16147 lines
520 KiB
JSON
16147 lines
520 KiB
JSON
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|
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "58410-2",
|
|
"display": "CBC panel - Blood by Automated count"
|
|
} ],
|
|
"text": "CBC panel - Blood by Automated count"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2021-03-03T00:31:56+01:00",
|
|
"end": "2021-03-03T00:46:56+01:00"
|
|
},
|
|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
|
|
},
|
|
"net": {
|
|
"value": 74.58,
|
|
"currency": "USD"
|
|
},
|
|
"adjudication": [ {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 14.916,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 59.664,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
|
|
"display": "Line Submitted Charge Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 74.58,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 74.58,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
} ],
|
|
"total": [ {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
|
|
"code": "submitted",
|
|
"display": "Submitted Amount"
|
|
} ],
|
|
"text": "Submitted Amount"
|
|
},
|
|
"amount": {
|
|
"value": 347.38,
|
|
"currency": "USD"
|
|
}
|
|
} ],
|
|
"payment": {
|
|
"amount": {
|
|
"value": 168.464,
|
|
"currency": "USD"
|
|
}
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "ExplanationOfBenefit"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b",
|
|
"resource": {
|
|
"resourceType": "Encounter",
|
|
"id": "32f2c544-f292-bddd-61e7-59fc9160551b",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
|
|
},
|
|
"identifier": [ {
|
|
"use": "official",
|
|
"system": "https://github.com/synthetichealth/synthea",
|
|
"value": "32f2c544-f292-bddd-61e7-59fc9160551b"
|
|
} ],
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e",
|
|
"display": "Armand155 Wilkinson796"
|
|
},
|
|
"participant": [ {
|
|
"type": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
|
|
"code": "PPRF",
|
|
"display": "primary performer"
|
|
} ],
|
|
"text": "primary performer"
|
|
} ],
|
|
"period": {
|
|
"start": "2021-04-07T01:31:56+02:00",
|
|
"end": "2021-04-07T01:46:56+02:00"
|
|
},
|
|
"individual": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099",
|
|
"display": "Dr. Pamelia915 Kilback373"
|
|
}
|
|
} ],
|
|
"period": {
|
|
"start": "2021-04-07T01:31:56+02:00",
|
|
"end": "2021-04-07T01:46:56+02:00"
|
|
},
|
|
"location": [ {
|
|
"location": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1",
|
|
"display": "ONE CALL HEALTHCARE PLLC"
|
|
}
|
|
} ],
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|
"serviceProvider": {
|
|
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3",
|
|
"display": "ONE CALL HEALTHCARE PLLC"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Encounter"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:997b6ee6-7ff2-52c5-2f33-6fa215568031",
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|
"resource": {
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|
"resourceType": "Observation",
|
|
"id": "997b6ee6-7ff2-52c5-2f33-6fa215568031",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
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|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "vital-signs",
|
|
"display": "Vital signs"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "8302-2",
|
|
"display": "Body Height"
|
|
} ],
|
|
"text": "Body Height"
|
|
},
|
|
"subject": {
|
|
"reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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|
},
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|
"encounter": {
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|
"reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b"
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|
},
|
|
"effectiveDateTime": "2021-04-07T01:31:56+02:00",
|
|
"issued": "2021-04-07T01:31:56.064+02:00",
|
|
"valueQuantity": {
|
|
"value": 56.1,
|
|
"unit": "cm",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "cm"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:d9e98df6-c845-ecbf-2e90-263f94a57f47",
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"resource": {
|
|
"resourceType": "Observation",
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|
"id": "d9e98df6-c845-ecbf-2e90-263f94a57f47",
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"status": "final",
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"category": [ {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b"
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|
},
|
|
"effectiveDateTime": "2021-04-07T01:31:56+02:00",
|
|
"issued": "2021-04-07T01:31:56.064+02:00",
|
|
"valueQuantity": {
|
|
"value": 1,
|
|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:4937034f-6635-7663-272e-8f543a91f98a",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "4937034f-6635-7663-272e-8f543a91f98a",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b"
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|
},
|
|
"effectiveDateTime": "2021-04-07T01:31:56+02:00",
|
|
"issued": "2021-04-07T01:31:56.064+02:00",
|
|
"valueQuantity": {
|
|
"value": 5,
|
|
"unit": "kg",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:879e1e02-d979-0909-d5bb-7f6184ce7075",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "879e1e02-d979-0909-d5bb-7f6184ce7075",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b"
|
|
},
|
|
"effectiveDateTime": "2021-04-07T01:31:56+02:00",
|
|
"issued": "2021-04-07T01:31:56.064+02:00",
|
|
"valueQuantity": {
|
|
"value": 51.817,
|
|
"unit": "%",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "%"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:9e2e298a-2f5e-b724-7e99-089333c472b4",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "9e2e298a-2f5e-b724-7e99-089333c472b4",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b"
|
|
},
|
|
"effectiveDateTime": "2021-04-07T01:31:56+02:00",
|
|
"issued": "2021-04-07T01:31:56.064+02:00",
|
|
"valueQuantity": {
|
|
"value": 43.17,
|
|
"unit": "%",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "%"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:31dbbbf9-da1c-52e2-f537-1b4b07a08343",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "31dbbbf9-da1c-52e2-f537-1b4b07a08343",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b"
|
|
},
|
|
"effectiveDateTime": "2021-04-07T01:31:56+02:00",
|
|
"issued": "2021-04-07T01:31:56.064+02:00",
|
|
"valueQuantity": {
|
|
"value": 38.93,
|
|
"unit": "cm",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "cm"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:331ccbdb-1c6a-05f9-8654-d6e5bd7d790e",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "331ccbdb-1c6a-05f9-8654-d6e5bd7d790e",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:32f2c544-f292-bddd-61e7-59fc9160551b"
|
|
},
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} ]
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"resourceType": "Coverage",
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"type": {
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"text": "Humana"
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} ]
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} ],
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"value": "18b9250f-62dc-e368-5dc1-bf9e3922811d"
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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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"code": "professional"
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"display": "ONE CALL HEALTHCARE PLLC"
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} ],
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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} ],
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} ]
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} ]
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},
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|
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|
"code": "77606-2",
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|
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|
} ],
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"method": "POST",
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"url": "Observation"
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}
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},
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"status": "final",
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"code": "vital-signs",
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} ],
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"coding": [ {
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"system": "http://loinc.org",
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"code": "8289-1",
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"display": "Head Occipital-frontal circumference Percentile"
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|
} ],
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"text": "Head Occipital-frontal circumference Percentile"
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},
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"reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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"code": "%"
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}
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},
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},
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} ],
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} ],
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},
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}
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},
