74163 lines
2.5 MiB
74163 lines
2.5 MiB
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"display": "Urgent Care Facility"
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} ]
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},
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"value": 10438.74,
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},
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"value": 0,
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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} ],
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"display": "Submitted Amount"
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} ],
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},
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},
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},
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"system": "http://snomed.info/sct",
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} ],
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},
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"individual": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999898890",
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} ]
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"location": {
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"display": "ALLIANCE HEALTH AT ROSEWOOD"
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"provider": {
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|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999898890"
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|
},
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"referral": {
|
|
"reference": "#referral"
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},
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"facility": {
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"reference": "Location?identifier=https://github.com/synthetichealth/synthea|4e165c5c-0402-33cb-8a45-2d8ce9c12fa8",
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"display": "ALLIANCE HEALTH AT ROSEWOOD"
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},
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"claim": {
|
|
"reference": "urn:uuid:9fe13a81-d963-9cfc-7b1d-ad6c2f1c84ca"
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},
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"outcome": "complete",
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"careTeam": [ {
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"sequence": 1,
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"provider": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999898890"
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|
},
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"role": {
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"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
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|
"code": "primary",
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|
"display": "Primary provider"
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|
} ]
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|
}
|
|
} ],
|
|
"insurance": [ {
|
|
"focal": true,
|
|
"coverage": {
|
|
"reference": "#coverage",
|
|
"display": "Medicaid"
|
|
}
|
|
} ],
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|
"item": [ {
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|
"sequence": 1,
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
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|
},
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|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "182813001",
|
|
"display": "Emergency treatment (procedure)"
|
|
} ],
|
|
"text": "Emergency treatment (procedure)"
|
|
},
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|
"servicedPeriod": {
|
|
"start": "2014-03-05T12:51:47+01:00",
|
|
"end": "2014-03-05T13:51:47+01:00"
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|
},
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|
"locationCodeableConcept": {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "20",
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|
"display": "Urgent Care Facility"
|
|
} ]
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|
},
|
|
"encounter": [ {
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|
"reference": "urn:uuid:344ca050-0301-9c7a-4a94-024bad6be6cd"
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|
} ]
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|
}, {
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"sequence": 2,
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"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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|
"code": "1",
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|
"display": "Medical care"
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|
} ]
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|
},
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|
"productOrService": {
|
|
"coding": [ {
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|
"system": "http://snomed.info/sct",
|
|
"code": "65546002",
|
|
"display": "Extraction of wisdom tooth"
|
|
} ],
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|
"text": "Extraction of wisdom tooth"
|
|
},
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|
"servicedPeriod": {
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|
"start": "2014-03-05T12:51:47+01:00",
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"end": "2014-03-05T13:51:47+01:00"
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},
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"locationCodeableConcept": {
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"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "20",
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"display": "Urgent Care Facility"
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|
} ]
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},
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|
"net": {
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|
"value": 12381.31,
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|
"currency": "USD"
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|
},
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"adjudication": [ {
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"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
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},
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"amount": {
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"value": 2476.262,
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|
"currency": "USD"
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}
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}, {
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"category": {
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|
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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|
"display": "Line Provider Payment Amount"
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|
} ]
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|
},
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|
"amount": {
|
|
"value": 9905.048,
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|
"currency": "USD"
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
|
|
} ]
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},
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"amount": {
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"value": 12381.31,
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"currency": "USD"
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}
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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|
"display": "Line Allowed Charge Amount"
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|
} ]
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},
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"amount": {
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|
"value": 12381.31,
|
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"currency": "USD"
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}
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
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|
},
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"amount": {
|
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"value": 0,
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|
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}
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|
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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|
"display": "Line Processing Indicator Code"
|
|
} ]
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|
}
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|
} ]
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|
} ],
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"total": [ {
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"code": "submitted",
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|
"display": "Submitted Amount"
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|
} ],
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"text": "Submitted Amount"
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|
},
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|
"amount": {
|
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"value": 12527.49,
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"currency": "USD"
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}
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|
} ],
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"payment": {
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"amount": {
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"value": 9905.048,
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"currency": "USD"
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}
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}
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|
},
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"request": {
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|
"method": "POST",
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|
"url": "ExplanationOfBenefit"
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|
}
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|
}, {
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|
"fullUrl": "urn:uuid:6f0c4f48-bacc-38a3-04e2-b2c0edd609dc",
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},
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"value": "6f0c4f48-bacc-38a3-04e2-b2c0edd609dc"
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} ],
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"code": "AMB"
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},
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"type": [ {
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"coding": [ {
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|
"system": "http://snomed.info/sct",
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|
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|
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|
} ],
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} ],
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f",
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"display": "Mrs. Vernetta697 Garnett735 Schaden604"
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} ],
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},
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"individual": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944595",
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}
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} ],
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|
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},
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"location": {
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"reference": "Location?identifier=https://github.com/synthetichealth/synthea|fff8ec92-cbb6-33ea-9cc6-4d4611fd0623",
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"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
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}
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|
} ],
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"serviceProvider": {
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|
"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
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}
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|
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|
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|
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|
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|
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|
},
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
} ],
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|
"code": {
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
},
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
|
"code": "8302-2",
|
|
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|
|
} ],
|
|
"text": "Body Height"
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|
},
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|
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|
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|
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|
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|
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|
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|
"value": 166.5,
|
|
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|
|
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|
|
"code": "cm"
|
|
}
|
|
},
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|
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|
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|
|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
|
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|
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|
"code": {
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|
"coding": [ {
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|
"system": "http://loinc.org",
|
|
"code": "72514-3",
|
|
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
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|
} ],
|
|
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
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|
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|
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|
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|
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|
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|
"valueQuantity": {
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
"id": "77de916e-9e6f-d5f6-6c9c-71c93562919e",
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|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ]
|
|
},
|
|
"status": "final",
|
|
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|
|
"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"
|
|
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|
|
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|
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|
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|
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|
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|
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|
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|
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|
|
"valueQuantity": {
|
|
"value": 71.5,
|
|
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|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg"
|
|
}
|
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|
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|
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|
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|
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|
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|
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|
} ],
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|
|
"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": "LA30125-1",
|
|
"display": "Food"
|
|
} ],
|
|
"text": "Food"
|
|
}
|
|
}, {
|
|
"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": 6452,
|
|
"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": "LA17849-3",
|
|
"display": "Medicaid"
|
|
} ],
|
|
"text": "Medicaid"
|
|
}
|
|
}, {
|
|
"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": "487 McKenzie Track Apt 90"
|
|
}, {
|
|
"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": 6,
|
|
"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": "LA33-6",
|
|
"display": "Yes"
|
|
} ],
|
|
"text": "Yes"
|
|
}
|
|
}, {
|
|
"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:eed075c2-1aee-963d-2507-e86c4bd491b5",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "eed075c2-1aee-963d-2507-e86c4bd491b5",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:6f0c4f48-bacc-38a3-04e2-b2c0edd609dc"
|
|
},
|
|
"effectiveDateTime": "2014-03-29T13:43:33+01:00",
|
|
"issued": "2014-03-29T13:43:33.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 0,
|
|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:63da65e1-fdbd-6640-a484-83d15dcf2aa0",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "63da65e1-fdbd-6640-a484-83d15dcf2aa0",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:6f0c4f48-bacc-38a3-04e2-b2c0edd609dc"
|
|
},
|
|
"effectiveDateTime": "2014-03-29T14:22:06+01:00",
|
|
"issued": "2014-03-29T14:22:06.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 5,
|
|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:5fd4130a-afb2-3d23-8658-97367b57f144",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "5fd4130a-afb2-3d23-8658-97367b57f144",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "survey",
|
|
"display": "Survey"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "44261-6",
|
|
"display": "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]"
|
|
} ],
|
|
"text": "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:6f0c4f48-bacc-38a3-04e2-b2c0edd609dc"
|
|
},
|
|
"effectiveDateTime": "2014-03-29T14:46:13+01:00",
|
|
"issued": "2014-03-29T14:46:13.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 4,
|
|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:3b188b89-5ae0-8c2c-e017-29bb085ee3b6",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "3b188b89-5ae0-8c2c-e017-29bb085ee3b6",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:6f0c4f48-bacc-38a3-04e2-b2c0edd609dc"
|
|
},
|
|
"effectiveDateTime": "2014-03-29T15:26:01+01:00",
|
|
"issued": "2014-03-29T15:26:01.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 2,
|
|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"value": 0,
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}
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}, {
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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}, {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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} ]
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},
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"system": "http://snomed.info/sct",
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"code": "314529007",
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"display": "Medication review due (situation)"
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} ],
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"text": "Medication review due (situation)"
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},
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"start": "2014-03-29T12:51:47+01:00",
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"end": "2014-03-29T13:24:43+01:00"
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},
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "19",
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"display": "Off Campus-Outpatient Hospital"
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} ]
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}
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}, {
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} ]
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},
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"system": "http://snomed.info/sct",
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"code": "430193006",
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"display": "Medication Reconciliation (procedure)"
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} ],
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"text": "Medication Reconciliation (procedure)"
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},
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} ]
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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}
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} ]
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},
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}
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}, {
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"value": 0,
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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}, {
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"display": "Medical care"
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} ]
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},
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"system": "http://loinc.org",
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"code": "57698-3",
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"display": "Lipid panel with direct LDL - Serum or Plasma"
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} ],
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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}
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} ]
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},
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}
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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} ]
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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}, {
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} ]
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},
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"code": "710824005",
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} ],
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},
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"end": "2014-03-29T13:24:43+01:00"
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},
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} ]
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},
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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}
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 345.12,
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}
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}, {
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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} ]
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},
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"productOrService": {
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"coding": [ {
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"system": "http://snomed.info/sct",
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|
"code": "160903007",
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|
"display": "Full-time employment (finding)"
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|
} ],
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"text": "Full-time employment (finding)"
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|
},
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"start": "2014-03-29T12:51:47+01:00",
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"end": "2014-03-29T13:24:43+01:00"
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},
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "19",
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"display": "Off Campus-Outpatient Hospital"
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} ]
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"productOrService": {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
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|
"code": "710841007",
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|
"display": "Assessment of anxiety (procedure)"
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|
} ],
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"text": "Assessment of anxiety (procedure)"
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},
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"start": "2014-03-29T12:51:47+01:00",
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"end": "2014-03-29T13:24:43+01:00"
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},
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"code": "19",
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"display": "Off Campus-Outpatient Hospital"
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} ]
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|
},
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"net": {
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"value": 431.40,
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"currency": "USD"
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},
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 86.28,
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|
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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|
"display": "Line Provider Payment Amount"
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|
} ]
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|
},
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|
"amount": {
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|
"value": 345.12,
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|
"currency": "USD"
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}
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|
}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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|
"display": "Line Submitted Charge Amount"
