3-989d-7b9d-f45b864da168"
}, {
"reference": "urn:uuid:09fa0a1e-53b4-3819-bb6a-51c2a1627ac1"
}, {
"reference": "urn:uuid:e539edc5-efb0-89f1-344e-b3cc11aa09ba"
}, {
"reference": "urn:uuid:686b0a6e-5472-eb6c-f5f0-00c6c215b0bf"
}, {
"reference": "urn:uuid:3b2390bc-c5f7-2f31-749c-53f28e4b9926"
}, {
"reference": "urn:uuid:2c40f566-9633-7562-cf90-9f325c4923a4"
}, {
"reference": "urn:uuid:8f587f15-0b3a-c192-08dc-ce403954efa0"
}, {
"reference": "urn:uuid:c0532460-e1ef-41ea-1cd8-75d267942a8e"
}, {
"reference": "urn:uuid:adebe898-cb4a-3c89-103f-14f7e69a63ab"
}, {
"reference": "urn:uuid:219a7b20-257b-5fcf-722f-5e408187d8a5"
}, {
"reference": "urn:uuid:e89b9006-f8f6-860b-1980-085c8b959a13"
}, {
"reference": "urn:uuid:bf0d9a8f-c03c-db57-6d4c-516f6f99f9ce"
}, {
"reference": "urn:uuid:3ec20e26-cd07-627d-5d75-4760c28ac2b7"
}, {
"reference": "urn:uuid:e5a733e9-59a1-33f4-dc46-88eacbea420b"
}, {
"reference": "urn:uuid:8a759397-c6af-1c7b-43d3-9011208f2420"
}, {
"reference": "urn:uuid:abaf5a02-a9e4-f55d-9060-2f2213d6d6a4"
}, {
"reference": "urn:uuid:7ea32815-4573-2e58-ad37-37cd9fba266e"
}, {
"reference": "urn:uuid:f27f4638-edff-949f-44e7-b91179c5b134"
}, {
"reference": "urn:uuid:635acba2-513b-ce64-b4a2-7b33d6d9c0b3"
}, {
"reference": "urn:uuid:b47aae3c-fd6d-4b30-ee17-285a5b71ecf9"
}, {
"reference": "urn:uuid:72088064-4317-6fb6-280d-c32067df02e7"
}, {
"reference": "urn:uuid:b297044e-ddd8-9638-6709-a93572701538"
}, {
"reference": "urn:uuid:879802c9-bb6c-3129-4b81-ab2f0a2d19c1"
}, {
"reference": "urn:uuid:c2cc5928-2dd9-f413-38e1-4d9ce94796fa"
}, {
"reference": "urn:uuid:79d27276-c3f4-26ba-df34-87582daa25bc"
}, {
"reference": "urn:uuid:a2869ff3-90c5-8682-dda0-911dc557cb4c"
}, {
"reference": "urn:uuid:a58c08d4-8a0e-9b28-6c2e-7759f5fff3bf"
}, {
"reference": "urn:uuid:9998dd61-fc0b-6fcc-74dc-8885916cecdc"
}, {
"reference": "urn:uuid:c9208a04-fa2a-68cd-b7b1-7a3eb6c36b44"
}, {
"reference": "urn:uuid:109df281-93bf-901e-c95e-771f0989b54a"
}, {
"reference": "urn:uuid:edca1344-df2e-ca46-a642-545d1d40bd90"
}, {
"reference": "urn:uuid:8b5733aa-582a-856a-56fb-84611396b3f6"
}, {
"reference": "urn:uuid:88a58732-b431-5ae7-1f60-9c63e231acd6"
}, {
"reference": "urn:uuid:20243a05-588d-24a8-4e13-a2d5f64bc48a"
}, {
"reference": "urn:uuid:a2b7f759-2de9-004a-dd61-fc68c2534b63"
}, {
"reference": "urn:uuid:ca7ccf2e-255f-0452-8695-20ea2906ca76"
}, {
"reference": "urn:uuid:98e3352c-60db-7b5f-bfb2-313fbabc4bb2"
}, {
"reference": "urn:uuid:cca102f9-2698-2d80-565f-eb4a4bcdfa85"
}, {
"reference": "urn:uuid:86d9d715-f5c7-1894-04f8-47275146490e"
}, {
"reference": "urn:uuid:48d32b3f-7b7d-ce80-3b50-04977671d16d"
}, {
"reference": "urn:uuid:41228a53-9830-50ec-db59-0b2c6429ecc9"
}, {
"reference": "urn:uuid:562c04c0-e9b1-5a0d-dae1-9a6057d86f97"
}, {
"reference": "urn:uuid:791044ca-a0c0-24e0-ef9b-dfcb409c0386"
}, {
"reference": "urn:uuid:76d4cc07-5a95-c7f3-8045-92614b217e56"
}, {
"reference": "urn:uuid:84d04c37-31a3-b418-7e3c-7f05c29cf441"
}, {
"reference": "urn:uuid:a7a484e5-1e50-6c5d-b231-c38c4d68c316"
}, {
"reference": "urn:uuid:b8c1cdb6-7a14-9aa1-7bf7-960ae409d41a"
}, {
"reference": "urn:uuid:8542a651-6cae-867f-5487-da9972ee1d67"
}, {
"reference": "urn:uuid:a613ab6f-6aad-1bd6-7aa8-afbd18efc494"
}, {
"reference": "urn:uuid:09b04520-f90c-6e31-37d5-e85ed6b4e3fb"
}, {
"reference": "urn:uuid:264a3ae5-3c05-1c9a-be15-311c192cd57e"
}, {
"reference": "urn:uuid:1a657b6b-343f-2fb8-296c-2dc1c0e71193"
}, {
"reference": "urn:uuid:95e81c04-9c08-6803-c6b5-8e19b685b661"
}, {
"reference": "urn:uuid:1e237b1a-99a5-c03c-0896-6ca005366910"
}, {
"reference": "urn:uuid:2bdc2f21-fb44-46dc-3813-8090e79b8ce7"
}, {
"reference": "urn:uuid:ba81cc93-b86a-ec2f-0bfe-9621e10e48b5"
}, {
"reference": "urn:uuid:f99f6b1d-ee6d-d401-f290-a9c242b525d9"
}, {
"reference": "urn:uuid:31c86df1-32fd-3afc-1164-aec2417af3f9"
}, {
"reference": "urn:uuid:12345484-22ba-2b3c-977a-f3d7ba465e98"
}, {
"reference": "urn:uuid:6c00552c-b59a-d9ed-cd9b-3956ea9576a9"
}, {
"reference": "urn:uuid:5f332a1b-8883-d1e4-9b1a-6027225a270d"
}, {
"reference": "urn:uuid:9ff8b814-642b-844e-c14d-181f12cdad25"
}, {
"reference": "urn:uuid:d31198f1-5e23-f2ec-6b07-82abc29d858c"
}, {
"reference": "urn:uuid:c71a4134-0207-fc6c-256b-7089f6bda3f3"
}, {
"reference": "urn:uuid:73f84075-11ad-d624-47e2-b366971966cd"
}, {
"reference": "urn:uuid:a896074e-991e-9be2-051b-4dedecb62816"
}, {
"reference": "urn:uuid:3951eb8e-a50c-1eef-d6a9-0acc4ada4aa5"
}, {