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"url": "Observation"
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}
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}, {
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"fullUrl": "urn:uuid:3c6617e5-5ee8-2192-ec7d-0dd0790b9418",
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"id": "3c6617e5-5ee8-2192-ec7d-0dd0790b9418",
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"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ]
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},
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"status": "final",
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"code": "vital-signs",
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} ]
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} ],
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"code": {
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"system": "http://loinc.org",
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"code": "85354-9",
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} ],
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},
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} ],
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"system": "http://unitsofmeasure.org",
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"code": "8480-6",
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"value": 124,
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}
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} ]
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},
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},
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},
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} ],
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},
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},
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"system": "http://snomed.info/sct",
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} ],
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}
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},
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},
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|
"status": "active",
|
|
"type": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
|
|
"code": "professional"
|
|
} ]
|
|
},
|
|
"use": "claim",
|
|
"patient": {
|
|
"reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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|
},
|
|
"billablePeriod": {
|
|
"start": "2021-06-09T01:46:56+02:00",
|
|
"end": "2022-06-09T01:46:56+02:00"
|
|
},
|
|
"created": "2021-06-09T01:46:56+02:00",
|
|
"insurer": {
|
|
"display": "Humana"
|
|
},
|
|
"provider": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099"
|
|
},
|
|
"referral": {
|
|
"reference": "#referral"
|
|
},
|
|
"facility": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1",
|
|
"display": "ONE CALL HEALTHCARE PLLC"
|
|
},
|
|
"claim": {
|
|
"reference": "urn:uuid:8925f8b1-3a8c-e9ea-c5f4-9f8e21e6e4c8"
|
|
},
|
|
"outcome": "complete",
|
|
"careTeam": [ {
|
|
"sequence": 1,
|
|
"provider": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099"
|
|
},
|
|
"role": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
|
|
"code": "primary",
|
|
"display": "Primary provider"
|
|
} ]
|
|
}
|
|
} ],
|
|
"insurance": [ {
|
|
"focal": true,
|
|
"coverage": {
|
|
"reference": "#coverage",
|
|
"display": "Humana"
|
|
}
|
|
} ],
|
|
"item": [ {
|
|
"sequence": 1,
|
|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "410620009",
|
|
"display": "Well child visit (procedure)"
|
|
} ],
|
|
"text": "Well child visit (procedure)"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2021-06-09T01:31:56+02:00",
|
|
"end": "2021-06-09T01:46:56+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",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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|
},
|
|
"encounter": [ {
|
|
"reference": "urn:uuid:f7f74f24-035a-5ced-7cc3-d814d0e1eb11"
|
|
} ]
|
|
}, {
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|
"sequence": 2,
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|
"informationSequence": [ 1 ],
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "49",
|
|
"display": "Hib (PRP-OMP)"
|
|
} ],
|
|
"text": "Hib (PRP-OMP)"
|
|
},
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|
"servicedPeriod": {
|
|
"start": "2021-06-09T01:31:56+02:00",
|
|
"end": "2021-06-09T01:46:56+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",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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|
},
|
|
"net": {
|
|
"value": 136.00,
|
|
"currency": "USD"
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|
},
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"adjudication": [ {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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|
"display": "Line Beneficiary Coinsurance Amount"
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|
} ]
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|
},
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|
"amount": {
|
|
"value": 27.200000000000003,
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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_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
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|
},
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|
"amount": {
|
|
"value": 108.80000000000001,
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|
"currency": "USD"
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|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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|
"display": "Line Submitted Charge Amount"
|
|
} ]
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|
},
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|
"amount": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
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|
},
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|
"amount": {
|
|
"value": 136.00,
|
|
"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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|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
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|
}, {
|
|
"sequence": 3,
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|
"informationSequence": [ 2 ],
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
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|
},
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|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "119",
|
|
"display": "rotavirus, monovalent"
|
|
} ],
|
|
"text": "rotavirus, monovalent"
|
|
},
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|
"servicedPeriod": {
|
|
"start": "2021-06-09T01:31:56+02:00",
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|
"end": "2021-06-09T01:46:56+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",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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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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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
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|
},
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|
"amount": {
|
|
"value": 108.80000000000001,
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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_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": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
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|
},
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|
"amount": {
|
|
"value": 136.00,
|
|
"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",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
}, {
|
|
"sequence": 4,
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|
"informationSequence": [ 3 ],
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
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|
},
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|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "10",
|
|
"display": "IPV"
|
|
} ],
|
|
"text": "IPV"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2021-06-09T01:31:56+02:00",
|
|
"end": "2021-06-09T01:46:56+02:00"
|
|
},
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|
"locationCodeableConcept": {
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|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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|
},
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|
"net": {
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|
"value": 136.00,
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|
"currency": "USD"
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},
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"adjudication": [ {
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"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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|
"display": "Line Beneficiary Coinsurance Amount"
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|
} ]
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|
},
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|
"amount": {
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|
"value": 27.200000000000003,
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|
"currency": "USD"
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}
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|
}, {
