32155 lines
1.0 MiB
32155 lines
1.0 MiB
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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://loinc.org",
|
|
"code": "58410-2",
|
|
"display": "CBC panel - Blood by Automated count"
|
|
} ],
|
|
"text": "CBC panel - Blood by Automated count"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2000-04-29T14:12:37+02:00",
|
|
"end": "2000-04-29T14:27:37+02:00"
|
|
},
|
|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
|
|
},
|
|
"net": {
|
|
"value": 74.58,
|
|
"currency": "USD"
|
|
},
|
|
"adjudication": [ {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 14.916,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 59.664,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
|
|
"display": "Line Submitted Charge Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 74.58,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 74.58,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
} ],
|
|
"total": [ {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
|
|
"code": "submitted",
|
|
"display": "Submitted Amount"
|
|
} ],
|
|
"text": "Submitted Amount"
|
|
},
|
|
"amount": {
|
|
"value": 347.38,
|
|
"currency": "USD"
|
|
}
|
|
} ],
|
|
"payment": {
|
|
"amount": {
|
|
"value": 168.464,
|
|
"currency": "USD"
|
|
}
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "ExplanationOfBenefit"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:48a38d8d-73eb-53f4-afe8-fde0ec59c8b3",
|
|
"resource": {
|
|
"resourceType": "Encounter",
|
|
"id": "48a38d8d-73eb-53f4-afe8-fde0ec59c8b3",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
|
|
},
|
|
"identifier": [ {
|
|
"use": "official",
|
|
"system": "https://github.com/synthetichealth/synthea",
|
|
"value": "48a38d8d-73eb-53f4-afe8-fde0ec59c8b3"
|
|
} ],
|
|
"status": "finished",
|
|
"class": {
|
|
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
|
|
"code": "AMB"
|
|
},
|
|
"type": [ {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "410620009",
|
|
"display": "Well child visit (procedure)"
|
|
} ],
|
|
"text": "Well child visit (procedure)"
|
|
} ],
|
|
"subject": {
|
|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08",
|
|
"display": "Alfonzo975 Murray856 Medhurst46"
|
|
},
|
|
"participant": [ {
|
|
"type": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
|
|
"code": "PPRF",
|
|
"display": "primary performer"
|
|
} ],
|
|
"text": "primary performer"
|
|
} ],
|
|
"period": {
|
|
"start": "2000-06-03T14:12:37+02:00",
|
|
"end": "2000-06-03T14:27:37+02:00"
|
|
},
|
|
"individual": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999963595",
|
|
"display": "Dr. Aura483 Bruen238"
|
|
}
|
|
} ],
|
|
"period": {
|
|
"start": "2000-06-03T14:12:37+02:00",
|
|
"end": "2000-06-03T14:27:37+02:00"
|
|
},
|
|
"location": [ {
|
|
"location": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d7ffa620-112e-3617-bc7e-d38bebda8c49",
|
|
"display": "DRACUT FAMILY HEALTHCARE"
|
|
}
|
|
} ],
|
|
"serviceProvider": {
|
|
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|19f958ef-57cf-33c1-b068-14b32a980813",
|
|
"display": "DRACUT FAMILY HEALTHCARE"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Encounter"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:ac1ac915-80f7-d2bf-9d85-44f3ff815828",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "ac1ac915-80f7-d2bf-9d85-44f3ff815828",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "vital-signs",
|
|
"display": "Vital signs"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "8302-2",
|
|
"display": "Body Height"
|
|
} ],
|
|
"text": "Body Height"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:48a38d8d-73eb-53f4-afe8-fde0ec59c8b3"
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|
},
|
|
"effectiveDateTime": "2000-06-03T14:12:37+02:00",
|
|
"issued": "2000-06-03T14:12:37.471+02:00",
|
|
"valueQuantity": {
|
|
"value": 55.1,
|
|
"unit": "cm",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "cm"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:b92357e1-2bb8-8ce0-5781-1be434a93759",
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|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "b92357e1-2bb8-8ce0-5781-1be434a93759",
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|
"status": "final",
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|
"category": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "vital-signs",
|
|
"display": "Vital signs"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "72514-3",
|
|
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
|
|
} ],
|
|
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:48a38d8d-73eb-53f4-afe8-fde0ec59c8b3"
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|
},
|
|
"effectiveDateTime": "2000-06-03T14:12:37+02:00",
|
|
"issued": "2000-06-03T14:12:37.471+02:00",
|
|
"valueQuantity": {
|
|
"value": 4,
|
|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:967bf76f-b9b6-6df6-4053-9afd5c84d47a",
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|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "967bf76f-b9b6-6df6-4053-9afd5c84d47a",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "vital-signs",
|
|
"display": "Vital signs"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "29463-7",
|
|
"display": "Body Weight"
|
|
} ],
|
|
"text": "Body Weight"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:48a38d8d-73eb-53f4-afe8-fde0ec59c8b3"
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|
},
|
|
"effectiveDateTime": "2000-06-03T14:12:37+02:00",
|
|
"issued": "2000-06-03T14:12:37.471+02:00",
|
|
"valueQuantity": {
|
|
"value": 5.2,
|
|
"unit": "kg",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:2ee88fd6-ca7c-e944-2379-fdab8205607b",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "2ee88fd6-ca7c-e944-2379-fdab8205607b",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-height" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "vital-signs",
|
|
"display": "Vital signs"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "77606-2",
|
|
"display": "Weight-for-length Per age and sex"
|
|
} ],
|
|
"text": "Weight-for-length Per age and sex"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:48a38d8d-73eb-53f4-afe8-fde0ec59c8b3"
|
|
},
|
|
"effectiveDateTime": "2000-06-03T14:12:37+02:00",
|
|
"issued": "2000-06-03T14:12:37.471+02:00",
|
|
"valueQuantity": {
|
|
"value": 83.356,
|
|
"unit": "%",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "%"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:dcaf6df1-9ece-573b-d417-d4051754ff83",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "dcaf6df1-9ece-573b-d417-d4051754ff83",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "vital-signs",
|
|
"display": "Vital signs"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "8289-1",
|
|
"display": "Head Occipital-frontal circumference Percentile"
|
|
} ],
|
|
"text": "Head Occipital-frontal circumference Percentile"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:48a38d8d-73eb-53f4-afe8-fde0ec59c8b3"
|
|
},
|
|
"effectiveDateTime": "2000-06-03T14:12:37+02:00",
|
|
"issued": "2000-06-03T14:12:37.471+02:00",
|
|
"valueQuantity": {
|
|
"value": 29.62,
|
|
"unit": "%",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "%"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:18d0ff22-6d28-86f3-9c45-43af2b9c1da1",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "18d0ff22-6d28-86f3-9c45-43af2b9c1da1",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "vital-signs",
|
|
"display": "Vital signs"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "9843-4",
|
|
"display": "Head Occipital-frontal circumference"
|
|
} ],
|
|
"text": "Head Occipital-frontal circumference"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:48a38d8d-73eb-53f4-afe8-fde0ec59c8b3"
|
|
},
|
|
"effectiveDateTime": "2000-06-03T14:12:37+02:00",
|
|
"issued": "2000-06-03T14:12:37.471+02:00",
|
|
"valueQuantity": {
|
|
"value": 38.32,
|
|
"unit": "cm",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "cm"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:9ab28f87-b930-7c2f-b5f3-944b0ec2dd42",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "9ab28f87-b930-7c2f-b5f3-944b0ec2dd42",
|
|
"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:cab042ec-9851-e5ed-80c8-0952376f5b08"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:48a38d8d-73eb-53f4-afe8-fde0ec59c8b3"
|
|
},
|
|
"effectiveDateTime": "2000-06-03T14:12:37+02:00",
|
|
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|
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} ],
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"system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
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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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},
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|
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|
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|
} ],
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"text": "Hib (PRP-OMP)"
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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": 136.00,
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"currency": "USD"
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"category": {
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"coding": [ {
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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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"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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"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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"value": 0,
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"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_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": 3,
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"informationSequence": [ 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": [ {
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"system": "http://hl7.org/fhir/sid/cvx",
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"code": "10",
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"display": "IPV"
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} ],