"reference": "urn:uuid:72b3b681-a433-e1f1-861f-472bd60ddbf6"
}, {
"reference": "urn:uuid:ce828f10-ce3e-4f78-325c-da53b9c95806"
}, {
"reference": "urn:uuid:ac118d95-2fbf-d748-101b-9e3513248659"
}, {
"reference": "urn:uuid:0d72e1aa-9559-07f1-8064-67162601dbdb"
}, {
"reference": "urn:uuid:ecce5f86-8a62-fd98-336d-b31e16965a1e"
}, {
"reference": "urn:uuid:a8e4bf4b-3217-83a8-c64a-e5b4ad5dd9c4"
}, {
"reference": "urn:uuid:0a532362-5c01-9fb1-f01b-c6bee1533d25"
}, {
"reference": "urn:uuid:e9ce9cd8-392c-dd73-30af-d44b236264eb"
}, {
"reference": "urn:uuid:39ea5fb2-1f0e-dce1-259e-bc1db0049d41"
}, {
"reference": "urn:uuid:1efa9d97-9751-50f3-2ef3-86f326e4d293"
}, {
"reference": "urn:uuid:593883f7-aff7-a959-ffab-3ee151c0b481"
}, {
"reference": "urn:uuid:e169e0b0-b727-1bd4-0520-2176c42b076a"
}, {
"reference": "urn:uuid:fd4d1bb7-0201-5503-cd38-efbd7515dfe2"
}, {
"reference": "urn:uuid:f946c60b-0857-64b9-7253-80fd5ff14f91"
}, {
"reference": "urn:uuid:d92e9f83-d850-0661-3e0f-6525e1f03fb2"
}, {
"reference": "urn:uuid:5026fb43-2ff5-9dca-8a4b-b5e9bcb55eba"
}, {
"reference": "urn:uuid:15f0009e-d78d-d186-6034-6d1fce0dd037"
}, {
"reference": "urn:uuid:880568d1-2bb6-19e1-8c15-fcd2be1afdb5"
}, {
"reference": "urn:uuid:77a1b0e2-dca0-91c4-c5bc-44157727818a"
}, {
"reference": "urn:uuid:bfddec70-5d85-688b-f38c-ed74175436ab"
}, {
"reference": "urn:uuid:acb90aff-3969-904a-3f86-fa3a376aa126"
}, {
"reference": "urn:uuid:e9d6e14d-52e6-3718-4cf7-97d70db12219"
}, {
"reference": "urn:uuid:821cfd84-5885-d93a-5397-3138e84cd075"
}, {
"reference": "urn:uuid:b0cc0aab-e2dd-d180-bc55-c15ffae19a05"
}, {
"reference": "urn:uuid:34077760-3e06-0bef-5b01-3b30fb24f0ae"
}, {
"reference": "urn:uuid:71a453c5-2606-be9f-674a-1a89589787f8"
}, {
"reference": "urn:uuid:3f339ab7-c4ee-4ce6-f357-7293cbdee6cc"
}, {
"reference": "urn:uuid:62556f60-578c-4643-35bb-70abc846d00f"
}, {
"reference": "urn:uuid:6c350403-525a-0cd5-6218-aaeac113bf6f"
}, {
"reference": "urn:uuid:3ffe8d56-342f-d04d-3794-384e6967bcfb"
}, {
"reference": "urn:uuid:0861c8cf-3411-35e8-eb5a-dc0580bc54ab"
}, {
"reference": "urn:uuid:83a38729-523d-898a-d4a6-9a38602aa5b5"
}, {
"reference": "urn:uuid:0e587b08-4c03-b0c3-4b3e-5406215db6be"
}, {
"reference": "urn:uuid:8ce7b2d7-d825-9aaf-9bb1-df8dde2215cc"
}, {
"reference": "urn:uuid:b11d9a38-90df-5f77-805e-3577672f4fb4"
}, {
"reference": "urn:uuid:c375c5d9-54c5-4fd6-92d6-80178668fa93"
}, {
"reference": "urn:uuid:bccb5a46-77bf-b8b6-3f5d-0d60427fd17f"
}, {
"reference": "urn:uuid:9dd94fec-a069-3949-5450-b900a2814f68"
}, {
"reference": "urn:uuid:e859885e-7060-064b-09ab-303356431323"
}, {
"reference": "urn:uuid:e6dc46dc-85c0-a1b8-ff32-ffe712ff48e7"
}, {
"reference": "urn:uuid:cb5bc246-a079-6f27-159c-550b0097000b"
}, {
"reference": "urn:uuid:2d826e10-a311-3176-04a3-c279b0e0d39f"
}, {
"reference": "urn:uuid:4808275d-e7d2-a983-aa24-9c4fe367229d"
}, {
"reference": "urn:uuid:0b90a9b2-3c07-493c-83d4-d1f2027f2704"
}, {
"reference": "urn:uuid:bcc2bc9f-dc6d-19e2-1948-033f3004a616"
}, {
"reference": "urn:uuid:4069c24f-c78b-f59c-fccb-5d33f1c0f038"
}, {
"reference": "urn:uuid:2c06f9d1-88c2-028e-857f-d4f249af105c"
}, {
"reference": "urn:uuid:22b64fef-dea4-0f97-655f-25fcdc585d45"
}, {
"reference": "urn:uuid:2910de8e-3135-619d-d6bf-952b03b2216b"
}, {
"reference": "urn:uuid:700c359a-1c04-4776-12dc-3664975ba4d0"
}, {
"reference": "urn:uuid:7f3b8fa9-ca82-a750-4b01-a5580d25f6fa"
}, {
"reference": "urn:uuid:b8b5e065-a9c7-fcf8-d333-2ec3da956f0d"
}, {
"reference": "urn:uuid:cca1c795-4920-6eda-eb58-92f5b3293442"
}, {
"reference": "urn:uuid:32ec1998-2b84-7616-4422-d2a2cef9f438"
}, {
"reference": "urn:uuid:74519b9e-b5a4-704e-8d13-758d7b3a2b92"
}, {
"reference": "urn:uuid:3b2bfa4d-3d6a-79be-7192-f21afcba6074"
}, {
"reference": "urn:uuid:6bc5c0a3-3fa8-5c4a-7652-ff4a6ec0b303"
}, {
"reference": "urn:uuid:784160d4-8ff2-8bac-3b77-2928f9e7c525"
}, {
"reference": "urn:uuid:062b9cf7-d6e8-3d0c-8212-a08d1d1163a7"
}, {
"reference": "urn:uuid:90a5956f-6f66-427f-42b8-e9bd1da8eb64"
}, {
"reference": "urn:uuid:c9fe3182-3c32-759f-8d9c-cca569a09b4c"
}, {
"reference": "urn:uuid:b609c2e6-70aa-d8f9-fdc4-0d8bccb6515e"
}, {
"reference": "urn:uuid:a2d58291-5790-c89c-b7ef-ffdfb5c1960e"
}, {
"reference": "urn:uuid:f1b29fde-c7ef-6e1a-771e-30879bd9e10c"
}, {
"reference": "urn:uuid:5e01ce02-da4e-ed1e-512c-1732664a515c"
}, {
"reference": "urn:uuid:75cad644-d1e7-90ff-bd2a-fb35f4750314"
}, {
"reference": "urn:uuid:2b18aacb-f656-601f-5090-8348a0d78ae1"