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|
} ]
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},
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"amount": {
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"value": 431.40,
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|
"currency": "USD"
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}
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}, {
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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|
},
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|
"amount": {
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|
"value": 431.40,
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|
"currency": "USD"
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|
}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
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|
"currency": "USD"
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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|
"display": "Line Processing Indicator Code"
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|
} ]
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|
}
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|
} ]
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|
}, {
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|
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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|
},
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|
"productOrService": {
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|
"coding": [ {
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|
"system": "http://loinc.org",
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|
"code": "69737-5",
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|
"display": "Generalized anxiety disorder 7 item (GAD-7)"
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} ],
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"text": "Generalized anxiety disorder 7 item (GAD-7)"
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},
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"start": "2014-03-29T12:51:47+01:00",
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"end": "2014-03-29T13:24:43+01:00"
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},
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "19",
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"display": "Off Campus-Outpatient Hospital"
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} ]
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},
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},
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 14.916,
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"value": 59.664,
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
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"currency": "USD"
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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}, {
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"sequence": 10,
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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|
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"code": "171207006",
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"display": "Depression screening (procedure)"
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} ],
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"display": "Off Campus-Outpatient Hospital"
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} ]
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"value": 86.28,
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 345.12,
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"value": 431.40,
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
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"currency": "USD"
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}
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"code": "454711000124102",
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"display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
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} ],
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} ]
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 86.28,
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"currency": "USD"
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 345.12,
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"value": 431.40,
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"currency": "USD"
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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} ]
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},
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"amount": {
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"value": 0,
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"currency": "USD"
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"coding": [ {
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"system": "http://loinc.org",
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"code": "55757-9",
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"display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
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} ],
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},
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"value": 14.916,
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
|
|
"currency": "USD"
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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|
"display": "Line Processing Indicator Code"
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} ]
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|
}
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|
} ]
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|
}, {
|
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"sequence": 13,
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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|
"code": "1",
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|
"display": "Medical care"
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|
} ]
|
|
},
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|
"productOrService": {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
|
|
"code": "715252007",
|
|
"display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
|
|
} ],
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|
"text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
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|
},
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|
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|
"end": "2014-03-29T13:24:43+01:00"
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|
},
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"locationCodeableConcept": {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "19",
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|
"display": "Off Campus-Outpatient Hospital"
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|
} ]
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|
},
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"currency": "USD"
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 6.098,
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"currency": "USD"
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}
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}, {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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|
"display": "Line Provider Payment Amount"
|
|
} ]
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|
},
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"amount": {
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|
"value": 24.392,
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|
"currency": "USD"
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}
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|
}, {
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"category": {
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|
"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"amount": {
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"value": 30.49,
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|
"currency": "USD"
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|
}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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|
"display": "Line Allowed Charge Amount"
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|
} ]
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|
},
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"amount": {
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"value": 30.49,
|
|
"currency": "USD"
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|
}
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|
}, {
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"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
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|
},
|
|
"amount": {
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|
"value": 0,
|
|
"currency": "USD"
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|
}
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|
}, {
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"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
}, {
|
|
"sequence": 14,
|
|
"informationSequence": [ 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": "44249-1",
|
|
"display": "PHQ-9 quick depression assessment panel [Reported.PHQ]"
|
|
} ],
|
|
"text": "PHQ-9 quick depression assessment panel [Reported.PHQ]"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2014-03-29T12:51:47+01:00",
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"system": "http://snomed.info/sct",
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"code": "252160004",
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} ],
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} ]
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} ]
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}
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} ]
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"code": "169230002",
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} ],
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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|
} ]
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},
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"system": "http://snomed.info/sct",
|
|
"code": "44608003",
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|
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|
} ],
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|
"text": "Blood group typing (procedure)"
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|
},
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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},
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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}
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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|
"display": "Line Processing Indicator Code"
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|
} ]
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}
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|
} ]
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}, {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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|
} ]
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|
},
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|
"productOrService": {
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"coding": [ {
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|
"system": "http://snomed.info/sct",
|
|
"code": "104091002",
|
|
"display": "Hemogram, automated, with RBC, WBC, Hgb, Hct, Indices, Platelet count, and manual WBC differential"
|
|
} ],
|
|
"text": "Hemogram, automated, with RBC, WBC, Hgb, Hct, Indices, Platelet count, and manual WBC differential"
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|
},
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|
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|
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},
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"display": "Line Beneficiary Part B Deductible Amount"
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"display": "Line Processing Indicator Code"
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}
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"code": "399014008",
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"display": "Administration of diphtheria, pertussis, and tetanus vaccine"
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} ],
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},
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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"value": 696.648,
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"system": "http://snomed.info/sct",
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"code": "268556000",
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} ],
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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} ],
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"system": "http://snomed.info/sct",
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|
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|
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|
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|
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|
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"request": {
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|
"method": "POST",
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|
"url": "ExplanationOfBenefit"
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|
}
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|
}, {
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"fullUrl": "urn:uuid:aaa035a1-4f69-adf4-9b14-57b72f569cbb",
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|
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"code": "AMB"
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|
},
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|
"type": [ {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
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|
"code": "424619006",
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|
"display": "Prenatal visit"
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|
} ],
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|
"text": "Prenatal visit"
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|
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"subject": {
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f",
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"display": "Mrs. Vernetta697 Garnett735 Schaden604"
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"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
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|
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|
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|
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|
},
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|
"individual": {
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|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998898",
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|
"display": "Dr. Emory494 Schuster709"
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|
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|
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},
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|
"reasonCode": [ {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
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|
"code": "72892002",
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|
"display": "Normal pregnancy"
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|
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|
} ],
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"location": {
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"reference": "Location?identifier=https://github.com/synthetichealth/synthea|ba567bd8-9344-3431-b3db-64be9efd6e3f",
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"display": "TUFTS MEDICAL CENTER"
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"reference": "urn:uuid:d17b9853-b151-92f7-39c1-c1c76ce38353"
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},
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"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
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"code": "primary",
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"reference": "urn:uuid:27b6ae4e-3a85-b099-12c3-a53a294856ce"
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} ]
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}, {
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"sequence": 2,
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"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
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|
},
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|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "65200003",
|
|
"display": "Insertion of intrauterine contraceptive device"
|
|
} ],
|
|
"text": "Insertion of intrauterine contraceptive device"
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|
},
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|
"servicedPeriod": {
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|
"start": "2016-11-29T21:51:47+01:00",
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"end": "2016-11-29T22:46:58+01:00"
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},
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"locationCodeableConcept": {
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"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "21",
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|
"display": "Inpatient Hospital"
|
|
} ]
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|
},
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"net": {
|
|
"value": 7703.71,
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|
"currency": "USD"
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|
},
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"adjudication": [ {
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"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
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|
},
|
|
"amount": {
|
|
"value": 1540.7420000000002,
|
|
"currency": "USD"
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|
}
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}, {
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"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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|
"display": "Line Provider Payment Amount"
|
|
} ]
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|
},
|
|
"amount": {
|
|
"value": 6162.968000000001,
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"currency": "USD"
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
|
|
} ]
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},
|
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"amount": {
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"value": 7703.71,
|
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"currency": "USD"
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
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|
},
|
|
"amount": {
|
|
"value": 7703.71,
|
|
"currency": "USD"
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|
}
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}, {
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"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
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|
}, {
|
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"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
} ],
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"total": [ {
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"category": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/adjudication",
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|
"code": "submitted",
|
|
"display": "Submitted Amount"
|
|
} ],
|
|
"text": "Submitted Amount"
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|
},
|
|
"amount": {
|
|
"value": 7846.29,
|
|
"currency": "USD"
|
|
}
|
|
} ],
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"payment": {
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|
"amount": {
|
|
"value": 6162.968000000001,
|
|
"currency": "USD"
|
|
}
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "ExplanationOfBenefit"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc",
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|
"resource": {
|
|
"resourceType": "Encounter",
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|
"id": "9d16c920-2e59-469e-f39d-3a2605fff0dc",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
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|
},
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|
"identifier": [ {
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|
"use": "official",
|
|
"system": "https://github.com/synthetichealth/synthea",
|
|
"value": "9d16c920-2e59-469e-f39d-3a2605fff0dc"
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|
} ],
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"status": "finished",
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"class": {
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|
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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|
"code": "AMB"
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|
},
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|
"type": [ {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
|
|
"code": "162673000",
|
|
"display": "General examination of patient (procedure)"
|
|
} ],
|
|
"text": "General examination of patient (procedure)"
|
|
} ],
|
|
"subject": {
|
|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f",
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"display": "Mrs. Vernetta697 Garnett735 Schaden604"
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},
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"participant": [ {
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|
"type": [ {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
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"code": "PPRF",
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|
"display": "primary performer"
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} ],
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"text": "primary performer"
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} ],
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"period": {
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|
"start": "2017-01-14T12:51:47+01:00",
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"end": "2017-01-14T13:23:44+01:00"
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|
},
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|
"individual": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944595",
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|
"display": "Dr. Ramona980 Jaramillo133"
|
|
}
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|
} ],
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"period": {
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|
"start": "2017-01-14T12:51:47+01:00",
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"end": "2017-01-14T13:23:44+01:00"
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},
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|
"location": [ {
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"location": {
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|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|fff8ec92-cbb6-33ea-9cc6-4d4611fd0623",
|
|
"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
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|
}
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|
} ],
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|
"serviceProvider": {
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|
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|7a75decf-7d3f-3b0d-8c2b-3abf0a8c7f58",
|
|
"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
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|
}
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|
},
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"request": {
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|
"method": "POST",
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|
"url": "Encounter"
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}
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|
}, {
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|
"fullUrl": "urn:uuid:56181b5c-77f9-3f33-9dad-7b4aee606471",
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"resource": {
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"resourceType": "Condition",
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"id": "56181b5c-77f9-3f33-9dad-7b4aee606471",
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"meta": {
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|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
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},
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"clinicalStatus": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
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"code": "resolved"
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|
} ]
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},
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|
"verificationStatus": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
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"code": "confirmed"
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} ]
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},
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"category": [ {
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"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
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|
"code": "encounter-diagnosis",
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|
"display": "Encounter Diagnosis"
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|
} ]
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|
} ],