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"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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|
"display": "Line Provider Payment Amount"
|
|
} ]
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|
},
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|
"amount": {
|
|
"value": 108.80000000000001,
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|
"currency": "USD"
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}
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|
}, {
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"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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|
"display": "Line Submitted Charge Amount"
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|
} ]
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},
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"amount": {
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|
"value": 136.00,
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"currency": "USD"
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}
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|
}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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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",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
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|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
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|
}, {
|
|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
}, {
|
|
"sequence": 5,
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|
"informationSequence": [ 4 ],
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
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|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "20",
|
|
"display": "DTaP"
|
|
} ],
|
|
"text": "DTaP"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2021-06-09T01:31:56+02:00",
|
|
"end": "2021-06-09T01:46:56+02:00"
|
|
},
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|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
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|
},
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|
"net": {
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|
"value": 136.00,
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|
"currency": "USD"
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|
},
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|
"category": {
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|
"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
|
|
"display": "Line Beneficiary Coinsurance Amount"
|
|
} ]
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|
},
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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",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
|
|
},
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|
"amount": {
|
|
"value": 108.80000000000001,
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|
"currency": "USD"
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|
}
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|
}, {
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
|
|
"display": "Line Submitted Charge Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
}, {
|
|
"sequence": 6,
|
|
"informationSequence": [ 5 ],
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "133",
|
|
"display": "Pneumococcal conjugate PCV 13"
|
|
} ],
|
|
"text": "Pneumococcal conjugate PCV 13"
|
|
},
|
|
"servicedPeriod": {
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"start": "2021-06-09T01:31:56+02:00",
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"end": "2021-06-09T01:46:56+02:00"
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},
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "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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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 27.200000000000003,
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 108.80000000000001,
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"amount": {
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"value": 136.00,
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"value": 136.00,
|
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}
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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|
"amount": {
|
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"value": 0,
|
|
"currency": "USD"
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}
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}, {
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"category": {
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"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": 7,
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"productOrService": {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
|
|
"code": "430193006",
|
|
"display": "Medication Reconciliation (procedure)"
|
|
} ],
|
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"text": "Medication Reconciliation (procedure)"
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},
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|
"start": "2021-06-09T01:31:56+02:00",
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"end": "2021-06-09T01:46:56+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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"value": 344.41,
|
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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": {
|
|
"value": 68.882,
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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": 275.528,
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
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"display": "Line Allowed Charge Amount"
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} ]
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},
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"amount": {
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"value": 344.41,
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}
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
|
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"value": 0,
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|
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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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"system": "http://terminology.hl7.org/CodeSystem/adjudication",
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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": 1161.21,
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}
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} ],
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}
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}
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},
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"request": {
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"method": "POST",
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"url": "ExplanationOfBenefit"
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}
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|
}, {
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"fullUrl": "urn:uuid:3ca2f3fe-0d57-d84f-aebb-772208f827af",
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"resource": {
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},
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"use": "official",
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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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"individual": {
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|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099",
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}
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"location": {
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"display": "ONE CALL HEALTHCARE PLLC"
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}
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} ],
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"display": "ONE CALL HEALTHCARE PLLC"
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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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|
"recordedDate": "2021-08-11T01:31:56+02:00"
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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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|
"display": "Vital signs"
|
|
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|
} ],
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|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "8302-2",
|
|
"display": "Body Height"
|
|
} ],
|
|
"text": "Body Height"
|
|
},
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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": "72514-3",
|
|
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
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|
} ],
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|
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|
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|
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|
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|
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|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
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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-body-weight" ]