}, {
"reference": "urn:uuid:5c5ac2da-85bc-4342-8d5c-f5e99890ea00"
}, {
"reference": "urn:uuid:aa044568-3ceb-f1de-3742-ec975542aae9"
}, {
"reference": "urn:uuid:c91d465e-0f9c-f11c-fee5-9ac804d669df"
}, {
"reference": "urn:uuid:0b4f8a6a-d9c0-5ff7-8589-223ef61315ee"
}, {
"reference": "urn:uuid:a22aa506-7892-020e-ccb9-da7907d71cf2"
}, {
"reference": "urn:uuid:1e8f082a-5d15-3e76-902d-d1eadb5e183c"
}, {
"reference": "urn:uuid:4ea5d8e5-6377-5f9e-1837-c34b42c13fb2"
}, {
"reference": "urn:uuid:b2b128e7-1e65-7eab-381c-b98ff24ff19d"
}, {
"reference": "urn:uuid:031050ea-d274-1402-56a7-dd1e2ef95aa1"
}, {
"reference": "urn:uuid:fd334c8b-cf4f-b3bc-0b49-b623a87d25ab"
}, {
"reference": "urn:uuid:d71c37fe-ad92-b56a-7258-7cd991bd4515"
}, {
"reference": "urn:uuid:fcaa028f-ed99-faf7-d6a2-4da41c3a72d5"
}, {
"reference": "urn:uuid:b74c770d-24b9-8de5-797c-685f268cc6ae"
}, {
"reference": "urn:uuid:82c04973-70c0-6ff0-2c8c-0f891f031340"
}, {
"reference": "urn:uuid:b6f27f72-6e18-c8d6-cc0c-fcc0cc499648"
}, {
"reference": "urn:uuid:20db7d00-adae-acc2-9956-a2d824f42648"
}, {
"reference": "urn:uuid:ce571cca-a37e-060e-d24f-99f346da8b60"
}, {
"reference": "urn:uuid:64f6afb3-39ff-3390-a849-c570bfb567cb"
}, {
"reference": "urn:uuid:85f6e76a-43f6-9806-1186-e68542c97279"
}, {
"reference": "urn:uuid:f8418a5a-7201-a3d9-bb77-52aedbf6dd52"
}, {
"reference": "urn:uuid:78ac496f-70bf-40ff-2278-0f851f01e44f"
}, {
"reference": "urn:uuid:a97b8b60-f485-1087-15dc-627860e31a8d"
}, {
"reference": "urn:uuid:535fea9d-4727-17db-0c6a-8ec2824ca912"
}, {
"reference": "urn:uuid:cc358caa-553c-33e1-4106-e3983c66d8a9"
}, {
"reference": "urn:uuid:b1de685a-5b66-ceb1-d03b-63ccff424b73"
}, {
"reference": "urn:uuid:b2c1f1ad-bc9b-ece5-65ac-07c40150800d"
}, {
"reference": "urn:uuid:09e41a53-046d-5b7c-5728-1dda6ddc5248"
}, {
"reference": "urn:uuid:5b332417-0c51-e7ec-301a-ff0748327ec8"
}, {
"reference": "urn:uuid:fc06c801-5593-9bdb-4c4d-2edaf70ad31a"
}, {
"reference": "urn:uuid:3a5b974a-d1bf-8280-71b7-861b9aeccc44"
}, {
"reference": "urn:uuid:3a50b8d9-8e89-5d4f-2537-a7f60296ac1f"
}, {
"reference": "urn:uuid:cf07d47b-2782-8c20-0574-ede0867fdefd"
}, {
"reference": "urn:uuid:ede17fe1-8b87-5c15-e943-c42183a67417"
}, {
"reference": "urn:uuid:6363bb39-6022-72cf-4543-0a96d0a3fac7"
}, {
"reference": "urn:uuid:323de323-648d-6dc3-7ec7-b5b1980c23f5"
}, {
"reference": "urn:uuid:c67a22d5-8dbc-7754-a08f-158d98af9d88"
}, {
"reference": "urn:uuid:8c5ce4da-ef81-6242-104b-be52ff94dcf8"
}, {
"reference": "urn:uuid:5dc40c15-e300-8860-546e-12ded21a7f20"
}, {
"reference": "urn:uuid:c4523903-e608-6089-b218-55a1c03f5158"
}, {
"reference": "urn:uuid:f0b29f44-2277-ffd4-1fc8-63c8b23957c3"
}, {
"reference": "urn:uuid:61062f57-d6ef-fa06-453f-7e9e5d4664e5"
}, {
"reference": "urn:uuid:cedbe7d6-541d-8519-7fd5-502af7d64b7e"
}, {
"reference": "urn:uuid:2dd3c51e-3341-a085-9f76-ea1438686799"
}, {
"reference": "urn:uuid:ac399741-1c1e-4797-5381-0d91ecd6f79b"
}, {
"reference": "urn:uuid:e2fc0e72-3e0e-ec0b-cf0d-88249dc88b59"
}, {
"reference": "urn:uuid:efe997fe-197e-578c-4c0c-1c2f19767c39"
}, {
"reference": "urn:uuid:76fcba5b-6c8f-f1b5-d75a-aea857963c6f"
}, {
"reference": "urn:uuid:da724fab-16d1-31eb-42aa-10f2e24ed189"
}, {
"reference": "urn:uuid:12b6e12b-a496-d390-bf87-aeca0dd0f8fc"
}, {
"reference": "urn:uuid:ee8866a8-d431-a8ff-0bbf-b6d8544887dd"
}, {
"reference": "urn:uuid:336520c0-0a6c-e668-e4b9-ba01eed8ea17"
}, {
"reference": "urn:uuid:274f83e6-b62e-9a2a-7a63-223664d0b5e1"
}, {
"reference": "urn:uuid:92c5208e-62e3-43cf-178a-5dac40034a51"
}, {
"reference": "urn:uuid:2956955f-6944-076b-3481-31c5771bc33e"
}, {
"reference": "urn:uuid:2cd7bc6d-bb19-6916-1f5b-0b754b321178"
}, {
"reference": "urn:uuid:5d3a1bee-bf7e-3406-d42b-d907ed89a5a8"
}, {
"reference": "urn:uuid:6e2fac1d-bc89-6498-a24e-475729f7c52c"
}, {
"reference": "urn:uuid:ef862565-2f5b-495f-7edc-09f970d83d10"
}, {
"reference": "urn:uuid:ba5318ac-6dcc-5548-96d2-c72e67361677"
}, {
"reference": "urn:uuid:b024dba0-a4a2-7147-4ee8-ceff5f25d8c4"
}, {
"reference": "urn:uuid:b7cc44d9-3cdd-6f64-db7c-f50f1a302915"
}, {
"reference": "urn:uuid:75193486-761b-3363-180c-005add5b2728"
}, {
"reference": "urn:uuid:99961a16-b9f6-f23a-afe5-ffb367a68be8"
}, {
"reference": "urn:uuid:139d4e9e-2ed4-2325-98e3-edf1c6605681"
}, {
"reference": "urn:uuid:3bc0b0e3-f16b-aa4e-9d5b-950e2666470a"
}, {
"reference": "urn:uuid:0b9d36b7-de94-3bec-a3be-2093ea3b246e"
}, {
"reference": "urn:uuid:6735178f-3896-4041-bbba-4f25fabf1762"