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"code": {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
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|
"code": "314529007",
|
|
"display": "Medication review due (situation)"
|
|
} ],
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"text": "Medication review due (situation)"
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|
},
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"subject": {
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"encounter": {
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|
"abatementDateTime": "2019-01-19T12:51:47+01:00",
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|
"recordedDate": "2017-01-14T12:51:47+01:00"
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|
},
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|
"request": {
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"method": "POST",
|
|
"url": "Condition"
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|
}
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|
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|
"fullUrl": "urn:uuid:5809ce99-5776-e8de-a809-082377ee676b",
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"resourceType": "Observation",
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|
"id": "5809ce99-5776-e8de-a809-082377ee676b",
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"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
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|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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|
"reference": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc"
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|
},
|
|
"effectiveDateTime": "2017-01-14T12:51:47+01:00",
|
|
"issued": "2017-01-14T12:51:47.284+01:00",
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|
"valueQuantity": {
|
|
"value": 166.5,
|
|
"unit": "cm",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "cm"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:15a05d17-08ca-ccc0-04dc-d61bafedf307",
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|
"resource": {
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|
"resourceType": "Observation",
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|
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|
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|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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|
"code": "vital-signs",
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|
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|
} ],
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|
"code": {
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|
"coding": [ {
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|
"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"
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|
},
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|
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|
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|
|
"issued": "2017-01-14T12:51:47.284+01:00",
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"valueQuantity": {
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"value": 2,
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|
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|
|
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|
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|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:5a9546ff-7044-d633-1a56-85ddfebf3425",
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|
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|
"id": "5a9546ff-7044-d633-1a56-85ddfebf3425",
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|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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|
"code": "vital-signs",
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|
"display": "Vital signs"
|
|
} ]
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|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "29463-7",
|
|
"display": "Body Weight"
|
|
} ],
|
|
"text": "Body Weight"
|
|
},
|
|
"subject": {
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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"encounter": {
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|
"reference": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc"
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|
},
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|
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|
|
"issued": "2017-01-14T12:51:47.284+01:00",
|
|
"valueQuantity": {
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|
"value": 76.9,
|
|
"unit": "kg",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:651c16c4-1bbe-63c6-1a2f-782c1bc55e1d",
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|
"resource": {
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|
"resourceType": "Observation",
|
|
"id": "651c16c4-1bbe-63c6-1a2f-782c1bc55e1d",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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|
},
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|
"encounter": {
|
|
"reference": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc"
|
|
},
|
|
"effectiveDateTime": "2017-01-14T12:51:47+01:00",
|
|
"issued": "2017-01-14T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 27.72,
|
|
"unit": "kg/m2",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg/m2"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:fc8c7e6c-f31e-db5a-e015-b772299600e7",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "fc8c7e6c-f31e-db5a-e015-b772299600e7",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc"
|
|
},
|
|
"effectiveDateTime": "2017-01-14T12:51:47+01:00",
|
|
"issued": "2017-01-14T12:51:47.284+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": 118,
|
|
"unit": "mm[Hg]",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "mm[Hg]"
|
|
}
|
|
} ]
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
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"reference": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc"
|
|
},
|
|
"effectiveDateTime": "2017-01-14T12:51:47+01:00",
|
|
"issued": "2017-01-14T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 431.79,
|
|
"unit": "10*3/uL",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "10*3/uL"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:7e4dd128-c945-e273-8d19-4904e28d2e92",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "7e4dd128-c945-e273-8d19-4904e28d2e92",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc"
|
|
},
|
|
"effectiveDateTime": "2017-01-14T12:51:47+01:00",
|
|
"issued": "2017-01-14T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 172.74,
|
|
"unit": "fL",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "fL"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:2303711f-2764-5291-26ef-25bbdcbfc902",
|
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"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "2303711f-2764-5291-26ef-25bbdcbfc902",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
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"encounter": {
|
|
"reference": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc"
|
|
},
|
|
"effectiveDateTime": "2017-01-14T12:51:47+01:00",
|
|
"issued": "2017-01-14T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 9.5357,
|
|
"unit": "fL",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "fL"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:46da981f-677b-0316-dd25-bbb92d945cf8",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "46da981f-677b-0316-dd25-bbb92d945cf8",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc"
|
|
},
|
|
"effectiveDateTime": "2017-01-14T12:51:47+01:00",
|
|
"issued": "2017-01-14T12:51:47.284+01:00",
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "266919005",
|
|
"display": "Never smoked tobacco (finding)"
|
|
} ],
|
|
"text": "Never smoked tobacco (finding)"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:7bcbc027-a486-9dd1-3459-f07b7c0a31ec",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "7bcbc027-a486-9dd1-3459-f07b7c0a31ec",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc"
|
|
},
|
|
"effectiveDateTime": "2017-01-14T13:23:44+01:00",
|
|
"issued": "2017-01-14T13:23:44.284+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": "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": 6452,
|
|
"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": "LA17849-3",
|
|
"display": "Medicaid"
|
|
} ],
|
|
"text": "Medicaid"
|
|
}
|
|
}, {
|
|
"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": "487 McKenzie Track Apt 90"
|
|
}, {
|
|
"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": 6,
|
|
"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": [ {
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"display": "Screening for domestic abuse (procedure)"
|
|
} ],
|
|
"text": "Screening for domestic abuse (procedure)"
|
|
},
|
|
"net": {
|
|
"value": 431.40,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"sequence": 10,
|
|
"informationSequence": [ 5 ],
|
|
"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]"
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|
},
|
|
"net": {
|
|
"value": 74.58,
|
|
"currency": "USD"
|
|
}
|
|
} ],
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|
"total": {
|
|
"value": 914.78,
|
|
"currency": "USD"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Claim"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:824d7785-4845-1443-3a87-8afd76d32fcc",
|
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"resource": {
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|
"resourceType": "ExplanationOfBenefit",
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|
"id": "824d7785-4845-1443-3a87-8afd76d32fcc",
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|
"contained": [ {
|
|
"resourceType": "ServiceRequest",
|
|
"id": "referral",
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|
"status": "completed",
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"intent": "order",
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|
"subject": {
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"requester": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944595"
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|
},
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|
"performer": [ {
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|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944595"
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|
} ]
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|
}, {
|
|
"resourceType": "Coverage",
|
|
"id": "coverage",
|
|
"status": "active",
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"type": {
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"text": "Medicaid"
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|
},
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"beneficiary": {
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"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"payor": [ {
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"display": "Medicaid"
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|
} ]
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|
} ],
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"identifier": [ {
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|
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
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|
"value": "fb58a242-9f70-70f1-ade5-6c1bb221cb8b"
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|
}, {
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|
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
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|
"value": "99999999999"
|
|
} ],
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|
"status": "active",
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|
"type": {
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|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
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|
"code": "professional"
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|
} ]
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|
},
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|
"use": "claim",
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"patient": {
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"billablePeriod": {
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"start": "2017-01-14T13:23:44+01:00",
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"end": "2018-01-14T13:23:44+01:00"
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|
},
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|
"created": "2017-01-14T13:23:44+01:00",
|
|
"insurer": {
|
|
"display": "Medicaid"
|
|
},
|
|
"provider": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944595"
|
|
},
|
|
"referral": {
|
|
"reference": "#referral"
|
|
},
|
|
"facility": {
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|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|fff8ec92-cbb6-33ea-9cc6-4d4611fd0623",
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|
"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
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|
},
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|
"claim": {
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|
"reference": "urn:uuid:fb58a242-9f70-70f1-ade5-6c1bb221cb8b"
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|
},
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|
"outcome": "complete",
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|
"careTeam": [ {
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|
"sequence": 1,
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|
"provider": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944595"
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|
},
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|
"role": {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
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|
"code": "primary",
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|
"display": "Primary provider"
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|
} ]
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}
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|
} ],
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"diagnosis": [ {
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"sequence": 1,
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"diagnosisReference": {
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"reference": "urn:uuid:56181b5c-77f9-3f33-9dad-7b4aee606471"
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},
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"type": [ {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
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|
"code": "principal"
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|
} ]
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|
} ]
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|
} ],
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|
"insurance": [ {
|
|
"focal": true,
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|
"coverage": {
|
|
"reference": "#coverage",
|
|
"display": "Medicaid"
|
|
}
|
|
} ],
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"item": [ {
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|
"sequence": 1,
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|
"category": {
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|
"coding": [ {
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|
"system": "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)"
|
|
},
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|
"servicedPeriod": {
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|
"start": "2017-01-14T12:51:47+01:00",
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|
"end": "2017-01-14T13:23:44+01:00"
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|
},
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|
"locationCodeableConcept": {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
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|
} ]
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|
},
|
|
"encounter": [ {
|
|
"reference": "urn:uuid:9d16c920-2e59-469e-f39d-3a2605fff0dc"
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|
} ]
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|
}, {
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|
"sequence": 2,
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|
"informationSequence": [ 1 ],
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
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|
} ]
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|
},
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|
"productOrService": {
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|
"coding": [ {
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|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "140",
|
|
"display": "Influenza, seasonal, injectable, preservative free"
|
|
} ],
|
|
"text": "Influenza, seasonal, injectable, preservative free"
|
|
},
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|
"servicedPeriod": {
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|
"start": "2017-01-14T12:51:47+01:00",
|
|
"end": "2017-01-14T13:23:44+01:00"
|
|
},
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|
"locationCodeableConcept": {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
|
|
},
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|
"net": {
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|
"value": 136.00,
|
|
"currency": "USD"
|
|
},
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|
"adjudication": [ {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
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|
},
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|
"amount": {
|
|
"value": 27.200000000000003,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"category": {
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|
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 108.80000000000001,
|
|
"currency": "USD"
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|
}
|
|
}, {
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|
"category": {
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|
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|
|
"system": "https://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": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
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|
"value": 0,
|
|
"currency": "USD"
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}
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|
}, {
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"category": {
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|
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|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
}, {
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|
"sequence": 3,
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|
"informationSequence": [ 2 ],
|
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"category": {
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"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
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|
} ]
|
|
},
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|
"productOrService": {
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|
"coding": [ {
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|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "52",
|
|
"display": "Hep A, adult"
|
|
} ],
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|
"text": "Hep A, adult"
|
|
},
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|
"servicedPeriod": {
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|
"start": "2017-01-14T12:51:47+01:00",
|
|
"end": "2017-01-14T13:23:44+01:00"
|
|
},
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|
"locationCodeableConcept": {
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|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
|
|
},
|
|
"net": {
|
|
"value": 136.00,
|
|
"currency": "USD"
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|
},
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|
"adjudication": [ {
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|
"category": {
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|
"coding": [ {
|
|
"system": "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"
|
|
}
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|
}, {
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"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
|
|
},
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|
"amount": {
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|
"value": 108.80000000000001,
|
|
"currency": "USD"
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}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://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"
|
|
}
|
|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
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|
},
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|
"amount": {
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|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
}, {
|
|
"sequence": 4,
|
|
"diagnosisSequence": [ 1 ],
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "314529007",
|
|
"display": "Medication review due (situation)"
|
|
} ],
|
|
"text": "Medication review due (situation)"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2017-01-14T12:51:47+01:00",
|
|
"end": "2017-01-14T13:23:44+01:00"
|
|
},
|
|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
|
|
}
|
|
}, {
|
|
"sequence": 5,
|
|
"informationSequence": [ 3 ],
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "58410-2",
|
|
"display": "CBC panel - Blood by Automated count"
|
|
} ],
|
|
"text": "CBC panel - Blood by Automated count"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2017-01-14T12:51:47+01:00",
|
|
"end": "2017-01-14T13:23:44+01:00"
|
|
},
|
|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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|
},
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|
"net": {
|
|
"value": 74.58,
|
|
"currency": "USD"
|
|
},
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|
"adjudication": [ {
|
|
"category": {
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|
"coding": [ {
|
|
"system": "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"
|
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}
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|
}, {
|
|
"category": {
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|
"coding": [ {
|
|
"system": "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": {
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|
"coding": [ {
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}
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} ]
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} ],
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 489.382,
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"currency": "USD"
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 1957.528,
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"amount": {
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"value": 2446.91,
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"value": 2446.91,
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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} ],
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"system": "http://terminology.hl7.org/CodeSystem/adjudication",
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} ],
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"text": "Submitted Amount"
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},
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"value": 2589.49,
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}
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} ],
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}
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}
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},
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"request": {
|
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"method": "POST",
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"url": "ExplanationOfBenefit"
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}
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}, {
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"fullUrl": "urn:uuid:3b8b8b5c-a6be-cc66-12f4-af3ea51c95c9",
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"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
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},
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"use": "official",
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"value": "3b8b8b5c-a6be-cc66-12f4-af3ea51c95c9"
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} ],
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"code": "AMB"
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},
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"type": [ {
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"coding": [ {
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"system": "http://snomed.info/sct",
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"code": "698314001",
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"display": "Consultation for treatment"
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} ],
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"text": "Consultation for treatment"
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} ],
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"subject": {
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"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f",
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"display": "Mrs. Vernetta697 Garnett735 Schaden604"
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},
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"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
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"code": "PPRF",
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} ],
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},
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"individual": {
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"display": "Dr. Emory494 Schuster709"
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},
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"reasonCode": [ {