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"text": "IPV"
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},
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"servicedPeriod": {
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|
"start": "2000-08-05T14:12:37+02:00",
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"end": "2000-08-05T14:27:37+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": "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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|
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|
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|
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"code": "social-history",
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|
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|
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|
} ],
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"reference": "urn:uuid:7eca8871-5d5f-0f98-b2f4-2575f6df06d6"
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}
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} ],
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"reference": "urn:uuid:d087f9d1-844c-b94a-0ec1-be709d987ff5"
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}
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} ],
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}
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} ],
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"productOrService": {
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"system": "http://snomed.info/sct",
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"code": "410620009",
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} ],
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"text": "Well child visit (procedure)"
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},
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"reference": "urn:uuid:27da5ed2-6d19-88db-171c-7d9ed01396b7"
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} ]
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}, {
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"system": "http://hl7.org/fhir/sid/cvx",
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"code": "10",
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} ],
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},
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}
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}, {
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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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},
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"value": 136.00,
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}
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}, {
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"system": "http://hl7.org/fhir/sid/cvx",
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"code": "20",
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} ],
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},
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"value": 136.00,
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}
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}, {
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"sequence": 5,
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"system": "http://hl7.org/fhir/sid/cvx",
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"code": "08",
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} ],
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},
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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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"coding": [ {
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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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"net": {
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"value": 484.47,
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}
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} ],
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"total": {
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"value": 1165.27,
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}
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},
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"request": {
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"method": "POST",
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"url": "Claim"
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}
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}, {
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"fullUrl": "urn:uuid:1e6c3f80-7489-5537-03e5-22e32a1e18bf",
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"resource": {
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"resourceType": "ExplanationOfBenefit",
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"id": "1e6c3f80-7489-5537-03e5-22e32a1e18bf",
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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:cab042ec-9851-e5ed-80c8-0952376f5b08"
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},
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"requester": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999963595"
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},
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"performer": [ {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999963595"
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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": "NO_INSURANCE"
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},
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"beneficiary": {
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"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
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},
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|
"payor": [ {
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|
"display": "NO_INSURANCE"
|
|
} ]
|
|
} ],
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"identifier": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
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"value": "98288b7b-f73c-34a3-0230-6dc9748957bf"
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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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"patient": {
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},
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"end": "2002-01-06T13:27:37+01:00"
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},
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"created": "2001-01-06T13:27:37+01:00",
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"insurer": {
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"display": "NO_INSURANCE"
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|
},
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"provider": {
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|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999963595"
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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|d7ffa620-112e-3617-bc7e-d38bebda8c49",
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|
"display": "DRACUT FAMILY HEALTHCARE"
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},
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"claim": {
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|
"reference": "urn:uuid:98288b7b-f73c-34a3-0230-6dc9748957bf"
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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|9999963595"
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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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|
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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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"encounter": [ {
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} ]
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|
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|
} ]
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},
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"productOrService": {
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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": "19",
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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_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": 27.200000000000003,
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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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|
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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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|
"amount": {
|
|
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|
|
"currency": "USD"
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}
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|
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|
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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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|
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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": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"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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|
|
"display": "Medical care"
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|
} ]
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|
},
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"productOrService": {
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|
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|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
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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": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