}, {
"reference": "urn:uuid:ec2bf21e-2ee7-8cd4-d167-57a668b895cf"
}, {
"reference": "urn:uuid:05f5781b-882d-0e66-c0b7-5fa6ed4a949c"
}, {
"reference": "urn:uuid:e9d1de59-9c62-7957-d444-cfdf07f3222b"
}, {
"reference": "urn:uuid:1b610e25-a9e6-2337-a0a7-ad7941725693"
}, {
"reference": "urn:uuid:cbba6dea-5f8f-c90c-f0b8-61f8c1177898"
}, {
"reference": "urn:uuid:ce39a44c-4665-df46-2e25-96d67c2e3468"
}, {
"reference": "urn:uuid:7b2d1dc1-636c-1961-a2da-ef245906922d"
}, {
"reference": "urn:uuid:1fea56de-2eef-fccb-4fa7-d27e092dd666"
}, {
"reference": "urn:uuid:6bc14475-a0d0-be8e-e7ab-79952117da82"
}, {
"reference": "urn:uuid:a376c260-4469-7be6-1dfd-31562600735b"
}, {
"reference": "urn:uuid:dfa09cbf-73b2-e231-2540-b0b705f8e9ad"
}, {
"reference": "urn:uuid:550004c3-339c-790c-26f2-c5179721411b"
}, {
"reference": "urn:uuid:1e000f0b-ab66-f74e-4e30-b0a5fe4d3c80"
}, {
"reference": "urn:uuid:aebdff2a-1371-e75b-5208-733fe0b44e08"
}, {
"reference": "urn:uuid:f3ff8cba-7712-fb71-a505-ada6d2d59e32"
}, {
"reference": "urn:uuid:4c5a121c-fb2c-7e7a-5495-2d9714c8c231"
}, {
"reference": "urn:uuid:438b2c92-57f3-1fb0-167f-3a6e06305978"
}, {
"reference": "urn:uuid:61cdca27-e4ec-77f3-0787-67baaab5bf36"
}, {
"reference": "urn:uuid:17fa2aee-75b1-1b48-d8ca-1ed13f215afa"
}, {
"reference": "urn:uuid:229a4935-7096-a48f-3da7-afe04d3ff4c3"
}, {
"reference": "urn:uuid:d9ee5551-f87a-7ff8-23f0-bd523778468f"
}, {
"reference": "urn:uuid:8dd6a9a0-ac4a-68b5-dbe3-7977d02f9331"
}, {
"reference": "urn:uuid:3e9a7acb-4caa-8df1-8e0c-9a6533e05667"
}, {
"reference": "urn:uuid:8532c84c-29a4-9300-70e9-281a3f63622b"
}, {
"reference": "urn:uuid:19f3911b-f7e6-eebd-53a0-6ffef4c4d731"
}, {
"reference": "urn:uuid:679c9754-6741-cf37-fdaa-c37f4ff5148e"
}, {
"reference": "urn:uuid:f452d00f-a1fe-30a1-c30f-4ae74ff67c7a"
}, {
"reference": "urn:uuid:00bbdf5d-2bf2-e2b0-33fa-6e2f887301eb"
}, {
"reference": "urn:uuid:1ad1d967-23ec-2f01-4a28-733732204fc6"
}, {
"reference": "urn:uuid:cb1e0993-920c-a042-44ea-92858598e50e"
}, {
"reference": "urn:uuid:e036a0df-1ad3-3e61-26ae-d4e266760587"
}, {
"reference": "urn:uuid:367c5147-7898-c86e-d02f-12d80e13beee"
}, {
"reference": "urn:uuid:515220bd-6276-7af3-0eee-7f6858fd20b1"
}, {
"reference": "urn:uuid:deca7f79-0b07-557a-04be-d874f8bd414e"
}, {
"reference": "urn:uuid:44dd2e02-ea4b-c37a-278c-68af797ecdfd"
}, {
"reference": "urn:uuid:d2e96750-4e73-6067-6850-a158c004b464"
}, {
"reference": "urn:uuid:8235512e-9149-ded7-8e54-88e2a31cfd49"
}, {
"reference": "urn:uuid:493533a1-cc87-3363-93da-885dc08b5891"
}, {
"reference": "urn:uuid:b4c8f564-b740-48f7-e9c2-c16df0337f3a"
}, {
"reference": "urn:uuid:ea78da2a-cd3d-7f2e-b7ea-ef454a8bdd5f"
}, {
"reference": "urn:uuid:cf57e2ab-019a-2044-4249-68169242f42f"
}, {
"reference": "urn:uuid:61279836-22d7-3c0a-8874-15a14d325691"
}, {
"reference": "urn:uuid:8dc5913c-a368-3fdf-a605-18a546c4c531"
}, {
"reference": "urn:uuid:3a4e706f-df66-3d24-65f7-56d2eb8a764f"
}, {
"reference": "urn:uuid:392fd281-ed04-8f1c-71e1-7cef503fe3ce"
}, {
"reference": "urn:uuid:188c5154-974d-b138-36b4-e32407eb4184"
}, {
"reference": "urn:uuid:aa828a26-304a-7b28-d868-b639b7cc239d"
}, {
"reference": "urn:uuid:34a4d1d9-e75e-fd9b-25e1-046a311931a7"
}, {
"reference": "urn:uuid:e86f235b-7a68-4e89-7ffb-56b7ffaeeddd"
}, {
"reference": "urn:uuid:256b081b-13c0-0a88-5a65-a4d7755aeeb2"
}, {
"reference": "urn:uuid:61f662b1-b7c4-a583-a8d0-380fb5301dd1"
}, {
"reference": "urn:uuid:096b0dd7-6702-19b7-920e-6a5cb91b79a2"
}, {
"reference": "urn:uuid:c34b60ae-8431-6999-37b7-cd487adbd0ae"
}, {
"reference": "urn:uuid:a8235e51-4f0d-fe7b-8213-f39427809112"
}, {
"reference": "urn:uuid:d8df1ab2-cec1-0d81-5cb6-363cd010bf50"
}, {
"reference": "urn:uuid:36c2050f-7618-cf50-1335-497b7637c322"
}, {
"reference": "urn:uuid:32a913b3-eb53-7103-ebfd-9cedd23e1c4e"
}, {
"reference": "urn:uuid:c5e6a373-8dba-844f-e73b-2a13cc100d26"
}, {
"reference": "urn:uuid:d3cefda9-7989-5465-e17d-405286c9d110"
}, {
"reference": "urn:uuid:8da23adc-68b8-b87e-e0ef-ef933f63307b"
}, {
"reference": "urn:uuid:2655c3c7-4d1f-9dfb-74b3-f494bf34b878"
}, {
"reference": "urn:uuid:68a5b416-0c89-9cee-1179-9e88fe0f087f"
}, {
"reference": "urn:uuid:2e5ad192-3ef3-1390-7c7f-98f838edcc0a"
}, {
"reference": "urn:uuid:f40eb072-d43f-eb20-84e2-b2f0191acf4b"
}, {
"reference": "urn:uuid:c2038d21-8f7f-ad62-54a1-5804e23e2003"
}, {
"reference": "urn:uuid:67d5a1c9-9fc7-b1a0-a88b-c2076c7b6b30"
}, {