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"coding": [ {
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"system": "http://snomed.info/sct",
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"code": "389095005",
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"display": "Contraception care (regime/therapy)"
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} ]
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} ],
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"location": [ {
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"location": {
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"display": "TUFTS MEDICAL CENTER"
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|
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"code": "resolved"
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} ]
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"code": "confirmed"
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} ]
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"code": {
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"coding": [ {
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"system": "http://snomed.info/sct",
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"code": "741062008",
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"display": "Not in labor force (finding)"
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} ],
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},
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} ],
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"code": {
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"code": "8302-2",
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"display": "Body Height"
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"code": "72514-3",
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|
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|
} ],
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},
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"code": "9279-1",
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|
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|
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|
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"code": "laboratory",
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|
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|
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|
} ],
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"code": {
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|
"coding": [ {
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|
"system": "http://loinc.org",
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|
"code": "2093-3",
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|
"display": "Cholesterol [Mass/volume] in Serum or Plasma"
|
|
} ],
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|
"text": "Cholesterol [Mass/volume] in Serum or Plasma"
|
|
},
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|
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|
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|
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"code": "laboratory",
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|
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"system": "http://loinc.org",
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|
"code": "2571-8",
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|
"display": "Triglycerides"
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|
} ],
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|
"text": "Triglycerides"
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|
},
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|
}
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},
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"code": "laboratory",
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|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "18262-6",
|
|
"display": "Low Density Lipoprotein Cholesterol"
|
|
} ],
|
|
"text": "Low Density Lipoprotein Cholesterol"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:f46c8386-fb50-237f-6075-04b58cb7ae7b"
|
|
},
|
|
"effectiveDateTime": "2019-01-19T12:51:47+01:00",
|
|
"issued": "2019-01-19T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 73.27,
|
|
"unit": "mg/dL",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "mg/dL"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:c5d2ed08-ab56-f929-9286-3bb491571224",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "c5d2ed08-ab56-f929-9286-3bb491571224",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:f46c8386-fb50-237f-6075-04b58cb7ae7b"
|
|
},
|
|
"effectiveDateTime": "2019-01-19T12:51:47+01:00",
|
|
"issued": "2019-01-19T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 52.94,
|
|
"unit": "mg/dL",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "mg/dL"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:c2e7cf9b-b40b-7086-0cf8-a261ce1edae0",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "c2e7cf9b-b40b-7086-0cf8-a261ce1edae0",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:f46c8386-fb50-237f-6075-04b58cb7ae7b"
|
|
},
|
|
"effectiveDateTime": "2019-01-19T12:51:47+01:00",
|
|
"issued": "2019-01-19T12:51:47.284+01:00",
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "266919005",
|
|
"display": "Never smoked tobacco (finding)"
|
|
} ],
|
|
"text": "Never smoked tobacco (finding)"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:e00cd878-57c4-4bb0-85d8-c4904caae7bc",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "e00cd878-57c4-4bb0-85d8-c4904caae7bc",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:f46c8386-fb50-237f-6075-04b58cb7ae7b"
|
|
},
|
|
"effectiveDateTime": "2019-01-19T13:23:30+01:00",
|
|
"issued": "2019-01-19T13:23:30.284+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": "LA30127-7",
|
|
"display": "Child care"
|
|
} ],
|
|
"text": "Child care"
|
|
}
|
|
}, {
|
|
"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": 6452,
|
|
"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": "LA17849-3",
|
|
"display": "Medicaid"
|
|
} ],
|
|
"text": "Medicaid"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "67875-5",
|
|
"display": "Employment status - current"
|
|
} ],
|
|
"text": "Employment status - current"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA30137-6",
|
|
"display": "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)"
|
|
} ],
|
|
"text": "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "82589-3",
|
|
"display": "Highest level of education"
|
|
} ],
|
|
"text": "Highest level of education"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "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": "487 McKenzie Track Apt 90"
|
|
}, {
|
|
"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": 6,
|
|
"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:79a8cdad-d305-e9ed-cf29-2eb11d023b6b",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "79a8cdad-d305-e9ed-cf29-2eb11d023b6b",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
|
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"fullUrl": "urn:uuid:505bf3d1-5569-3668-7eea-0f5a83ec5b00",
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|
"resource": {
|
|
"resourceType": "ExplanationOfBenefit",
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|
"id": "505bf3d1-5569-3668-7eea-0f5a83ec5b00",
|
|
"contained": [ {
|
|
"resourceType": "ServiceRequest",
|
|
"id": "referral",
|
|
"status": "completed",
|
|
"intent": "order",
|
|
"subject": {
|
|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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|
},
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|
"requester": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944595"
|
|
},
|
|
"performer": [ {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944595"
|
|
} ]
|
|
}, {
|
|
"resourceType": "Coverage",
|
|
"id": "coverage",
|
|
"status": "active",
|
|
"type": {
|
|
"text": "Medicaid"
|
|
},
|
|
"beneficiary": {
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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|
},
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|
"payor": [ {
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|
"display": "Medicaid"
|
|
} ]
|
|
} ],
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|
"identifier": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
|
|
"value": "5fb18102-95b9-244e-ad0b-540cc7551345"
|
|
}, {
|
|
"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
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|
"value": "99999999999"
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|
} ],
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|
"status": "active",
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|
"type": {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
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|
"code": "professional"
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|
} ]
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|
},
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|
"use": "claim",
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"patient": {
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"billablePeriod": {
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"start": "2019-01-19T13:23:30+01:00",
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"end": "2020-01-19T13:23:30+01:00"
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|
},
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|
"created": "2019-01-19T13:23:30+01:00",
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|
"insurer": {
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|
"display": "Medicaid"
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|
},
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|
"provider": {
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|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944595"
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|
},
|
|
"referral": {
|
|
"reference": "#referral"
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|
},
|
|
"facility": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|fff8ec92-cbb6-33ea-9cc6-4d4611fd0623",
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|
"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
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|
},
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|
"claim": {
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|
"reference": "urn:uuid:5fb18102-95b9-244e-ad0b-540cc7551345"
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|
},
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|
"outcome": "complete",
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"careTeam": [ {
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|
"sequence": 1,
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|
"provider": {
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|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999944595"
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|
},
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|
"role": {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
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|
"code": "primary",
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|
"display": "Primary provider"
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|
} ]
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|
}
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|
} ],
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|
"diagnosis": [ {
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|
"sequence": 1,
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|
"diagnosisReference": {
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|
"reference": "urn:uuid:98ff240f-2585-2e48-0818-4f4379ae75e9"
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},
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|
"type": [ {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
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|
"code": "principal"
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|
} ]
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|
} ]
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|
} ],
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|
"insurance": [ {
|
|
"focal": true,
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|
"coverage": {
|
|
"reference": "#coverage",
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|
"display": "Medicaid"
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|
}
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|
} ],
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|
"item": [ {
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|
"sequence": 1,
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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|
"display": "Medical care"
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|
} ]
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|
},
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|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "162673000",
|
|
"display": "General examination of patient (procedure)"
|
|
} ],
|
|
"text": "General examination of patient (procedure)"
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|
},
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|
"servicedPeriod": {
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|
"start": "2019-01-19T12:51:47+01:00",
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|
"end": "2019-01-19T13:23:30+01:00"
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|
},
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"locationCodeableConcept": {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "19",
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|
"display": "Off Campus-Outpatient Hospital"
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|
} ]
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|
},
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|
"encounter": [ {
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|
"reference": "urn:uuid:f46c8386-fb50-237f-6075-04b58cb7ae7b"
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|
} ]
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}, {
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"sequence": 2,
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"informationSequence": [ 1 ],
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"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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|
"code": "1",
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|
"display": "Medical care"
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|
} ]
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|
},
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|
"productOrService": {
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|
"coding": [ {
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|
"system": "http://hl7.org/fhir/sid/cvx",
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|
"code": "140",
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|
"display": "Influenza, seasonal, injectable, preservative free"
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|
} ],
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|
"text": "Influenza, seasonal, injectable, preservative free"
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|
},
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"servicedPeriod": {
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|
"start": "2019-01-19T12:51:47+01:00",
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|
"end": "2019-01-19T13:23:30+01:00"
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},
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"locationCodeableConcept": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "19",
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|
"display": "Off Campus-Outpatient Hospital"
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|
} ]
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|
},
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"net": {
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|
"value": 136.00,
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|
"currency": "USD"
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|
},
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"adjudication": [ {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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|
"display": "Line Beneficiary Coinsurance Amount"
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|
} ]
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},
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"amount": {
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"value": 27.200000000000003,
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|
"currency": "USD"
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|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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|
"display": "Line Provider Payment Amount"
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|
} ]
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},
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|
"amount": {
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|
"value": 108.80000000000001,
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"currency": "USD"
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}
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}, {
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|
"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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|
"display": "Line Submitted Charge Amount"
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|
} ]
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},
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"amount": {
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|
"value": 136.00,
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|
"currency": "USD"
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|
}
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|
}, {
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|
"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
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|
},
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"amount": {
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|
"value": 136.00,
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|
"currency": "USD"
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}
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|
}, {
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"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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|
"display": "Line Beneficiary Part B Deductible Amount"
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|
} ]
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|
},
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|
"amount": {
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|
"value": 0,
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|
"currency": "USD"
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}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
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|
}, {
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"sequence": 3,
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|
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"category": {
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|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
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|
},
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|
"productOrService": {
|
|
"coding": [ {
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|
"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"
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|
},
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|
"servicedPeriod": {
|
|
"start": "2019-01-19T12:51:47+01:00",
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|
"end": "2019-01-19T13:23:30+01:00"
|
|
},
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"locationCodeableConcept": {
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"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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|
},
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"net": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
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},
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"adjudication": [ {
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
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|
} ]
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|
},
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"amount": {
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|
"value": 27.200000000000003,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
|
|
},
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|
"amount": {
|
|
"value": 108.80000000000001,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
|
|
"display": "Line Submitted Charge Amount"
|
|
} ]
|
|
},
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|
"amount": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
|
|
}, {
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|
"category": {
|
|
"coding": [ {
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|
"system": "https://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"
|
|
}
|
|
}, {
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|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "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"
|
|
} ]
|
|
},
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|
"productOrService": {
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|
"coding": [ {
|
|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "52",
|
|
"display": "Hep A, adult"
|
|
} ],
|
|
"text": "Hep A, adult"
|
|
},
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|
"servicedPeriod": {
|
|
"start": "2019-01-19T12:51:47+01:00",
|
|
"end": "2019-01-19T13:23:30+01:00"
|
|
},
|
|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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|
},
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|
"net": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
},
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|
"adjudication": [ {
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|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
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|
},
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|
"amount": {
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|
"value": 27.200000000000003,
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|
"currency": "USD"
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|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
|
|
},
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|
"amount": {
|
|
"value": 108.80000000000001,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
|
|
"display": "Line Submitted Charge Amount"
|
|
} ]
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|
},
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|
"amount": {
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|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
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|
},
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|
"amount": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
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|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
}, {
|
|
"sequence": 5,
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "430193006",
|
|
"display": "Medication Reconciliation (procedure)"
|
|
} ],
|
|
"text": "Medication Reconciliation (procedure)"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2019-01-19T12:51:47+01:00",
|
|
"end": "2019-01-19T13:23:30+01:00"
|
|
},
|
|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
|
|
},
|
|
"net": {
|
|
"value": 617.74,
|
|
"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": 123.548,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 494.192,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
|
|
"display": "Line Submitted Charge Amount"
|
|
} ]
|
|
},
|
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"amount": {
|
|
"value": 617.74,
|
|
"currency": "USD"
|
|
}
|
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}, {
|
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"category": {
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"coding": [ {
|
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
|
|
},
|
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"amount": {
|
|
"value": 617.74,
|
|
"currency": "USD"
|
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}
|
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}, {
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"category": {
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"coding": [ {
|
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "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 ],
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"category": {
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"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
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"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"
|
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},
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"servicedPeriod": {
|
|
"start": "2019-01-19T12:51:47+01:00",
|
|
"end": "2019-01-19T13:23:30+01:00"
|
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},
|
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"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
|
|
},
|
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"net": {
|
|
"value": 74.58,
|
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"currency": "USD"
|
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},
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|
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"category": {
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"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
|
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},
|
|
"amount": {
|
|
"value": 14.916,
|
|
"currency": "USD"
|
|
}
|
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}, {
|
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"category": {
|
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"coding": [ {
|
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