|
|
},
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|
"amount": {
|
|
"value": 27.200000000000003,
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|
"currency": "USD"
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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_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
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|
},
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|
"amount": {
|
|
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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/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
|
|
"display": "Line Submitted Charge Amount"
|
|
} ]
|
|
},
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|
"amount": {
|
|
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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",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
|
|
},
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|
"amount": {
|
|
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|
|
"currency": "USD"
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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_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible 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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|
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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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|
|
"category": {
|
|
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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": {
|
|
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|
|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "20",
|
|
"display": "DTaP"
|
|
} ],
|
|
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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://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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|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
},
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|
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|
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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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|
}, {
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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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|
"currency": "USD"
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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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"currency": "USD"
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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": 136.00,
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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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}
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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": 5,
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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": "08",
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"display": "Hep B, adolescent or pediatric"
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} ],
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"text": "Hep B, adolescent or pediatric"
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},
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"start": "2001-01-06T13:12:37+01:00",
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"end": "2001-01-06T13:27:37+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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"net": {
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"value": 136.00,
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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": 27.200000000000003,
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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": 108.80000000000001,
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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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_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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"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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"coding": [ {
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"system": "http://snomed.info/sct",
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"code": "430193006",
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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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} ],
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},
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999963595",
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"display": "DRACUT FAMILY HEALTHCARE"
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},
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|
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"code": "confirmed"
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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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"code": {
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|
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|
"system": "http://loinc.org",
|
|
"code": "8302-2",
|
|
"display": "Body Height"
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|
} ],
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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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|
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
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|
} ],
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|
"text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
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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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|
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|
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|
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|
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|
} ],
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} ],
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|
"text": "Seizure disorder"
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},
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"servicedPeriod": {
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"start": "2001-04-25T14:12:37+02:00",
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"end": "2001-04-25T15:21:24+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": "20",
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"display": "Urgent Care Facility"
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} ]
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}
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}, {
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"sequence": 3,
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"diagnosisSequence": [ 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://snomed.info/sct",
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"code": "703151001",
|
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"display": "History of single seizure (situation)"
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|
} ],
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"text": "History of single seizure (situation)"
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},
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"servicedPeriod": {
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"start": "2001-04-25T14:12:37+02:00",
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"end": "2001-04-25T15:21:24+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": "20",
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"display": "Urgent Care Facility"
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} ]
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}
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}, {
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"sequence": 4,
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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://snomed.info/sct",
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"code": "54550000",
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|
"display": "Electroencephalogram (procedure)"
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} ],
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"text": "Electroencephalogram (procedure)"
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},
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"servicedPeriod": {
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"start": "2001-04-25T14:12:37+02:00",
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"end": "2001-04-25T15:21:24+02:00"
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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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"display": "Urgent Care Facility"
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} ]
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},
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"value": 8051.44,
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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": 1610.288,
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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": 6441.152,
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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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"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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"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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"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": 8197.62,
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}
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} ],