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|
},
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|
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|
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|
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|
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|
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|
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|
|
} ]
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|
} ],
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|
"code": {
|
|
"coding": [ {
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|
"system": "http://loinc.org",
|
|
"code": "29463-7",
|
|
"display": "Body Weight"
|
|
} ],
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|
"text": "Body Weight"
|
|
},
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|
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|
"reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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|
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|
},
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|
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|
"issued": "2021-08-11T01:31:56.064+02:00",
|
|
"valueQuantity": {
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|
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|
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|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
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|
}
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|
}, {
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|
"fullUrl": "urn:uuid:97e24a41-37d5-b235-ce75-4ae754b54ec5",
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"resource": {
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|
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|
"id": "97e24a41-37d5-b235-ce75-4ae754b54ec5",
|
|
"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": {
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|
"reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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|
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|
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|
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|
},
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"effectiveDateTime": "2021-08-11T01:31:56+02:00",
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"value": 64.772,
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"code": "%"
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}
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},
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"method": "POST",
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"url": "Observation"
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}
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}, {
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"fullUrl": "urn:uuid:cf7cacbb-ae98-cfe1-effd-4e3446a3639c",
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"id": "cf7cacbb-ae98-cfe1-effd-4e3446a3639c",
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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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"system": "http://loinc.org",
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"code": "8289-1",
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"display": "Head Occipital-frontal circumference Percentile"
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} ],
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"text": "Head Occipital-frontal circumference Percentile"
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},
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"reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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}
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},
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} ],
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"code": "9843-4",
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"display": "Head Occipital-frontal circumference"
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} ],
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"text": "Head Occipital-frontal circumference"
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},
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"code": "cm"
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}
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},
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"method": "POST",
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"url": "Observation"
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}
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}, {
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"fullUrl": "urn:uuid:c1cc8278-93e5-de68-ffc3-90d46280a1d5",
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"id": "c1cc8278-93e5-de68-ffc3-90d46280a1d5",
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"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure" ]
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},
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"status": "final",
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"code": "vital-signs",
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} ]
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} ],
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"code": {
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"coding": [ {
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"system": "http://loinc.org",
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"code": "85354-9",
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"display": "Blood pressure panel with all children optional"
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} ],
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"text": "Blood pressure panel with all children optional"
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},
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"code": "8462-4",
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} ],
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},
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"system": "http://unitsofmeasure.org",
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}
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"system": "http://loinc.org",
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"code": "8480-6",
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} ],
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},
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"value": 122,
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"code": "mm[Hg]"
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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": "9279-1",
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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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"code": "social-history",
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} ],
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"code": "72166-2",
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} ],
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},
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"system": "http://snomed.info/sct",
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"code": "266919005",
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|
} ],
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"text": "Never smoked tobacco (finding)"
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}
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},
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"fullUrl": "urn:uuid:1620251a-0974-95d7-8b28-fddccd634855",
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"resourceType": "Immunization",
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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": "119",
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|
} ],
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"text": "rotavirus, monovalent"
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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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"system": "http://hl7.org/fhir/sid/cvx",
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"display": "ONE CALL HEALTHCARE PLLC"
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},
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"method": "POST",
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"fullUrl": "urn:uuid:aa18b10d-fa93-8197-de77-e4c129353bb6",
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},
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"coding": [ {
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"system": "http://hl7.org/fhir/sid/cvx",
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"code": "133",
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"display": "Pneumococcal conjugate PCV 13"
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},
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"role": {
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"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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"diagnosis": [ {
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"sequence": 1,
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"diagnosisReference": {
|
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"reference": "urn:uuid:070f7b67-8eb6-9ee2-2843-4adfa68f6508"