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"display": "Line Provider Payment Amount"
|
|
} ]
|
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},
|
|
"amount": {
|
|
"value": 59.664,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
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"category": {
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"coding": [ {
|
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
|
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"display": "Line Submitted Charge Amount"
|
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} ]
|
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},
|
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"amount": {
|
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"value": 74.58,
|
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"currency": "USD"
|
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}
|
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}, {
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"category": {
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"coding": [ {
|
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
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"value": 74.58,
|
|
"currency": "USD"
|
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}
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}, {
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"category": {
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"coding": [ {
|
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
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} ]
|
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},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
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}
|
|
}, {
|
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"category": {
|
|
"coding": [ {
|
|
"system": "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": "2019-01-19T12:51:47+01:00",
|
|
"end": "2019-01-19T13:23:30+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"
|
|
},
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|
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"category": {
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|
"coding": [ {
|
|
"system": "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": {
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"coding": [ {
|
|
"system": "https://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"
|
|
}
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|
}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"amount": {
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"value": 431.40,
|
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
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"display": "Line Beneficiary Part B Deductible Amount"
|
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} ]
|
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},
|
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"amount": {
|
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"value": 0,
|
|
"currency": "USD"
|
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}
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}, {
|
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"category": {
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"coding": [ {
|
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
|
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} ]
|
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}
|
|
} ]
|
|
}, {
|
|
"sequence": 8,
|
|
"diagnosisSequence": [ 1 ],
|
|
"category": {
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"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
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},
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|
"productOrService": {
|
|
"coding": [ {
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|
"system": "http://snomed.info/sct",
|
|
"code": "741062008",
|
|
"display": "Not in labor force (finding)"
|
|
} ],
|
|
"text": "Not in labor force (finding)"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2019-01-19T12:51:47+01:00",
|
|
"end": "2019-01-19T13:23:30+01:00"
|
|
},
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|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
|
|
}
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}, {
|
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"sequence": 9,
|
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"category": {
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|
"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
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"code": "1",
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|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "710841007",
|
|
"display": "Assessment of anxiety (procedure)"
|
|
} ],
|
|
"text": "Assessment of anxiety (procedure)"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2019-01-19T12:51:47+01:00",
|
|
"end": "2019-01-19T13:23:30+01:00"
|
|
},
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"locationCodeableConcept": {
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|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
|
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},
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|
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|
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"currency": "USD"
|
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},
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
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"display": "Line Beneficiary Coinsurance Amount"
|
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} ]
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},
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"amount": {
|
|
"value": 86.28,
|
|
"currency": "USD"
|
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}
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}, {
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"category": {
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|
"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
|
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},
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"amount": {
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"value": 345.12,
|
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"currency": "USD"
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}
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}, {
|
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"category": {
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"coding": [ {
|
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
|
|
"display": "Line Submitted Charge Amount"
|
|
} ]
|
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},
|
|
"amount": {
|
|
"value": 431.40,
|
|
"currency": "USD"
|
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}
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|
}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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|
"display": "Line Allowed Charge Amount"
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|
} ]
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|
},
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"amount": {
|
|
"value": 431.40,
|
|
"currency": "USD"
|
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
|
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} ]
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},
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"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
|
|
} ]
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|
}
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|
} ]
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|
}, {
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|
|
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|
"category": {
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"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
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|
"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)"
|
|
},
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|
"servicedPeriod": {
|
|
"start": "2019-01-19T12:51:47+01:00",
|
|
"end": "2019-01-19T13:23:30+01:00"
|
|
},
|
|
"locationCodeableConcept": {
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|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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|
},
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|
"net": {
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|
"value": 74.58,
|
|
"currency": "USD"
|
|
},
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|
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
|
|
},
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|
"amount": {
|
|
"value": 14.916,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
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|
"coding": [ {
|
|
"system": "https://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"
|
|
}
|
|
}, {
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|
"category": {
|
|
"coding": [ {
|
|
"system": "https://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"
|
|
}
|
|
}, {
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|
"category": {
|
|
"coding": [ {
|
|
"system": "https://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": 1668.52,
|
|
"currency": "USD"
|
|
}
|
|
} ],
|
|
"payment": {
|
|
"amount": {
|
|
"value": 1630.16,
|
|
"currency": "USD"
|
|
}
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "ExplanationOfBenefit"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:99b03c90-60ea-495f-5de4-f4e71d703627",
|
|
"resource": {
|
|
"resourceType": "Encounter",
|
|
"id": "99b03c90-60ea-495f-5de4-f4e71d703627",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
|
|
},
|
|
"identifier": [ {
|
|
"use": "official",
|
|
"system": "https://github.com/synthetichealth/synthea",
|
|
"value": "99b03c90-60ea-495f-5de4-f4e71d703627"
|
|
} ],
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"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"payor": [ {
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"display": "Medicaid"
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} ]
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} ],
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"identifier": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
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"value": "b568dc08-75c1-04fc-d950-2cfc640fdc14"
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}, {
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"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
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"value": "99999999999"
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} ],
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"system": "http://terminology.hl7.org/CodeSystem/claim-type",
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"code": "professional"
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} ]
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},
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"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"start": "2019-11-14T19:09:00+01:00",
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"end": "2020-11-14T19:09:00+01:00"
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},
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"created": "2019-11-14T19:09:00+01:00",
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"insurer": {
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"display": "Medicaid"
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},
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"provider": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998898"
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},
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"referral": {
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"reference": "#referral"
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},
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"reference": "Location?identifier=https://github.com/synthetichealth/synthea|ba567bd8-9344-3431-b3db-64be9efd6e3f",
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"display": "TUFTS MEDICAL CENTER"
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},
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"claim": {
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"reference": "urn:uuid:b568dc08-75c1-04fc-d950-2cfc640fdc14"
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},
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"outcome": "complete",
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"careTeam": [ {
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"sequence": 1,
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"provider": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998898"
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},
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"role": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
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"code": "primary",
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"display": "Primary provider"
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} ]
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}
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} ],
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"sequence": 1,
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"reference": "urn:uuid:75852d41-15ed-071e-e719-185a870ac897"
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},
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"type": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
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"code": "principal"
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} ]
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} ]
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} ],
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"insurance": [ {
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"focal": true,
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"coverage": {
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"reference": "#coverage",
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"display": "Medicaid"
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}
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} ],
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"productOrService": {
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"coding": [ {
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"system": "http://snomed.info/sct",
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"code": "185345009",
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"display": "Encounter for symptom"
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} ],
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"text": "Encounter for symptom"
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},
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"servicedPeriod": {
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"start": "2019-11-14T18:51:47+01:00",
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"end": "2019-11-14T19:09:00+01:00"
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},
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"locationCodeableConcept": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "21",
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"display": "Inpatient Hospital"
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} ]
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},
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"encounter": [ {
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"reference": "urn:uuid:99b03c90-60ea-495f-5de4-f4e71d703627"
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} ]
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}, {
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"sequence": 2,
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"diagnosisSequence": [ 1 ],
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"productOrService": {
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"coding": [ {
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"system": "http://snomed.info/sct",
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"code": "10509002",
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"display": "Acute bronchitis (disorder)"
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} ],
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"text": "Acute bronchitis (disorder)"
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},
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"servicedPeriod": {
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"start": "2019-11-14T18:51:47+01:00",
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"end": "2019-11-14T19:09:00+01:00"
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},
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"locationCodeableConcept": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "21",
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"display": "Inpatient Hospital"
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} ]
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}
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}, {
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"sequence": 3,
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"productOrService": {
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"coding": [ {
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"system": "http://snomed.info/sct",
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"code": "23426006",
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"display": "Measurement of respiratory function (procedure)"
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} ],
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"text": "Measurement of respiratory function (procedure)"
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},
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"servicedPeriod": {
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"start": "2019-11-14T18:51:47+01:00",
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"end": "2019-11-14T19:09:00+01:00"
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},
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "21",
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"display": "Inpatient Hospital"
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} ]
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},
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"net": {
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"value": 261.93,
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},
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 52.386,
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 209.544,
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"amount": {
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"value": 261.93,
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"value": 261.93,
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
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"display": "Line Processing Indicator Code"
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}
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} ],
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},
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"request": {
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},
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} ],
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"status": "finished",
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"code": "AMB"
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"type": [ {
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"system": "http://snomed.info/sct",
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"display": "Mrs. Vernetta697 Garnett735 Schaden604"
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"individual": {
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"system": "http://snomed.info/sct",
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"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998898"
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}, {
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"resourceType": "Coverage",
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"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
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"value": "99999999999"
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"system": "http://unitsofmeasure.org",
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|
"code": "mm[Hg]"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "8480-6",
|
|
"display": "Systolic Blood Pressure"
|
|
} ],
|
|
"text": "Systolic Blood Pressure"
|
|
},
|
|
"valueQuantity": {
|
|
"value": 113,
|
|
"unit": "mm[Hg]",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "mm[Hg]"
|
|
}
|
|
} ]
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:cb3cd4c4-25c7-b97e-0229-16f82200bd89",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "cb3cd4c4-25c7-b97e-0229-16f82200bd89",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:333ceb7b-6507-2b99-5394-32cd18bc545f"
|
|
},
|
|
"effectiveDateTime": "2019-11-23T12:51:47+01:00",
|
|
"issued": "2019-11-23T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 96,
|
|
"unit": "/min",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "/min"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:fe7a9232-ec87-4153-2396-6153aa369f1a",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "fe7a9232-ec87-4153-2396-6153aa369f1a",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:333ceb7b-6507-2b99-5394-32cd18bc545f"
|
|
},
|
|
"effectiveDateTime": "2019-11-23T12:51:47+01:00",
|
|
"issued": "2019-11-23T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 15,
|
|
"unit": "/min",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "/min"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:19798d15-4441-4d06-6a82-d067a24dd699",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "19798d15-4441-4d06-6a82-d067a24dd699",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:333ceb7b-6507-2b99-5394-32cd18bc545f"
|
|
},
|
|
"effectiveDateTime": "2019-11-23T12:51:47+01:00",
|
|
"issued": "2019-11-23T12:51:47.284+01:00",
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "266919005",
|
|
"display": "Never smoked tobacco (finding)"
|
|
} ],
|
|
"text": "Never smoked tobacco (finding)"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:02a528b7-9a47-6037-b875-ca78ea3fb285",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "02a528b7-9a47-6037-b875-ca78ea3fb285",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:333ceb7b-6507-2b99-5394-32cd18bc545f"
|
|
},
|
|
"effectiveDateTime": "2019-11-23T13:42:53+01:00",
|
|
"issued": "2019-11-23T13:42:53.284+01:00",
|
|
"component": [ {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "76501-6",
|
|
"display": "Within the last year, have you been afraid of your partner or ex-partner?"
|
|
} ],
|
|
"text": "Within the last year, have you been afraid of your partner or ex-partner?"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA32-8",
|
|
"display": "No"
|
|
} ],
|
|
"text": "No"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93026-3",
|
|
"display": "Do you feel physically and emotionally safe where you currently live?"
|
|
} ],
|
|
"text": "Do you feel physically and emotionally safe where you currently live?"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA33-6",
|
|
"display": "Yes"
|
|
} ],
|
|
"text": "Yes"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93027-1",
|
|
"display": "Are you a refugee?"
|
|
} ],
|
|
"text": "Are you a refugee?"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA32-8",
|
|
"display": "No"
|
|
} ],
|
|
"text": "No"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93028-9",
|
|
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
|
|
} ],
|
|
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA32-8",
|
|
"display": "No"
|
|
} ],
|
|
"text": "No"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93038-8",
|
|
"display": "Stress level"
|
|
} ],
|
|
"text": "Stress level"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA13863-8",
|
|
"display": "A little bit"
|
|
} ],
|
|
"text": "A little bit"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93029-7",
|
|
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
|
|
} ],
|
|
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA30132-7",
|
|
"display": "5 or more times a week"
|
|
} ],
|
|
"text": "5 or more times a week"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93030-5",
|
|
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
|
|
} ],
|
|
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA32-8",
|
|
"display": "No"
|
|
} ],
|
|
"text": "No"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93031-3",
|
|
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
|
|
} ],
|
|
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA30122-8",
|
|
"display": "I choose not to answer this question"
|
|
} ],
|
|
"text": "I choose not to answer this question"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "63586-2",
|
|
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
|
|
} ],
|
|
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
|
|
},
|
|
"valueQuantity": {
|
|
"value": 6452,
|
|
"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": "LA17849-3",
|
|
"display": "Medicaid"
|
|
} ],
|
|
"text": "Medicaid"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "67875-5",
|
|
"display": "Employment status - current"
|
|
} ],
|
|
"text": "Employment status - current"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA30137-6",
|
|
"display": "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)"
|
|
} ],
|
|
"text": "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "82589-3",
|
|
"display": "Highest level of education"
|
|
} ],
|
|
"text": "Highest level of education"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "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": "487 McKenzie Track Apt 90"
|
|
}, {
|
|
"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": 6,
|
|
"unit": "{#}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{#}"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "54899-0",
|
|
"display": "Preferred language"
|
|
} ],
|
|
"text": "Preferred language"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA43-5",
|
|
"display": "English"
|
|
} ],
|
|
"text": "English"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93034-7",
|
|
"display": "Have you been discharged from the armed forces of the United States?"