"reference": "urn:uuid:8563058d-1120-26fa-1196-621257bf7a92"
}, {
"reference": "urn:uuid:f7f0abc5-c35d-40df-f28d-68275e416b14"
}, {
"reference": "urn:uuid:45a4f3c1-abd8-9721-085d-36d61ea90033"
}, {
"reference": "urn:uuid:8bf8fdd3-b6f8-c8e0-a141-82de589b5652"
}, {
"reference": "urn:uuid:918b7f0c-1a75-f3fc-4bfb-5f08ce51f173"
}, {
"reference": "urn:uuid:0c6d7863-6bb3-b7ec-113b-cc34c66dfb92"
}, {
"reference": "urn:uuid:38b84891-43f0-7c1e-a0f0-02c8cf11f90a"
}, {
"reference": "urn:uuid:e1c66ede-3f4a-9f7b-8a9a-595130d00b0c"
}, {
"reference": "urn:uuid:ab8b041a-c24e-0ced-dee7-896161a1a479"
}, {
"reference": "urn:uuid:c896a0a4-24bb-b2a0-c4dd-b9902ff721f5"
}, {
"reference": "urn:uuid:81a309a7-49a0-e8bd-96eb-c94641c3762f"
}, {
"reference": "urn:uuid:66e5d7d9-2eaf-0307-1dc8-fcaf60f57672"
}, {
"reference": "urn:uuid:56a8b1b7-b582-a1d7-28f8-7948aeef12f9"
}, {
"reference": "urn:uuid:49fe7783-129f-17b7-c0ea-bc6167ecad2b"
}, {
"reference": "urn:uuid:5f76eb19-c3a1-02a6-33d0-19d2a8e2664d"
}, {
"reference": "urn:uuid:96dd3035-855d-ab7d-7f45-5e0e82b7bfa3"
}, {
"reference": "urn:uuid:0197c8da-6cf6-f6f1-fcbf-c4057dd25dfd"
}, {
"reference": "urn:uuid:351e976d-18be-aa73-bacb-0d2211dfb145"
}, {
"reference": "urn:uuid:a956ac99-b2ff-2d7b-51d1-f1da42fa7331"
}, {
"reference": "urn:uuid:0d44cf67-9246-8ea1-a6a3-02d50f3fdb0a"
}, {
"reference": "urn:uuid:af316b93-a2f0-1bd0-a19d-7005cebd7669"
}, {
"reference": "urn:uuid:14c669aa-0949-0f18-790c-de0bc9ea56e3"
}, {
"reference": "urn:uuid:0c5f2459-c625-3ee4-dbf9-204c4576390f"
}, {
"reference": "urn:uuid:42be55c2-4102-e961-889d-ab93b4cdacbc"
}, {
"reference": "urn:uuid:0ad3637c-2b9b-70ef-9491-24bc65ba98b6"
}, {
"reference": "urn:uuid:182baa86-b4cf-c46e-6861-6ba10bc2e791"
}, {
"reference": "urn:uuid:c5110a3d-a3f2-5fed-ed8d-c074fc92fae2"
}, {
"reference": "urn:uuid:ebf1e46d-c289-5f46-193a-17b13fb75e78"
}, {
"reference": "urn:uuid:1cd39c5f-b510-5c5b-2778-126561ae9314"
}, {
"reference": "urn:uuid:a697e074-0c0f-7b92-2c44-5e37c69e172c"
}, {
"reference": "urn:uuid:a0cc22aa-2d1f-5429-4282-4615bdc99b8a"
}, {
"reference": "urn:uuid:da4039b3-b38e-ddb2-ae00-bdcb3a1838c5"
}, {
"reference": "urn:uuid:b2d9952d-a347-2fe2-0f5e-dbccf6debc16"
}, {
"reference": "urn:uuid:111a0307-1532-a3d3-cd7b-9deb3f679e6f"
}, {
"reference": "urn:uuid:d7526906-747f-96e1-b449-116ce169bbe5"
}, {
"reference": "urn:uuid:f8c1b350-7c24-8ffe-82f7-7ba59fd4b745"
}, {
"reference": "urn:uuid:61fab5b9-e8a3-a7a4-4e52-4a653cd1595e"
}, {
"reference": "urn:uuid:7a7f860a-42ca-e303-fcb9-6a9843b693cb"
}, {
"reference": "urn:uuid:ab12da86-4c44-4260-ff7c-cfbfc5077828"
}, {
"reference": "urn:uuid:d3ca1a76-2a3f-bfdb-e978-5d1979e98ba1"
}, {
"reference": "urn:uuid:8022235f-bbb9-50eb-37b2-ebea56f412e7"
}, {
"reference": "urn:uuid:045ab631-0bc3-bb6e-1f3e-e0c3002a58b3"
}, {
"reference": "urn:uuid:0242a675-2504-4067-7f0c-372c0f20a7b8"
}, {
"reference": "urn:uuid:9231e05f-bca9-3729-687e-fe7b88f97ea9"
}, {
"reference": "urn:uuid:70c98937-f358-7063-fa67-cb7bb2a0e85b"
}, {
"reference": "urn:uuid:fda0ae6a-91ac-a9db-d18b-215c17183a84"
}, {
"reference": "urn:uuid:ae63bc93-dc8e-47ea-0ae9-03333025d41e"
}, {
"reference": "urn:uuid:dd330f03-99d6-3973-2697-b498ed92e7d9"
}, {
"reference": "urn:uuid:813528ea-cec7-8421-fb85-618e2b4cd665"
}, {
"reference": "urn:uuid:3750ec72-d5e3-2fd1-e9f5-291ccfa705b2"
}, {
"reference": "urn:uuid:15e1b358-94e3-fd7a-6d77-1c791fd590ed"
}, {
"reference": "urn:uuid:9fd5c524-4fb7-2dfc-ef7f-90ea6565709f"
}, {
"reference": "urn:uuid:a127513a-0a94-efc6-133c-6bb758f32094"
}, {
"reference": "urn:uuid:3601019c-68e0-40af-257f-30a87d4cdc69"
}, {
"reference": "urn:uuid:3854445a-fd44-e829-ccde-7a235269bb47"
}, {
"reference": "urn:uuid:c3c72647-0027-8d7d-4f04-1c5163effbcb"
}, {
"reference": "urn:uuid:d90ba52a-4dc6-a66f-ac9e-5639f1992cce"
}, {
"reference": "urn:uuid:4ee3f291-b296-a41a-0930-dd810e39912f"
}, {
"reference": "urn:uuid:f294fa55-4e73-d8f2-447f-edda4380eb06"
}, {
"reference": "urn:uuid:7d6b5fc7-6229-3a23-5845-bd3e83635580"
}, {
"reference": "urn:uuid:a69579ed-bb87-6e99-8af3-6f22690a23ce"
}, {
"reference": "urn:uuid:ab89ef60-b06b-64c1-a8d0-296ef72ee17d"
}, {
"reference": "urn:uuid:0f5c59ba-0567-d102-6fe0-ab197f13afc3"
}, {
"reference": "urn:uuid:e3667cff-58ee-06cf-ac81-14b48f5ff015"
}, {
"reference": "urn:uuid:7e412771-703c-1230-3d37-067392fe06e6"
}, {
"reference": "urn:uuid:14ce6f44-23de-bc1c-d175-90a9b33db858"
}, {
"reference": "urn:uuid:e87be79f-9274-665e-76cc-6c9dc7592185"
}, {