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}
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},
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"method": "POST",
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}
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}, {
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"fullUrl": "urn:uuid:cdca2cd8-2fa2-b095-097f-1f77e126e517",
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"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",
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"system": "https://github.com/synthetichealth/synthea",
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"code": "EMER"
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},
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"system": "http://snomed.info/sct",
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"code": "50849002",
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} ],
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"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
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},
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"individual": {
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},
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"system": "http://snomed.info/sct",
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"location": {
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"display": "LOWELL COMMUNITY HEALTH CENTER"
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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": "198405",
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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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|
"resourceType": "Coverage",
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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://terminology.hl7.org/CodeSystem/claim-type",
|
|
"code": "institutional"
|
|
} ]
|
|
},
|
|
"use": "claim",
|
|
"patient": {
|
|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
|
|
},
|
|
"billablePeriod": {
|
|
"start": "2001-05-24T14:27:37+02:00",
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|
"end": "2002-05-24T14:27:37+02:00"
|
|
},
|
|
"created": "2001-05-24T14:27:37+02:00",
|
|
"insurer": {
|
|
"display": "Medicare"
|
|
},
|
|
"provider": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999903195"
|
|
},
|
|
"referral": {
|
|
"reference": "#referral"
|
|
},
|
|
"facility": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|8c400ba1-0320-32b3-816f-733cbacc03a7",
|
|
"display": "19 VARNUM STREET OPERATING COMPANY, LLC"
|
|
},
|
|
"claim": {
|
|
"reference": "urn:uuid:62837e84-0abc-b9d6-5921-7927dc585abe"
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|
},
|
|
"outcome": "complete",
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|
"careTeam": [ {
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|
"sequence": 1,
|
|
"provider": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999903195"
|
|
},
|
|
"role": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
|
|
"code": "primary",
|
|
"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:ba260d1c-7516-4fd7-3934-744bc664171a"
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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",
|
|
"code": "principal"
|
|
} ]
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|
} ]
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|
} ],
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|
"insurance": [ {
|
|
"focal": true,
|
|
"coverage": {
|
|
"reference": "#coverage",
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|
"display": "Medicare"
|
|
}
|
|
} ],
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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": {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
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|
"code": "449411000124106",
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|
"display": "Admission to skilled nursing facility (procedure)"
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|
} ],
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|
"text": "Admission to skilled nursing facility (procedure)"
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|
},
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|
"servicedPeriod": {
|
|
"start": "2001-05-08T14:12:37+02:00",
|
|
"end": "2001-05-24T14:27:37+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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|
"encounter": [ {
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|
"reference": "urn:uuid:d6d2f70a-b396-ca71-33a2-7604769b3f28"
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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": "25675004",
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|
"display": "Patient transfer to skilled nursing facility (procedure)"
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|
} ],
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|
"text": "Patient transfer to skilled nursing facility (procedure)"
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|
},
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|
"servicedPeriod": {
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|
"start": "2001-05-08T14:12:37+02:00",
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|
"end": "2001-05-24T14:27:37+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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}, {
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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": "63332003",
|
|
"display": "History AND physical examination (procedure)"
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|
} ],
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|
"text": "History AND physical examination (procedure)"
|
|
},
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|
"servicedPeriod": {
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|
"start": "2001-05-08T14:12:37+02:00",
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|
"end": "2001-05-24T14:27:37+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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"net": {
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"value": 431.40,
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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": 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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"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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"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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"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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"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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"sequence": 4,
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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://snomed.info/sct",
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|
"code": "315639002",
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|
"display": "Initial patient assessment (procedure)"
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|
} ],
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|
"text": "Initial patient assessment (procedure)"
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|
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|
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"end": "2001-05-24T14:27:37+02:00"
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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": "21",
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|
"display": "Inpatient Hospital"
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|
} ]
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|
},
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|
"value": 431.40,
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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": 86.28,
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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": 345.12,
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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_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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"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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"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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"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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|
"sequence": 5,
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|
"informationSequence": [ 1 ],
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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://snomed.info/sct",
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|
"code": "228869008",
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|
"display": "Manual wheelchair (physical object)"
|
|
} ],
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|
"text": "Manual wheelchair (physical object)"
|
|
},
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|
"servicedPeriod": {
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|
"start": "2001-05-08T14:12:37+02:00",
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|
"end": "2001-05-24T14:27:37+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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},
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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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}
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|
}, {
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"category": {
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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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|
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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_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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|