|
|
} ],
|
|
"text": "Have you been discharged from the armed forces of the United States?"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA32-8",
|
|
"display": "No"
|
|
} ],
|
|
"text": "No"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93035-4",
|
|
"display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
|
|
} ],
|
|
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA30122-8",
|
|
"display": "I choose not to answer this question"
|
|
} ],
|
|
"text": "I choose not to answer this question"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "32624-9",
|
|
"display": "Race"
|
|
} ],
|
|
"text": "Race"
|
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},
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"fullUrl": "urn:uuid:ab936d65-3f62-3f3c-4e64-2e99b03e8a3d",
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"resource": {
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"resourceType": "ExplanationOfBenefit",
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"id": "ab936d65-3f62-3f3c-4e64-2e99b03e8a3d",
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"contained": [ {
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"resourceType": "ServiceRequest",
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"id": "referral",
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"status": "completed",
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"intent": "order",
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"subject": {
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"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"requester": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199"
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},
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"performer": [ {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199"
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} ]
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}, {
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"resourceType": "Coverage",
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"id": "coverage",
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"status": "active",
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"type": {
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"text": "Medicaid"
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},
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"beneficiary": {
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"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"payor": [ {
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"display": "Medicaid"
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} ]
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} ],
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"identifier": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
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"value": "d5e0f1e6-5654-fc3a-3fb7-6c6275fbb806"
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}, {
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"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
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"value": "99999999999"
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} ],
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"status": "active",
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"type": {
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"system": "http://terminology.hl7.org/CodeSystem/claim-type",
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"code": "professional"
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} ]
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},
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"use": "claim",
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"patient": {
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},
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"end": "2020-11-23T13:42:53+01:00"
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},
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"created": "2019-11-23T13:42:53+01:00",
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"insurer": {
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"display": "Medicaid"
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},
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"provider": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199"
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},
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"referral": {
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"reference": "#referral"
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},
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"facility": {
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"reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287",
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"display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC"
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},
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"claim": {
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"reference": "urn:uuid:d5e0f1e6-5654-fc3a-3fb7-6c6275fbb806"
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},
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"outcome": "complete",
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"careTeam": [ {
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"sequence": 1,
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"provider": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199"
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},
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"role": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
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"code": "primary",
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"display": "Primary provider"
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} ]
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}
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} ],
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"reference": "urn:uuid:0e025bd1-f9a0-06c0-bb72-45c9ec8477ef"
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"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
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"code": "principal"
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} ]
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} ]
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"reference": "urn:uuid:b9bcde73-41c1-9ffd-6daf-7a174a5542db"
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"code": "principal"
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} ]
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} ]
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} ],
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"insurance": [ {
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"focal": true,
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"coverage": {
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}
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} ],
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"code": "1",
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} ]
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},
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"productOrService": {
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"coding": [ {
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"system": "http://snomed.info/sct",
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"code": "702927004",
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} ],
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"text": "Urgent care clinic (environment)"
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},
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},
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "20",
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} ]
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},
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"encounter": [ {
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"reference": "urn:uuid:333ceb7b-6507-2b99-5394-32cd18bc545f"
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} ]
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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},
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"productOrService": {
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"system": "http://hl7.org/fhir/sid/cvx",
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"code": "140",
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} ],
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"text": "Influenza, seasonal, injectable, preservative free"
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},
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},
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} ]
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}, {
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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"code": "1",
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"system": "http://loinc.org",
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"code": "69737-5",
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} ],
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"code": "171207006",
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|
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|
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|
} ],
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
"system": "http://snomed.info/sct",
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|
"code": "702927004",
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|
"display": "Urgent care clinic (environment)"
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|
} ],
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|
"text": "Urgent care clinic (environment)"
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|
} ],
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"subject": {
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|
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|
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|
} ],
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|
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|
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|
"end": "2019-11-30T13:06:47+01:00"
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|
},
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|
"individual": {
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|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999939199",
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|
"display": "Dr. Josefina523 Portillo767"
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|
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|
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|
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},
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"location": {
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|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|340fb698-66ad-37b5-a6d7-12214e8b5287",
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|
"display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC"
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}
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|
} ],
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"serviceProvider": {
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|
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9ce6072b-d039-3cde-8eaf-950211b8ae88",
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|
"display": "MIDDLETON FAMILY MEDICINE URGENT CARE, LLC"
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}
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|
},
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|
"request": {
|
|
"method": "POST",
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|
"url": "Encounter"
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|
}
|
|
}, {
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|
}
|
|
} ],
|
|
"item": [ {
|
|
"sequence": 1,
|
|
"category": {
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|
"coding": [ {
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|
"system": "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": {
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|
"start": "2019-11-30T12:51:47+01:00",
|
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"end": "2019-11-30T13:06:47+01:00"
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|
},
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|
"locationCodeableConcept": {
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|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "20",
|
|
"display": "Urgent Care Facility"
|
|
} ]
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|
},
|
|
"encounter": [ {
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|
"reference": "urn:uuid:59cb1257-6a68-6ce7-2eb3-0b01f52e374d"
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|
} ]
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}, {
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"sequence": 2,
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"informationSequence": [ 1 ],
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"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
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|
},
|
|
"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": "2019-11-30T12:51:47+01:00",
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"end": "2019-11-30T13:06:47+01:00"
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},
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"locationCodeableConcept": {
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"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "20",
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|
"display": "Urgent Care Facility"
|
|
} ]
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|
},
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|
"net": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
},
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"adjudication": [ {
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|
"category": {
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|
"coding": [ {
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|
"system": "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"
|
|
}
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|
}, {
|
|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 108.80000000000001,
|
|
"currency": "USD"
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|
}
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|
}, {
|
|
"category": {
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|
"coding": [ {
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|
"system": "https://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": {
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|
"coding": [ {
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|
"system": "https://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"
|
|
}
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|
}, {
|
|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
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|
"coding": [ {
|
|
"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": [ {
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|
"category": {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
|
|
"code": "submitted",
|
|
"display": "Submitted Amount"
|
|
} ],
|
|
"text": "Submitted Amount"
|
|
},
|
|
"amount": {
|
|
"value": 278.58,
|
|
"currency": "USD"
|
|
}
|
|
} ],
|
|
"payment": {
|
|
"amount": {
|
|
"value": 108.80000000000001,
|
|
"currency": "USD"
|
|
}
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "ExplanationOfBenefit"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:57d32253-7f11-17c7-c45a-fbebb48e7e1f",
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|
"resource": {
|
|
"resourceType": "Encounter",
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|
"id": "57d32253-7f11-17c7-c45a-fbebb48e7e1f",
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|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
|
|
},
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|
"identifier": [ {
|
|
"use": "official",
|
|
"system": "https://github.com/synthetichealth/synthea",
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|
"value": "57d32253-7f11-17c7-c45a-fbebb48e7e1f"
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|
} ],
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"status": "finished",
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|
"class": {
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|
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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|
"code": "AMB"
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|
},
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|
"type": [ {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
|
|
"code": "185349003",
|
|
"display": "Encounter for check up (procedure)"
|
|
} ],
|
|
"text": "Encounter for check up (procedure)"
|
|
} ],
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|
"subject": {
|
|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f",
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|
"display": "Mrs. Vernetta697 Garnett735 Schaden604"
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|
},
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|
"participant": [ {
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|
"type": [ {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
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|
"code": "PPRF",
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|
"display": "primary performer"
|
|
} ],
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"text": "primary performer"
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|
} ],
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"period": {
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|
"start": "2019-12-07T12:51:47+01:00",
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|
"end": "2019-12-07T13:51:24+01:00"
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|
},
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|
"individual": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998898",
|
|
"display": "Dr. Emory494 Schuster709"
|
|
}
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|
} ],
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"period": {
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|
"start": "2019-12-07T12:51:47+01:00",
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|
"end": "2019-12-07T13:51:24+01:00"
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|
},
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"location": [ {
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"location": {
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|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|ba567bd8-9344-3431-b3db-64be9efd6e3f",
|
|
"display": "TUFTS MEDICAL CENTER"
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|
}
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|
} ],
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"serviceProvider": {
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|
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|901c2d40-1ca3-3879-9a20-c663b8adc0a9",
|
|
"display": "TUFTS MEDICAL CENTER"
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|
}
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|
},
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|
"request": {
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|
"method": "POST",
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|
"url": "Encounter"
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}, {
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|
"fullUrl": "urn:uuid:f54c28e1-685b-4c0a-d36a-5a76eec82f57",
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"resource": {
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"resourceType": "Condition",
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|
"id": "f54c28e1-685b-4c0a-d36a-5a76eec82f57",
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"meta": {
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|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
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|
},
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|
"clinicalStatus": {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
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"code": "active"
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|
} ]
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},
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|
"verificationStatus": {
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"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
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"code": "confirmed"
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} ]
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},
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"category": [ {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
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|
"code": "encounter-diagnosis",
|
|
"display": "Encounter Diagnosis"
|
|
} ]
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|
} ],
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"code": {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
|
|
"code": "160903007",
|
|
"display": "Full-time employment (finding)"
|
|
} ],
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|
"text": "Full-time employment (finding)"
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|
},
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|
"subject": {
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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"encounter": {
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"reference": "urn:uuid:57d32253-7f11-17c7-c45a-fbebb48e7e1f"
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|
"recordedDate": "2019-12-07T13:51:24+01:00"
|
|
},
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|
"request": {
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|
"method": "POST",
|
|
"url": "Condition"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:6d19f931-70c5-2026-eb6f-b983f7a99800",
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"resource": {
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"resourceType": "Observation",
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|
"id": "6d19f931-70c5-2026-eb6f-b983f7a99800",
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|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
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|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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|
"code": "vital-signs",
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|
"display": "Vital signs"
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|
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|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "8302-2",
|
|
"display": "Body Height"
|
|
} ],
|
|
"text": "Body Height"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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|
"effectiveDateTime": "2019-12-07T12:51:47+01:00",
|
|
"issued": "2019-12-07T12:51:47.284+01:00",
|
|
"valueQuantity": {
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|
"value": 166.5,
|
|
"unit": "cm",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "cm"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
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|
}
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|
}, {
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|
"fullUrl": "urn:uuid:d1dab837-7393-73d2-a6f7-6f7f6d103d7c",
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"resource": {
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"resourceType": "Observation",
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"id": "d1dab837-7393-73d2-a6f7-6f7f6d103d7c",
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|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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|
"code": "vital-signs",
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|
"display": "Vital signs"
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|
} ],
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"code": {
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|
"coding": [ {
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|
"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"
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|
},
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|
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|
"issued": "2019-12-07T12:51:47.284+01:00",
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|
"valueQuantity": {
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|
"value": 3,
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|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
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|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
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|
}
|
|
}, {
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|
"fullUrl": "urn:uuid:6342aad7-3f59-ce4c-204f-b24c733cbaa4",
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"resource": {
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|
"resourceType": "Observation",
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|
"id": "6342aad7-3f59-ce4c-204f-b24c733cbaa4",
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|
"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": {
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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"encounter": {
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|
"reference": "urn:uuid:57d32253-7f11-17c7-c45a-fbebb48e7e1f"
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|
},
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|
"effectiveDateTime": "2019-12-07T12:51:47+01:00",
|
|
"issued": "2019-12-07T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 79.8,
|
|
"unit": "kg",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:8c4ac0fd-8a19-0d2d-3c46-02598c6eb7c7",
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|
"resource": {
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|
"resourceType": "Observation",
|
|
"id": "8c4ac0fd-8a19-0d2d-3c46-02598c6eb7c7",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:57d32253-7f11-17c7-c45a-fbebb48e7e1f"
|
|
},
|
|
"effectiveDateTime": "2019-12-07T12:51:47+01:00",
|
|
"issued": "2019-12-07T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 28.77,
|
|
"unit": "kg/m2",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg/m2"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:99b8fa27-601b-6266-f162-7a27f7633bfd",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "99b8fa27-601b-6266-f162-7a27f7633bfd",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:57d32253-7f11-17c7-c45a-fbebb48e7e1f"
|
|
},
|
|
"effectiveDateTime": "2019-12-07T12:51:47+01:00",
|
|
"issued": "2019-12-07T12:51:47.284+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": 126,
|
|
"unit": "mm[Hg]",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "mm[Hg]"
|
|
}
|
|
} ]
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:8e368a28-4086-a6aa-56f9-36b99e822e70",
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"resource": {