"reference": "urn:uuid:7de08142-82e9-3ff9-d613-c85b903a64e5"
}, {
"reference": "urn:uuid:38448745-92d7-db1a-99ac-b7dd3abab520"
}, {
"reference": "urn:uuid:a619df41-3a1b-803c-2513-c853401f2347"
}, {
"reference": "urn:uuid:8943df10-6efe-6344-e307-523d92d56b18"
}, {
"reference": "urn:uuid:daab62fa-d95b-68d5-23a1-f634f8832a70"
}, {
"reference": "urn:uuid:857ba216-b686-6ce2-3e19-a1e51e8c9bfe"
}, {
"reference": "urn:uuid:662d64eb-1b59-de84-69fb-6159b93fc939"
}, {
"reference": "urn:uuid:03bc8254-b861-c50d-f27c-807c9f2c6793"
}, {
"reference": "urn:uuid:28bdc6ae-0309-825c-d8fd-c0dd65ffd4ee"
}, {
"reference": "urn:uuid:67127388-1bf2-6845-71c3-281cddb683d0"
}, {
"reference": "urn:uuid:de9b9a38-c34c-301b-8fb3-b79b5118fd85"
}, {
"reference": "urn:uuid:ec08bc1d-1a88-bb3e-87d8-10810cb6e111"
}, {
"reference": "urn:uuid:2c512f79-f5ce-291d-05d1-70991fab3d28"
}, {
"reference": "urn:uuid:5bd862d4-b26d-6578-2771-da8609d76e28"
}, {
"reference": "urn:uuid:0742bfe0-6595-97d4-11fa-2db3cd0b30db"
}, {
"reference": "urn:uuid:b574afbb-c955-dc88-2f85-9b7e13232e80"
}, {
"reference": "urn:uuid:cd64bb22-279e-9d24-1a45-239a485ded03"
}, {
"reference": "urn:uuid:2c05103d-c8d0-cec9-d6dd-ad713dfc15fc"
}, {
"reference": "urn:uuid:777ced4e-e09d-3ff5-3250-b27127e7ed51"
}, {
"reference": "urn:uuid:cb4fd9e5-5e06-9543-6356-d6b793ed1517"
}, {
"reference": "urn:uuid:161e9c76-eeb8-1da4-7321-e219c1d5dd12"
}, {
"reference": "urn:uuid:a25823a1-4be3-4dd5-723e-4a246be34eca"
}, {
"reference": "urn:uuid:04dffa0d-b994-f2f5-67b1-f00fbbb54e5d"
}, {
"reference": "urn:uuid:2c9dcf8d-5ccf-9dd4-c849-9ecda4c70ab4"
}, {
"reference": "urn:uuid:2b3244d0-0df5-c692-5b53-540cbd822268"
}, {
"reference": "urn:uuid:a4c9a92c-5f32-e672-aa65-a7b0bfbfe74f"
}, {
"reference": "urn:uuid:16465af2-5155-575f-cf4d-e392da5db757"
}, {
"reference": "urn:uuid:ad769cca-ff95-86fb-7f9e-51b97cd71d6b"
}, {
"reference": "urn:uuid:4ceaf4aa-f711-e15f-7150-aae11892bb2b"
}, {
"reference": "urn:uuid:854d5ab4-c2bc-5c72-8fda-995bf1d4b32b"
}, {
"reference": "urn:uuid:18c126ce-1d43-17c5-dbf6-ef228738513d"
}, {
"reference": "urn:uuid:3e72d559-5e20-ef65-2b50-f839cb1724c0"
}, {
"reference": "urn:uuid:179e7136-3187-3335-3c63-db5f08a887c9"
}, {
"reference": "urn:uuid:ccf1014a-84fe-a9a9-8712-34e51adfaff1"
}, {
"reference": "urn:uuid:70f15847-a9eb-f8fd-70bf-5d8886a308ce"
}, {
"reference": "urn:uuid:ca8a4901-b393-8ace-97fc-5e1c30e1e8ff"
}, {
"reference": "urn:uuid:7fb4e2aa-d4a6-b277-f2a6-6816654f8661"
}, {
"reference": "urn:uuid:565c2146-3c83-81bb-1c0b-58b2cdbd351d"
}, {
"reference": "urn:uuid:e154416d-9818-2177-9b7d-188eecaf1737"
}, {
"reference": "urn:uuid:eee25e11-db1a-f3d2-f67d-cb40cbb72be1"
}, {
"reference": "urn:uuid:904f520d-00e4-c898-598e-d72f6192362f"
}, {
"reference": "urn:uuid:cffe12e7-2cdb-e95d-5d3c-ba164532a268"
}, {
"reference": "urn:uuid:48d93c48-de08-e89c-7ea1-90b2d342615f"
}, {
"reference": "urn:uuid:6a074935-2e4e-3a2b-77de-7ddd69fa172b"
}, {
"reference": "urn:uuid:c9dd5082-188f-f0bc-ffa5-a5a8c0513946"
}, {
"reference": "urn:uuid:371cd60f-c20f-449b-7aef-f3cb1bbf67ca"
}, {
"reference": "urn:uuid:44d93356-ff3f-25a4-95ca-45f5cfdc19f0"
}, {
"reference": "urn:uuid:0f6319d8-1dec-f617-9b96-765d648c49ae"
}, {
"reference": "urn:uuid:9e699016-03fe-fbd4-9906-4c779ee32609"
}, {
"reference": "urn:uuid:e16fe330-18ad-0ff6-f8fb-b95c430ee91d"
}, {
"reference": "urn:uuid:a462b534-3142-f8d3-ecad-3f5d08644d71"
}, {
"reference": "urn:uuid:467c839b-ac61-30c8-63b6-e8e880dec480"
}, {
"reference": "urn:uuid:1a5fc886-528d-a295-f8db-f62547abb751"
}, {
"reference": "urn:uuid:1fbb8829-4fc1-3a07-6f65-53ef656f7caa"
}, {
"reference": "urn:uuid:d92e6b39-38ad-17c6-4b43-85b6870b4894"
}, {
"reference": "urn:uuid:4dd4ab5d-2297-cc80-9c5a-7452e13a8a2f"
}, {
"reference": "urn:uuid:71351828-9a96-3fd8-c5d7-09b88cbf16f9"
}, {
"reference": "urn:uuid:2c22dc82-7190-f2ff-6927-b27f8540600d"
}, {
"reference": "urn:uuid:e84ac9c1-9e35-644c-b96b-0f4f69f321cb"
}, {
"reference": "urn:uuid:b20f6722-c493-3bae-3d68-d39140e0e1e4"
}, {
"reference": "urn:uuid:bac72860-b815-6443-5896-37aa2b17ffb1"
}, {
"reference": "urn:uuid:f9412bed-5dcc-7464-6fd5-25584358a645"
}, {
"reference": "urn:uuid:0bb32d85-7038-c387-65f7-f4697a7a8a79"
}, {
"reference": "urn:uuid:07e4121f-d2a2-5c8a-89a5-8bcac2803aff"
}, {
"reference": "urn:uuid:cbb8b993-2ea7-3f53-3c4e-a09be8bdcb82"
}, {
"reference": "urn:uuid:7a25d230-d58b-bb45-032e-30677fd63d48"
}, {
"reference": "urn:uuid:9c7d4b89-4654-022b-c767-e0977275a910"