"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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|
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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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|
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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_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": 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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|
"productOrService": {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
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|
"code": "370789001",
|
|
"display": "Development of individualized plan of care (procedure)"
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|
} ],
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|
"text": "Development of individualized plan of care (procedure)"
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|
},
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|
"servicedPeriod": {
|
|
"start": "2001-05-08T14:12:37+02:00",
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|
"end": "2001-05-24T14:27:37+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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|
"net": {
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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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|
"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": 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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"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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"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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"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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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Processing Indicator Code"
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"display": "Line Processing Indicator Code"
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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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"display": "Vital signs"
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} ]
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} ],
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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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} ],
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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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"system": "http://loinc.org",
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"code": "29463-7",
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"display": "Body Weight"
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} ],
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},
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"code": "77606-2",
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"system": "http://snomed.info/sct",
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"resourceType": "Immunization",
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},
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}
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"resourceType": "DiagnosticReport",
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"code": "34117-2",
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"system": "http://loinc.org",
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"code": "51847-2",
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} ]
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} ],
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"value": "4b0ad948-3798-93c6-15c5-4bccd2e87159"
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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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},
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},
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},
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"facility": {
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"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d7ffa620-112e-3617-bc7e-d38bebda8c49",
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"display": "DRACUT FAMILY HEALTHCARE"
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},
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"reference": "urn:uuid:4b0ad948-3798-93c6-15c5-4bccd2e87159"
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},
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"outcome": "complete",
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"provider": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999963595"
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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": "Medicare"
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}
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} ],
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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": "410620009",
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"display": "Well child visit (procedure)"
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} ],
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"text": "Well child visit (procedure)"
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},
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"servicedPeriod": {
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"end": "2001-10-06T14:27:37+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": "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:72f91a7b-c6ed-4c2f-51c1-ab9c12a4d811"
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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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"productOrService": {
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"coding": [ {
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|
"system": "http://hl7.org/fhir/sid/cvx",
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|
"code": "20",
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|
"display": "DTaP"
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|
} ],
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"text": "DTaP"
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|
},
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"servicedPeriod": {
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|
"start": "2001-10-06T14:12:37+02:00",
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"end": "2001-10-06T14:27:37+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": "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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|
"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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"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",
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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": 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",
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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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|
"total": [ {
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|
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"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight" ]
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},
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"code": "vital-signs",
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"display": "Vital signs"
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} ],
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|
"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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"code": "77606-2",
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"display": "Weight-for-length Per age and sex"
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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/head-occipital-frontal-circumference-percentile" ]
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},
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"code": "vital-signs",
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} ],
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|
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|
"code": "8289-1",
|
|
"display": "Head Occipital-frontal circumference Percentile"
|
|
} ],
|
|
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},
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"code": "%"
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|
}
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},
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"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ]
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|
},
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} ],
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"code": "9843-4",
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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": "39156-5",
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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-blood-pressure" ]
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},
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|
"code": "vital-signs",
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|
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|
} ],
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|
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|
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|
"code": "85354-9",
|
|
"display": "Blood pressure panel with all children optional"
|
|
} ],
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|
},
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|
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|
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|
"code": "8480-6",
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|