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"resourceType": "Observation",
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"id": "8e368a28-4086-a6aa-56f9-36b99e822e70",
|
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"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"encounter": {
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"reference": "urn:uuid:57d32253-7f11-17c7-c45a-fbebb48e7e1f"
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},
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"effectiveDateTime": "2019-12-07T12:51:47+01:00",
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"issued": "2019-12-07T12:51:47.284+01:00",
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"valueQuantity": {
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|
"value": 64,
|
|
"unit": "/min",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "/min"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
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}, {
|
|
"fullUrl": "urn:uuid:9134788b-f64d-69b6-9e97-58e86737d5cc",
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"resource": {
|
|
"resourceType": "Observation",
|
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"id": "9134788b-f64d-69b6-9e97-58e86737d5cc",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"encounter": {
|
|
"reference": "urn:uuid:57d32253-7f11-17c7-c45a-fbebb48e7e1f"
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|
},
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|
"effectiveDateTime": "2019-12-07T12:51:47+01:00",
|
|
"issued": "2019-12-07T12:51:47.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 16,
|
|
"unit": "/min",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "/min"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:fb17a50b-beab-4f63-2efc-bd0e523a517e",
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|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "fb17a50b-beab-4f63-2efc-bd0e523a517e",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:57d32253-7f11-17c7-c45a-fbebb48e7e1f"
|
|
},
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|
"effectiveDateTime": "2019-12-07T12:51:47+01:00",
|
|
"issued": "2019-12-07T12:51:47.284+01:00",
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "266919005",
|
|
"display": "Never smoked tobacco (finding)"
|
|
} ],
|
|
"text": "Never smoked tobacco (finding)"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:3d0ac6aa-b313-4887-5fd2-6242d714b964",
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|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "3d0ac6aa-b313-4887-5fd2-6242d714b964",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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|
},
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|
"encounter": {
|
|
"reference": "urn:uuid:57d32253-7f11-17c7-c45a-fbebb48e7e1f"
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|
},
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|
"effectiveDateTime": "2019-12-07T13:51:24+01:00",
|
|
"issued": "2019-12-07T13:51:24.284+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": "LA30125-1",
|
|
"display": "Food"
|
|
} ],
|
|
"text": "Food"
|
|
}
|
|
}, {
|
|
"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": 6452,
|
|
"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": "LA17849-3",
|
|
"display": "Medicaid"
|
|
} ],
|
|
"text": "Medicaid"
|
|
}
|
|
}, {
|
|
"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": "487 McKenzie Track Apt 90"
|
|
}, {
|
|
"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": 6,
|
|
"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": [ {
|
|
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} ]
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},
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},
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},
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},
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"display": "ALLIANCE HEALTH AT ROSEWOOD"
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},
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"reference": "urn:uuid:4a4306fb-fd26-251d-1c4f-c613699c5624"
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},
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"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
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"code": "primary",
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"code": "principal"
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} ]
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} ],
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"code": "125605004",
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} ],
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},
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},
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"code": "33737001",
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} ],
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},
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},
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"code": "399208008",
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} ],
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"display": "Line Beneficiary Coinsurance Amount"
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"value": 1785.9099999999999,
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} ]
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} ],
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"coding": [ {
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"system": "http://loinc.org",
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"code": "72514-3",
|
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"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
|
|
} ],
|
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"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
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},
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"subject": {
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"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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"value": 3,
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"system": "http://unitsofmeasure.org",
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"code": "{score}"
|
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}
|
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},
|
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"request": {
|
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"method": "POST",
|
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"url": "Observation"
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}
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}, {
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"fullUrl": "urn:uuid:c93bab98-0292-03ec-5f0b-553ca5abafb9",
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"resourceType": "Observation",
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"id": "c93bab98-0292-03ec-5f0b-553ca5abafb9",
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"meta": {
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"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ]
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},
|
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"status": "final",
|
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"category": [ {
|
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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"code": "vital-signs",
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"display": "Vital signs"
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} ]
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} ],
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"code": {
|
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"coding": [ {
|
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"system": "http://loinc.org",
|
|
"code": "29463-7",
|
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"display": "Body Weight"
|
|
} ],
|
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"text": "Body Weight"
|
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},
|
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"subject": {
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"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
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},
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"value": 82.5,
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"unit": "kg",
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"system": "http://unitsofmeasure.org",
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"code": "kg"
|
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}
|
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},
|
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"request": {
|
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"method": "POST",
|
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"url": "Observation"
|
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}
|
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}, {
|
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"fullUrl": "urn:uuid:cc97a016-4251-17b0-131c-ab9d400d93a1",
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"resource": {
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"resourceType": "Observation",
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"id": "cc97a016-4251-17b0-131c-ab9d400d93a1",
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"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
|
|
},
|
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"status": "final",
|
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"category": [ {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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"code": "vital-signs",
|
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"display": "Vital signs"
|
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} ]
|
|
} ],
|
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"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
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"code": "39156-5",
|
|
"display": "Body mass index (BMI) [Ratio]"
|
|
} ],
|
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"text": "Body mass index (BMI) [Ratio]"
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},
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"subject": {
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"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
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},
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"effectiveDateTime": "2021-01-23T12:51:47+01:00",
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"issued": "2021-01-23T12:51:47.284+01:00",
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"valueQuantity": {
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"value": 29.74,
|
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"unit": "kg/m2",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg/m2"
|
|
}
|
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},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:5ffdace1-82c4-9faa-5a5d-9fbd991f81ed",
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"resource": {
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|
"resourceType": "Observation",
|
|
"id": "5ffdace1-82c4-9faa-5a5d-9fbd991f81ed",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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|
"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"
|
|
},
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|
"subject": {
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
|
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"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
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},
|
|
"effectiveDateTime": "2021-01-23T12:51:47+01:00",
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"issued": "2021-01-23T12:51:47.284+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": 116,
|
|
"unit": "mm[Hg]",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "mm[Hg]"
|
|
}
|
|
} ]
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:174a4444-4477-4565-e60e-87fb6b9e483a",
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|
"resource": {
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|
"resourceType": "Observation",
|
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"id": "174a4444-4477-4565-e60e-87fb6b9e483a",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
|
|
},
|
|
"effectiveDateTime": "2021-01-23T12:51:47+01:00",
|
|
"issued": "2021-01-23T12:51:47.284+01:00",
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|
"valueQuantity": {
|
|
"value": 93,
|
|
"unit": "/min",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "/min"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:052cad2e-01a3-f742-5528-68fb55516113",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "052cad2e-01a3-f742-5528-68fb55516113",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
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|
"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"
|
|
} ],
|
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"text": "Respiratory rate"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
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|
},
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|
"effectiveDateTime": "2021-01-23T12:51:47+01:00",
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"issued": "2021-01-23T12:51:47.284+01:00",
|
|
"valueQuantity": {
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|
"value": 13,
|
|
"unit": "/min",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "/min"
|
|
}
|
|
},
|
|
"request": {
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|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:1015692c-784b-85ff-7d9b-1a280f3d58ba",
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|
"resource": {
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|
"resourceType": "Observation",
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"id": "1015692c-784b-85ff-7d9b-1a280f3d58ba",
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"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": {
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|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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},
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"encounter": {
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"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
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},
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"effectiveDateTime": "2021-01-23T12:51:47+01:00",
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|
"issued": "2021-01-23T12:51:47.284+01:00",
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "266919005",
|
|
"display": "Never smoked tobacco (finding)"
|
|
} ],
|
|
"text": "Never smoked tobacco (finding)"
|
|
}
|
|
},
|
|
"request": {
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|
"method": "POST",
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|
"url": "Observation"
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|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:e82d895a-c182-592d-7513-5aebb3eb8342",
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"resource": {
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"resourceType": "Observation",
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"id": "e82d895a-c182-592d-7513-5aebb3eb8342",
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"meta": {
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|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
|
|
},
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"status": "final",
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"category": [ {
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|
"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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"code": "survey",
|
|
"display": "Survey"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
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|
"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]"
|
|
},
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|
"subject": {
|
|
"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
|
|
},
|
|
"effectiveDateTime": "2021-01-23T13:21:59+01:00",
|
|
"issued": "2021-01-23T13:21:59.284+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": {
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|
"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": [ {
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|
"system": "http://loinc.org",
|
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"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": [ {
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|
"system": "http://loinc.org",
|
|
"code": "LA32-8",
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"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?"
|
|
} ],
|
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"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?"
|
|
},
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|
"valueCodeableConcept": {
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|
"coding": [ {
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|
"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"
|
|
},
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"valueCodeableConcept": {
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"coding": [ {
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"system": "http://loinc.org",
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"code": "LA6568-5",
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"display": "Not at all"
|
|
} ],
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|
"text": "Not at all"
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}
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}, {
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"code": {
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|
"coding": [ {
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|
"system": "http://loinc.org",
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|
"code": "93029-7",
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|
"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)?"
|
|
} ],
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|
"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)?"
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|
},
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"valueCodeableConcept": {
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"coding": [ {
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"system": "http://loinc.org",
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"code": "LA30132-7",
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"display": "5 or more times a week"
|
|
} ],
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"text": "5 or more times a week"
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}
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}, {
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"code": {
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"coding": [ {
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"system": "http://loinc.org",
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"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"
|
|
},
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|
"valueCodeableConcept": {
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"coding": [ {
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"system": "http://loinc.org",
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"code": "LA32-8",
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"display": "No"
|
|
} ],
|
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"text": "No"
|
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}
|
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}, {
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"code": {
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"coding": [ {
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"system": "http://loinc.org",
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"code": "93031-3",
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"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?"
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|
} ],
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"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?"
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},
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"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": 6452,
|
|
"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": "LA17849-3",
|
|
"display": "Medicaid"
|
|
} ],
|
|
"text": "Medicaid"
|
|
}
|
|
}, {
|
|
"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": "487 McKenzie Track Apt 90"
|
|
}, {
|
|
"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": 6,
|
|
"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": "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": "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:ec34b506-d93b-e720-ee6b-6224640ba196",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "ec34b506-d93b-e720-ee6b-6224640ba196",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
|
|
},
|
|
"effectiveDateTime": "2021-01-23T13:46:32+01:00",
|
|
"issued": "2021-01-23T13:46:32.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 7,
|
|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:ab6051a3-4284-dba2-fdd2-cd7670138a5a",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "ab6051a3-4284-dba2-fdd2-cd7670138a5a",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
|
|
},
|
|
"effectiveDateTime": "2021-01-23T14:25:50+01:00",
|
|
"issued": "2021-01-23T14:25:50.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 1,
|
|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:ae2ef5bb-911b-984c-7404-49d3e0f5217b",
|
|
"resource": {
|
|
"resourceType": "Procedure",
|
|
"id": "ae2ef5bb-911b-984c-7404-49d3e0f5217b",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
|
|
},
|
|
"performedPeriod": {
|
|
"start": "2021-01-23T12:51:47+01:00",
|
|
"end": "2021-01-23T13:06:47+01:00"
|
|
},
|
|
"location": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|fff8ec92-cbb6-33ea-9cc6-4d4611fd0623",
|
|
"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Procedure"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:1db22738-3430-dd08-b8f6-697b484e3a4e",
|
|
"resource": {
|
|
"resourceType": "Procedure",
|
|
"id": "1db22738-3430-dd08-b8f6-697b484e3a4e",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
|
|
},
|
|
"performedPeriod": {
|
|
"start": "2021-01-23T12:51:47+01:00",
|
|
"end": "2021-01-23T13:21:59+01:00"
|
|
},
|
|
"location": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|fff8ec92-cbb6-33ea-9cc6-4d4611fd0623",
|
|
"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Procedure"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:548bc186-b586-eb29-f970-2f296b60cbcf",
|
|
"resource": {
|
|
"resourceType": "Procedure",
|
|
"id": "548bc186-b586-eb29-f970-2f296b60cbcf",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
|
|
},
|
|
"performedPeriod": {
|
|
"start": "2021-01-23T13:21:59+01:00",
|
|
"end": "2021-01-23T13:46:32+01:00"
|
|
},
|
|
"location": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|fff8ec92-cbb6-33ea-9cc6-4d4611fd0623",
|
|
"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Procedure"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:79539200-35ec-41b2-fd02-d55b36a0dc7b",
|
|
"resource": {
|
|
"resourceType": "Procedure",
|
|
"id": "79539200-35ec-41b2-fd02-d55b36a0dc7b",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
|
|
},
|
|
"performedPeriod": {
|
|
"start": "2021-01-23T13:46:32+01:00",
|
|
"end": "2021-01-23T13:59:44+01:00"
|
|
},
|
|
"location": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|fff8ec92-cbb6-33ea-9cc6-4d4611fd0623",
|
|
"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Procedure"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:04a088db-b357-28ed-7222-e421d0c537af",
|
|
"resource": {
|
|
"resourceType": "Procedure",
|
|
"id": "04a088db-b357-28ed-7222-e421d0c537af",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:a69a2535-1ab0-fabf-2203-db3e8a0e7cde"
|
|
},
|
|
"performedPeriod": {
|
|
"start": "2021-01-23T13:59:44+01:00",
|
|
"end": "2021-01-23T14:25:50+01:00"
|
|
},
|
|
"location": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|fff8ec92-cbb6-33ea-9cc6-4d4611fd0623",
|
|
"display": "NEW ENGLAND PROFESSIONAL HOME HEALTH CARE LLC"
|
|
}
|
|
},
|
|
"request": {
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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} ]
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} ],
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} ]
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},
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"start": "2021-04-24T14:06:47+02:00",
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"end": "2022-04-24T14:06:47+02:00"
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},
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"created": "2021-04-24T14:06:47+02:00",
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"insurer": {
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"display": "Medicaid"
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},
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"provider": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998898"
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},
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"referral": {
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"reference": "#referral"
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},
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"facility": {
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"reference": "Location?identifier=https://github.com/synthetichealth/synthea|ba567bd8-9344-3431-b3db-64be9efd6e3f",
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"display": "TUFTS MEDICAL CENTER"
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},
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"claim": {
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"reference": "urn:uuid:5efffeb2-c9f4-2005-bcad-e405821aad72"
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},
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"outcome": "complete",
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"careTeam": [ {
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"sequence": 1,
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"provider": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999998898"
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},
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"role": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
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"code": "primary",
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"display": "Primary provider"
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} ]
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}
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} ],
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"insurance": [ {
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"focal": true,
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"coverage": {
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"reference": "#coverage",
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"display": "Medicaid"