}, {
"reference": "urn:uuid:7bf1f0cf-ebdd-eb08-bdd8-0ab4dc6391aa"
}, {
"reference": "urn:uuid:1d84a5b4-4e5f-81ce-0c61-655c278ba0cd"
}, {
"reference": "urn:uuid:58e7ec43-294f-bac5-2741-353817165f53"
}, {
"reference": "urn:uuid:e3f92db1-1866-b98f-1ced-4a9b0e7a295f"
}, {
"reference": "urn:uuid:2e9398e9-3e01-2755-3dc2-6da3151791b1"
}, {
"reference": "urn:uuid:d6d3e544-29a6-3843-4aea-e89b3ae8263b"
}, {
"reference": "urn:uuid:1c8efd96-bee4-1435-6638-d4a0b87c69f5"
}, {
"reference": "urn:uuid:d659d772-ffbd-96b2-6a46-0c88caff17ed"
}, {
"reference": "urn:uuid:501330f5-7732-2a90-0a85-76756e45f965"
}, {
"reference": "urn:uuid:d1363115-db97-16a8-66ca-465355689458"
}, {
"reference": "urn:uuid:7a630dd0-bfbd-43e7-63e6-b56c5cbdca05"
}, {
"reference": "urn:uuid:71611cd6-aca4-6b5b-3cf5-0c124af81fac"
}, {
"reference": "urn:uuid:294df629-af85-df7c-088d-a2b7003fabd5"
}, {
"reference": "urn:uuid:6dedc318-5a41-11fd-77a0-ab7edd331221"
}, {
"reference": "urn:uuid:2b17089b-4df6-621c-2fc8-5a665b996fa5"
}, {
"reference": "urn:uuid:4ce6797b-9ee2-3758-7653-1f0b4c4f3b6a"
}, {
"reference": "urn:uuid:6fffba91-3b18-0d97-5572-cb44d25bc1eb"
}, {
"reference": "urn:uuid:3d0f6fe5-30ef-af14-146b-680264c56ba7"
}, {
"reference": "urn:uuid:0c80f3b6-e016-b5c0-96f5-2e2842713e21"
}, {
"reference": "urn:uuid:75222b73-3a20-4be4-1163-e0eb7233fe2c"
}, {
"reference": "urn:uuid:2ea2c547-ac68-4826-1934-970848537fe8"
}, {
"reference": "urn:uuid:1515a571-295d-59de-be5d-b38597ce7e74"
}, {
"reference": "urn:uuid:ac210da4-72a3-24a7-f986-9b7905e3e362"
}, {
"reference": "urn:uuid:bb951178-1c13-b50f-d3ff-c83325b4cdaa"
}, {
"reference": "urn:uuid:830d0b9e-776d-89d2-2cd1-c4abbfad7049"
}, {
"reference": "urn:uuid:429d31bc-a773-4da5-fd12-56c4db699c7f"
}, {
"reference": "urn:uuid:3ba0faa6-a21f-9a18-5ae5-ea0159c103a1"
}, {
"reference": "urn:uuid:c0e16881-4e44-5867-8621-d0839dcb60cf"
}, {
"reference": "urn:uuid:1cc0178c-04ab-2a86-f5a9-e28455c4c5c0"
}, {
"reference": "urn:uuid:48fe8993-fab5-601c-7ec6-ddfdefeed8df"
}, {
"reference": "urn:uuid:387a8fa1-df6a-2741-0440-a550220d76eb"
}, {
"reference": "urn:uuid:0ff3ba5a-3256-5d32-bbe2-e7a0e4582a07"
}, {
"reference": "urn:uuid:6f5123d9-e6aa-fbdb-285b-c8f2764b8d12"
}, {
"reference": "urn:uuid:6730aa29-a6f9-1df4-24d1-25fe34f2d9c5"
}, {
"reference": "urn:uuid:59e78251-d3ab-4974-92a2-f60b3b410bf8"
}, {
"reference": "urn:uuid:306eb4cf-e49a-4474-0790-0677b9802781"
}, {
"reference": "urn:uuid:080a5c8b-e1d1-9cd3-3722-b344ec5edb7a"
}, {
"reference": "urn:uuid:9bc4a9b8-ad02-8b7a-bb03-a17dd5392494"
}, {
"reference": "urn:uuid:06d82386-0a14-3bbe-5b7d-be5b643d12df"
}, {
"reference": "urn:uuid:db3d8953-deca-5736-e60a-84aecf43572f"
}, {
"reference": "urn:uuid:a5171ef9-061a-82e4-c89e-eff78240829b"
}, {
"reference": "urn:uuid:9f97c703-5b7f-affd-83c1-fbfdf83c1158"
}, {
"reference": "urn:uuid:ba5443c2-f4ef-d0a2-9d61-1ae44697a588"
}, {
"reference": "urn:uuid:530c7cb9-37eb-f45c-5ab9-3eef0a453e94"
}, {
"reference": "urn:uuid:c5728fa3-85f4-1fc4-faf6-dd51c89d724c"
}, {
"reference": "urn:uuid:7da4c5dc-dcd4-855a-7ec1-c9669de82484"
}, {
"reference": "urn:uuid:785b1476-fcfa-e49f-ad7b-5ab77de355c1"
}, {
"reference": "urn:uuid:51ba46d2-e990-7f29-cf08-a503b7029443"
}, {
"reference": "urn:uuid:d06bf668-b595-02a5-6114-ca5328868811"
}, {
"reference": "urn:uuid:94758826-da20-cbaa-3f9e-50077590eb9b"
}, {
"reference": "urn:uuid:4022ad52-1140-2330-c575-58b8af7cc68c"
}, {
"reference": "urn:uuid:37225ce5-17fc-62ef-3da6-ec44c8f1c46b"
}, {
"reference": "urn:uuid:26a20bb1-819f-856b-fc01-f2c415348b47"
}, {
"reference": "urn:uuid:b1f58275-3140-c8c9-c70f-ffc38f71963b"
}, {
"reference": "urn:uuid:71b40b56-47ee-8ce8-f71f-9bff1bd8ffd9"
}, {
"reference": "urn:uuid:534b7e52-c8e8-215d-9b3d-5fc038580a02"
}, {
"reference": "urn:uuid:ba94a1a8-d10b-cfda-6aa9-b51461b62651"
}, {
"reference": "urn:uuid:dc2722b2-52bf-729a-e2cd-e76bfc83b898"
}, {
"reference": "urn:uuid:805510a5-a194-f1e5-e2ad-022d1da38cf0"
}, {
"reference": "urn:uuid:2be54746-e7a4-c3b9-804f-3c806067f981"
}, {
"reference": "urn:uuid:d3c59dfb-d9a5-c4b6-e973-e09f294f907c"
}, {
"reference": "urn:uuid:27caf04d-63af-16f3-598d-cb07cdb1bb83"
}, {
"reference": "urn:uuid:702fd7e8-4fb9-19b6-d15d-230c9d675c5f"
}, {
"reference": "urn:uuid:445d3a1f-9c95-87bf-c8d4-9b93def3f8f5"
}, {
"reference": "urn:uuid:ae06a544-f839-c138-20d0-44fa07bc7f73"
}, {
"reference": "urn:uuid:ab6f117c-1639-a1a6-567d-f2d97d34cb87"
}, {