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|
} ],
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|
"value": 107,
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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-respiratory-rate" ]
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|
},
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"code": "vital-signs",
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|
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|
} ],
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|
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"system": "http://loinc.org",
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|
"code": "9279-1",
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|
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|
|
} ],
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"text": "Respiratory rate"
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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-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ]
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|
},
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"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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"code": "social-history",
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|
"display": "Social history"
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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": "72166-2",
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|
"display": "Tobacco smoking status"
|
|
} ],
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|
"text": "Tobacco smoking status"
|
|
},
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|
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|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
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"issued": "2003-04-05T14:12:37.471+02:00",
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"coding": [ {
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|
"system": "http://snomed.info/sct",
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|
"code": "266919005",
|
|
"display": "Never smoked tobacco (finding)"
|
|
} ],
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|
"text": "Never smoked tobacco (finding)"
|
|
}
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|
},
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|
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|
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|
"url": "Observation"
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}
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|
"fullUrl": "urn:uuid:f1e2fe36-5cca-bc9f-3575-0f2755276ca7",
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|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ]
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},
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"status": "completed",
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"code": {
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|
"coding": [ {
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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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"text": "Medication Reconciliation (procedure)"
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},
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"subject": {
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},
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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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},
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"value": 111.748,
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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": 446.992,
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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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"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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"text": "Submitted Amount"
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},
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"value": 831.54,
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"currency": "USD"
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}
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} ],
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"value": 555.792,
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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:937011d4-0abd-bbb4-7960-2c60b1e9fce4",
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},
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"code": "AMB"
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},
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"system": "http://snomed.info/sct",
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|
"code": "410620009",
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|
"display": "Well child visit (procedure)"
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|
} ],
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"text": "Well child visit (procedure)"
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} ],
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"subject": {
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"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08",
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"display": "Alfonzo975 Murray856 Medhurst46"
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},
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"type": [ {
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"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
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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|9999963595",
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"display": "Dr. Aura483 Bruen238"
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}
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} ],
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"period": {
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"location": [ {
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"location": {
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"reference": "Location?identifier=https://github.com/synthetichealth/synthea|d7ffa620-112e-3617-bc7e-d38bebda8c49",
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"display": "DRACUT FAMILY HEALTHCARE"
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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|19f958ef-57cf-33c1-b068-14b32a980813",
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"display": "DRACUT FAMILY HEALTHCARE"
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}
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"request": {
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"method": "POST",
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"code": "confirmed"
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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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|
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|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ]
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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": "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": "8289-1",
|
|
"display": "Head Occipital-frontal circumference Percentile"
|
|
} ],
|
|
"text": "Head Occipital-frontal circumference Percentile"
|
|
},
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|
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|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
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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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|
|
"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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"id": "f8c307f3-cffd-1f9e-01d5-6532751e2fb9",
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"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ]
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|
},
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|
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|
|
"category": [ {
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|
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|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"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": "9843-4",
|
|
"display": "Head Occipital-frontal circumference"
|
|
} ],
|
|
"text": "Head Occipital-frontal circumference"
|
|
},
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|
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|
"reference": "urn:uuid:cab042ec-9851-e5ed-80c8-0952376f5b08"
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|
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|
"valueQuantity": {
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|
"value": 48.8,
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|
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|
"code": "cm"
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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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"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:cab042ec-9851-e5ed-80c8-0952376f5b08"
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},
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"billablePeriod": {
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"start": "2003-10-04T14:27:37+02:00",
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"end": "2004-10-04T14:27:37+02:00"
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},
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"created": "2003-10-04T14:27:37+02:00",
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"insurer": {
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"display": "NO_INSURANCE"
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},
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"provider": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999963595"