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}
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} ],
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"productOrService": {
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"coding": [ {
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"system": "http://snomed.info/sct",
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"code": "33879002",
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"display": "Administration of vaccine to produce active immunity (procedure)"
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} ],
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"text": "Administration of vaccine to produce active immunity (procedure)"
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},
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"servicedPeriod": {
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"start": "2021-04-24T13:51:47+02:00",
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"end": "2021-04-24T14:06:47+02:00"
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},
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "21",
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"display": "Inpatient Hospital"
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} ]
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"encounter": [ {
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"reference": "urn:uuid:3a38053f-7c84-d280-ba0b-6133cd5585bd"
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} ]
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}, {
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"sequence": 2,
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"category": {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"productOrService": {
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"coding": [ {
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"system": "http://hl7.org/fhir/sid/cvx",
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"code": "208",
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"display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose"
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} ],
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"text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose"
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},
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"servicedPeriod": {
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"start": "2021-04-24T13:51:47+02:00",
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"end": "2021-04-24T14:06:47+02:00"
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},
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"locationCodeableConcept": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "21",
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"display": "Inpatient Hospital"
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} ]
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},
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"value": 136.00,
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 27.200000000000003,
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 108.80000000000001,
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"amount": {
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"value": 136.00,
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
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} ]
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}
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} ]
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} ],
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"value": 278.58,
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"payment": {
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},
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"request": {
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}
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"code": "EMER"
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"individual": {
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"system": "http://www.nubc.org/patient-discharge",
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} ],
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"location": [ {
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"location": {
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|
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"coding": [ {
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|
"system": "http://snomed.info/sct",
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|
"code": "235919008",
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|
"display": "Cholelithiasis"
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|
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"text": "Cholelithiasis"
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|
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|
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|
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|
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|
"code": "26464-8",
|
|
"display": "Leukocytes [#/volume] in Blood"
|
|
} ],
|
|
"text": "Leukocytes [#/volume] in Blood"
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ]
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|
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|
"display": "Laboratory"
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|
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|
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|
"code": {
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|
"coding": [ {
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|
"system": "http://loinc.org",
|
|
"code": "26453-1",
|
|
"display": "Erythrocytes [#/volume] in Blood"
|
|
} ],
|
|
"text": "Erythrocytes [#/volume] in Blood"
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|
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|
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"reference": "urn:uuid:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
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|
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|
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|
"valueQuantity": {
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|
"value": 5.2635,
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|
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|
"system": "http://unitsofmeasure.org",
|
|
"code": "10*6/uL"
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|
}
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|
},
|
|
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|
|
"method": "POST",
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|
"url": "Observation"
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|
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|
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|
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|
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|
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"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:ed9f0729-d071-645f-a404-0155ed58c9e4",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "ed9f0729-d071-645f-a404-0155ed58c9e4",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
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},
|
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"encounter": {
|
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"reference": "urn:uuid:6ae1ec6e-b748-37a6-eece-c1f9799acd13"
|
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},
|
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"effectiveDateTime": "2023-01-28T12:51:47+01:00",
|
|
"issued": "2023-01-28T12:51:47.284+01:00",
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "266919005",
|
|
"display": "Never smoked tobacco (finding)"
|
|
} ],
|
|
"text": "Never smoked tobacco (finding)"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:79399b56-d863-928c-8abb-21ff4033b223",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "79399b56-d863-928c-8abb-21ff4033b223",
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"meta": {
|
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"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ]
|
|
},
|
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"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
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},
|
|
"encounter": {
|
|
"reference": "urn:uuid:6ae1ec6e-b748-37a6-eece-c1f9799acd13"
|
|
},
|
|
"effectiveDateTime": "2023-01-28T13:30:30+01:00",
|
|
"issued": "2023-01-28T13:30:30.284+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": "LA13909-9",
|
|
"display": "Somewhat"
|
|
} ],
|
|
"text": "Somewhat"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93029-7",
|
|
"display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
|
|
} ],
|
|
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA30131-9",
|
|
"display": "3 to 5 times a week"
|
|
} ],
|
|
"text": "3 to 5 times a week"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93030-5",
|
|
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
|
|
} ],
|
|
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA32-8",
|
|
"display": "No"
|
|
} ],
|
|
"text": "No"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "93031-3",
|
|
"display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
|
|
} ],
|
|
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
|
|
},
|
|
"valueCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "LA30125-1",
|
|
"display": "Food"
|
|
} ],
|
|
"text": "Food"
|
|
}
|
|
}, {
|
|
"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": 6452,
|
|
"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": "LA17849-3",
|
|
"display": "Medicaid"
|
|
} ],
|
|
"text": "Medicaid"
|
|
}
|
|
}, {
|
|
"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": "487 McKenzie Track Apt 90"
|
|
}, {
|
|
"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": 6,
|
|
"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:9f5f501d-3fd2-6600-bfa6-4bd533fa73e8",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "9f5f501d-3fd2-6600-bfa6-4bd533fa73e8",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:6ae1ec6e-b748-37a6-eece-c1f9799acd13"
|
|
},
|
|
"effectiveDateTime": "2023-01-28T13:54:19+01:00",
|
|
"issued": "2023-01-28T13:54:19.284+01:00",
|
|
"valueQuantity": {
|
|
"value": 5,
|
|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:a39bd717-f5b0-d8d6-2181-c50b0e0fec1a",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "a39bd717-f5b0-d8d6-2181-c50b0e0fec1a",
|
|
"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:d69b1a9b-e1e3-0b42-07c1-b37cae947f7f"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:6ae1ec6e-b748-37a6-eece-c1f9799acd13"
|
|
},
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|
"display": "Off Campus-Outpatient Hospital"
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|
} ]
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},
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"encounter": [ {
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|
"reference": "urn:uuid:6ae1ec6e-b748-37a6-eece-c1f9799acd13"
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} ]
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}, {
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"sequence": 2,
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
|
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"display": "Medical care"
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|
} ]
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},
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"productOrService": {
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"coding": [ {
|
|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "140",
|
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"display": "Influenza, seasonal, injectable, preservative free"
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|
} ],
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"text": "Influenza, seasonal, injectable, preservative free"
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},
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"servicedPeriod": {
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"start": "2023-01-28T12:51:47+01:00",
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"end": "2023-01-28T13:30:30+01:00"
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},
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"locationCodeableConcept": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
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"code": "19",
|
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"display": "Off Campus-Outpatient Hospital"
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} ]
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},
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"net": {
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"value": 136.00,
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"currency": "USD"
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},
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
|
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"value": 27.200000000000003,
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"currency": "USD"
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 108.80000000000001,
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"currency": "USD"
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"amount": {
|
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"value": 136.00,
|
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"currency": "USD"
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
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"display": "Line Allowed Charge Amount"
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|
} ]
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},
|
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"amount": {
|
|
"value": 136.00,
|
|
"currency": "USD"
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
|
|
"amount": {
|
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"value": 0,
|
|
"currency": "USD"
|
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
|
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} ]
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}
|
|
} ]
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|
}, {
|
|
"sequence": 3,
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"diagnosisSequence": [ 1 ],
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
|
|
"display": "Medical care"
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} ]
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},
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"productOrService": {
|
|
"coding": [ {
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|
"system": "http://snomed.info/sct",
|
|
"code": "314529007",
|
|
"display": "Medication review due (situation)"
|
|
} ],
|
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"text": "Medication review due (situation)"
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},
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"servicedPeriod": {
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"start": "2023-01-28T12:51:47+01:00",
|
|
"end": "2023-01-28T13:30:30+01:00"
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},
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"locationCodeableConcept": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
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} ]
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}
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}, {
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"sequence": 4,
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"productOrService": {
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"coding": [ {
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|
"system": "http://snomed.info/sct",
|
|
"code": "430193006",
|
|
"display": "Medication Reconciliation (procedure)"
|
|
} ],
|
|
"text": "Medication Reconciliation (procedure)"
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|
},
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"servicedPeriod": {
|
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"start": "2023-01-28T12:51:47+01:00",
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"end": "2023-01-28T13:30:30+01:00"
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},
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "19",
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"display": "Off Campus-Outpatient Hospital"
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} ]
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},
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"value": 383.98,
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},
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 76.796,
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"currency": "USD"
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 307.184,
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"currency": "USD"
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"amount": {
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"value": 383.98,
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"value": 383.98,
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"currency": "USD"
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
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"currency": "USD"
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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|
} ]
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}, {
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"sequence": 5,
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"category": {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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|
"display": "Medical care"
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|
} ]
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|
},
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"productOrService": {
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"coding": [ {
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|
"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"
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|
},
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"servicedPeriod": {
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|
"start": "2023-01-28T12:51:47+01:00",
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|
"end": "2023-01-28T13:30:30+01:00"
|
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},
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "19",
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|
"display": "Off Campus-Outpatient Hospital"
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} ]
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},
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},
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 14.916,
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"currency": "USD"
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}
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|
}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 59.664,
|
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"currency": "USD"
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"amount": {
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"value": 74.58,
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"currency": "USD"
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"value": 74.58,
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"currency": "USD"
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
|
|
"currency": "USD"
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}
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|
}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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|
"display": "Line Processing Indicator Code"
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} ]
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|
}
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|
} ]
|
|
}, {
|
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"sequence": 6,
|
|
"informationSequence": [ 3 ],
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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|
"display": "Medical care"
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|
} ]
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|
},
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|
"productOrService": {
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|
"coding": [ {
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|
"system": "http://loinc.org",
|
|
"code": "58410-2",
|
|
"display": "CBC panel - Blood by Automated count"
|
|
} ],
|
|
"text": "CBC panel - Blood by Automated count"
|
|
},
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|
"servicedPeriod": {
|
|
"start": "2023-01-28T12:51:47+01:00",
|
|
"end": "2023-01-28T13:30:30+01:00"
|
|
},
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|
"locationCodeableConcept": {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
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|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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|
},
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"net": {
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|
"value": 74.58,
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|
"currency": "USD"
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},
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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|
"display": "Line Beneficiary Coinsurance Amount"
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|
} ]
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|
},
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|
"amount": {
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|
"value": 14.916,
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|
"currency": "USD"
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|
}
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|
}, {
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"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
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|
},
|
|
"amount": {
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|
"value": 59.664,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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|
"display": "Line Submitted Charge Amount"
|
|
} ]
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|
},
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|
"amount": {
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|
"value": 74.58,
|
|
"currency": "USD"
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|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 74.58,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "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": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "710824005",
|
|
"display": "Assessment of health and social care needs (procedure)"
|
|
} ],
|
|
"text": "Assessment of health and social care needs (procedure)"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2023-01-28T12:51:47+01:00",
|
|
"end": "2023-01-28T13:30:30+01:00"
|
|
},
|
|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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|
},
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|
"net": {
|
|
"value": 431.40,
|
|
"currency": "USD"
|
|
},
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|
"adjudication": [ {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
|
|
},
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|
"amount": {
|
|
"value": 86.28,
|
|
"currency": "USD"
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|
}
|
|
}, {
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://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": [ {
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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|
} ]
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},
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"amount": {
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"value": 345.12,
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"currency": "USD"
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}
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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|
"display": "Line Submitted Charge Amount"
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|
} ]
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},
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"amount": {
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"value": 431.40,
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"currency": "USD"
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"value": 431.40,
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}, {
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
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"currency": "USD"
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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}, {
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"code": "1",
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} ]
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},
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"coding": [ {
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"system": "http://snomed.info/sct",
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"code": "454711000124102",
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} ],
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"text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)"
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},
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"end": "2023-01-28T13:30:30+01:00"
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},
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "19",
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"display": "Off Campus-Outpatient Hospital"
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} ]
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},
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"value": 431.40,
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},
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"category": {
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 86.28,
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"display": "Line Submitted Charge Amount"
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"display": "Line Allowed Charge Amount"
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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}, {
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"sequence": 15,
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"informationSequence": [ 6 ],
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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} ],
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"display": "Line Beneficiary Coinsurance Amount"
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},
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"request": {
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"method": "POST",
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"url": "Provenance"
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}
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} ]
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}
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