"reference": "urn:uuid:122d9950-9b77-f094-e59c-af74e59ef320"
}, {
"reference": "urn:uuid:0aa87c85-b6b6-94ad-a4f0-ddc1b34831ca"
}, {
"reference": "urn:uuid:3b6033db-7516-334f-7d67-734a191d2725"
}, {
"reference": "urn:uuid:1f2735be-24bc-594f-bbfe-9be8edc97602"
}, {
"reference": "urn:uuid:5cb8e31d-8f5a-6967-36ed-dba887369c3d"
}, {
"reference": "urn:uuid:732d2930-1f71-5a6a-53cf-ec21c81816f0"
}, {
"reference": "urn:uuid:9701da0d-9625-fa95-5525-f736bfa4ceb9"
}, {
"reference": "urn:uuid:4bdb5293-ba6b-ebc9-4b4b-e524d68231a2"
}, {
"reference": "urn:uuid:6f0b8989-38dd-1fff-70e3-469310f1c5f8"
}, {
"reference": "urn:uuid:7ea8d8f1-011e-3813-1372-9b239e838e83"
}, {
"reference": "urn:uuid:f13d705a-79b9-a983-5452-7de7a7f22feb"
}, {
"reference": "urn:uuid:d64b1874-de60-fc76-8bdc-a51495d18857"
}, {
"reference": "urn:uuid:ce0f1be7-3cf5-6600-ef5e-a8f5d89c9d56"
}, {
"reference": "urn:uuid:c15b6960-9409-42a4-4bfd-c6223c1a0402"
}, {
"reference": "urn:uuid:d21742ed-50a0-3519-81d8-0ef155dc2762"
}, {
"reference": "urn:uuid:e9c01bfb-c41f-dbb6-9bcc-ad02c34b981b"
}, {
"reference": "urn:uuid:7d7673dc-9ed6-54b6-faa6-f6430dfa1a2e"
}, {
"reference": "urn:uuid:9dc003f5-cb25-e881-5185-80c816fd22f1"
}, {
"reference": "urn:uuid:d6f1bcd3-296d-f311-a4ab-df2eb33aa5af"
}, {
"reference": "urn:uuid:42e8a301-4629-2123-d9dc-47eb25a4a608"
}, {
"reference": "urn:uuid:cf281600-d53a-9922-75fe-e68e4e54bae0"
}, {
"reference": "urn:uuid:900856b0-3fe2-ebc8-1b85-135e335f2d71"
}, {
"reference": "urn:uuid:49cece6d-61a4-7c4e-fdbe-d5640fd1dec0"
}, {
"reference": "urn:uuid:0db8c0de-8d62-b81a-c3e9-6c48a71246b1"
}, {
"reference": "urn:uuid:c25d4ae0-b3d4-2b24-d590-311ff71aa6a8"
}, {
"reference": "urn:uuid:a312afeb-243f-c76b-1d9e-6ae807ac28ac"
}, {
"reference": "urn:uuid:d4b1359b-2a39-666b-38c7-49df1727bd82"
}, {
"reference": "urn:uuid:372e8b81-788e-7128-a0d3-b4b4671794f2"
}, {
"reference": "urn:uuid:af6d0d46-1773-30f3-a82d-6f23a28e51ff"
}, {
"reference": "urn:uuid:e8488080-f73d-1f1d-d19f-11222dfeb51d"
}, {
"reference": "urn:uuid:c042c1d0-82c7-a26d-42e8-5324613d20a8"
}, {
"reference": "urn:uuid:033ece28-ff44-c2fd-a342-6202a777fe80"
}, {
"reference": "urn:uuid:434b0e8b-590b-ed51-6e82-c02c0b151110"
}, {
"reference": "urn:uuid:9e907494-3ecd-a86a-84f2-a2d06a50ad38"
}, {
"reference": "urn:uuid:9e2a22e2-041e-e7b7-d018-5c4ee906f34d"
}, {
"reference": "urn:uuid:e465106a-b4e2-248f-e770-2904993cac33"
}, {
"reference": "urn:uuid:f3f8f9b8-91ac-c48d-c7e3-6caa17185536"
}, {
"reference": "urn:uuid:abfb0d4e-9ee8-b7e2-0880-53edf2804416"
}, {
"reference": "urn:uuid:1ecb486d-c427-7b5d-daad-f9a19fac68ae"
}, {
"reference": "urn:uuid:c8bcc96b-7ae7-fbb1-f45f-56dd90331ba3"
}, {
"reference": "urn:uuid:87de3c1b-0ff8-17b1-7167-aec0eec460cf"
}, {
"reference": "urn:uuid:588aa9bd-0977-39eb-c90d-d2ac77295b3f"
}, {
"reference": "urn:uuid:378a0298-d492-139b-f3eb-9d7cfec70e37"
}, {
"reference": "urn:uuid:e852a079-2659-c835-9027-865c3330e987"
}, {
"reference": "urn:uuid:9f949093-8a36-14ba-2875-6fb1e43adf0e"
}, {
"reference": "urn:uuid:272393ab-325b-612e-fd17-e1597504c9ad"
}, {
"reference": "urn:uuid:1eab82ee-9cd6-0784-8a0d-6d3545e60f98"
}, {
"reference": "urn:uuid:2d68f693-1b52-8a26-9508-e0266e8011b7"
}, {
"reference": "urn:uuid:a00a6c8b-e922-434e-cf22-c344f3af81f5"
}, {
"reference": "urn:uuid:c607e6af-883e-bcac-2ffd-20284b748501"
}, {
"reference": "urn:uuid:44032919-5dd7-c111-9d90-f5f51649c782"
}, {
"reference": "urn:uuid:7180bca5-c325-c14e-6ea6-c8eade09ebe5"
}, {
"reference": "urn:uuid:cf0328ac-8c8d-250a-11d9-28581b9aa7f5"
}, {
"reference": "urn:uuid:a0b43f8e-d38e-52d0-7160-88a5e25780d7"
}, {
"reference": "urn:uuid:a07347ef-265a-0d7e-4848-2dd233312ed0"
}, {
"reference": "urn:uuid:651b6ac1-4875-5fdb-1e25-f7ffefa47832"
}, {
"reference": "urn:uuid:1faa8b4a-17ea-bdef-22b9-8a73fcf58a03"
}, {
"reference": "urn:uuid:3cdd7acc-c6ab-85a9-217a-ed56fc73dad8"
} ],
"recorded": "2023-09-07T11:29:53.294+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|9999993790",
"display": "Dr. Maryann106 Hintz995"
},
"onBehalfOf": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
}, {
"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|9999993790",
"display": "Dr. Maryann106 Hintz995"
},
"onBehalfOf": {
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|5b0cd0a0-f277-3a66-bee6-d64b5be4a3f5",
"display": "BERKSHIRE MEDICAL CENTER INC - 1"
}
} ]
},
"request": {
"method": "POST",
"url": "Provenance"
}
} ]
}
Reference in New Issue View Git Blame Copy Permalink