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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|d7ffa620-112e-3617-bc7e-d38bebda8c49",
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"display": "DRACUT FAMILY HEALTHCARE"
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},
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"claim": {
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"reference": "urn:uuid:d6391dea-6edd-d9b5-e8e5-958c5e178b8c"
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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|9999963595"
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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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"reference": "urn:uuid:0758e514-9fab-3195-5f50-b711a4b9695d"
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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": [ {
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"focal": true,
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"coverage": {
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"reference": "#coverage",
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"display": "NO_INSURANCE"
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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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"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": "410620009",
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"display": "Well child visit (procedure)"
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} ],
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"text": "Well child visit (procedure)"
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},
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"servicedPeriod": {
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"start": "2003-10-04T14:12:37+02:00",
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"end": "2003-10-04T14:27:37+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": "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:937011d4-0abd-bbb4-7960-2c60b1e9fce4"
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} ]
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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": "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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"servicedPeriod": {
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"start": "2003-10-04T14:12:37+02:00",
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"end": "2003-10-04T14:27:37+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": "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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"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": "430193006",
|
|
"display": "Medication Reconciliation (procedure)"
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} ],
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"text": "Medication Reconciliation (procedure)"
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},
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"servicedPeriod": {
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"start": "2003-10-04T14:12:37+02:00",
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"end": "2003-10-04T14:27:37+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": "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": 586.12,
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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": 117.224,
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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": 468.896,
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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": 586.12,
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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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} ],
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"text": "Submitted Amount"
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},
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"request": {
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},
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"display": "Line Submitted Charge Amount"
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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": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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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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"display": "Line Submitted Charge Amount"
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"reference": "urn:uuid:187e3a4f-2227-0f47-ae8d-7e9c1ecf3a45"
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}, {
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"reference": "urn:uuid:b486bbce-87c6-048d-03b7-34ee44e07919"
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"reference": "urn:uuid:fd0d1b44-9286-611f-eb45-9dc9180cba99"
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"reference": "urn:uuid:6bdac2f1-2b8b-d703-3af9-7c038789f7ab"
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"reference": "urn:uuid:c11cbca1-8c8c-5289-5761-5e050e9ea492"
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"reference": "urn:uuid:007af4cb-4de1-84b3-b705-514b48c402cc"
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"reference": "urn:uuid:b66175be-5dd7-d060-ed40-32c4b3c8ccde"
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}, {
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"reference": "urn:uuid:17c5a219-351c-65ac-e1ed-3061138c5a57"
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}, {
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"reference": "urn:uuid:5c42213a-f9a1-0509-857b-5dea15d462ba"
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}, {
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"reference": "urn:uuid:b1de119e-e94e-e485-4ccb-9ae8b3345d67"
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}, {
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"reference": "urn:uuid:1dfe75a7-c835-3273-f896-709bb798d493"
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"reference": "urn:uuid:8be5047a-4bc3-7178-ea1d-e8e9c6025371"
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}, {
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"reference": "urn:uuid:46e02280-5f67-2f96-f873-4fe19079800e"
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}, {
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"reference": "urn:uuid:a9a46542-d06f-7087-4285-21734138f747"
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}, {
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"reference": "urn:uuid:7ea0b7b1-7959-0b51-ec08-f733adbc9c13"
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}, {
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"reference": "urn:uuid:6daaa2af-8c5d-82a0-a108-53d8c59a31bc"
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}, {
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"reference": "urn:uuid:1d8db6e5-0adc-3937-0306-987ff8658301"
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}, {
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"reference": "urn:uuid:69ab7a8b-b223-77e4-a702-0ef67e98b0ad"
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"reference": "urn:uuid:6a7cd6cb-e7e5-17ad-f8b6-09324a1d9604"
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} ],
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"recorded": "2004-04-24T14:12:37.471+02:00",
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"agent": [ {
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"type": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
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"code": "author",
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"display": "Author"
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} ],
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"text": "Author"
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},
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"who": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999963595",
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"display": "Dr. Aura483 Bruen238"
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},
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"onBehalfOf": {
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"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|19f958ef-57cf-33c1-b068-14b32a980813",
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"display": "DRACUT FAMILY HEALTHCARE"
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}
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}, {
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"type": {
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"coding": [ {
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"system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type",
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"code": "transmitter",
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"display": "Transmitter"
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} ],
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"text": "Transmitter"
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},
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"who": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999963595",
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"display": "Dr. Aura483 Bruen238"
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},
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"onBehalfOf": {
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"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|19f958ef-57cf-33c1-b068-14b32a980813",
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"display": "DRACUT FAMILY HEALTHCARE"
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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": "Provenance"
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|
}
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} ]
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}
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