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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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"insurance": [ {
|
|
"focal": true,
|
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"coverage": {
|
|
"reference": "#coverage",
|
|
"display": "Humana"
|
|
}
|
|
} ],
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"item": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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|
} ]
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},
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"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "410620009",
|
|
"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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"start": "2021-08-11T01:31:56+02:00",
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"end": "2021-08-11T01:46:56+02:00"
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},
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "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:3ca2f3fe-0d57-d84f-aebb-772208f827af"
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} ]
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}, {
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"category": {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"productOrService": {
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"coding": [ {
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"system": "http://hl7.org/fhir/sid/cvx",
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"code": "49",
|
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"display": "Hib (PRP-OMP)"
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} ],
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"text": "Hib (PRP-OMP)"
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},
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"start": "2021-08-11T01:31:56+02:00",
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"end": "2021-08-11T01:46:56+02:00"
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},
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "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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}, {
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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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}
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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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"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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"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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"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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"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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"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "119",
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|
"display": "rotavirus, monovalent"
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|
} ],
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"text": "rotavirus, monovalent"
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},
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"display": "Off Campus-Outpatient Hospital"
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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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"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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"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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"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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"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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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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|
}
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|
} ]
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}, {
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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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|
"display": "Medical care"
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|
} ]
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},
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"coding": [ {
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|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "10",
|
|
"display": "IPV"
|
|
} ],
|
|
"text": "IPV"
|
|
},
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|
|
"start": "2021-08-11T01:31:56+02:00",
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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|
"code": "19",
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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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"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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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge 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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"amount": {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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"display": "Line Beneficiary Part B Deductible Amount"
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} ]
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},
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"amount": {
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"value": 0,
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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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"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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"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "20",
|
|
"display": "DTaP"
|
|
} ],
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|
"text": "DTaP"
|
|
},
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"code": "19",
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|
"display": "Off Campus-Outpatient Hospital"
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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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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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|
"display": "Line Provider Payment Amount"
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|
} ]
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|
},
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"amount": {
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|
"value": 108.80000000000001,
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|
"currency": "USD"
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}
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"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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|
"amount": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
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"coding": [ {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
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|
},
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|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
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|
}, {
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|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
}, {
|
|
"sequence": 6,
|
|
"informationSequence": [ 5 ],
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|
"category": {
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|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "133",
|
|
"display": "Pneumococcal conjugate PCV 13"
|
|
} ],
|
|
"text": "Pneumococcal conjugate PCV 13"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2021-08-11T01:31:56+02:00",
|
|
"end": "2021-08-11T01:46:56+02:00"
|
|
},
|
|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
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|
} ]
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|
},
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|
|
"value": 136.00,
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|
"currency": "USD"
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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|
"display": "Line Beneficiary Coinsurance Amount"
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|
} ]
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},
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"amount": {
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"value": 27.200000000000003,
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"currency": "USD"
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}
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
|
|
"display": "Line Provider Payment Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 108.80000000000001,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
|
|
"display": "Line Submitted Charge Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
|
|
"display": "Line Allowed Charge Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 136.00,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
|
|
"display": "Line Beneficiary Part B Deductible Amount"
|
|
} ]
|
|
},
|
|
"amount": {
|
|
"value": 0,
|
|
"currency": "USD"
|
|
}
|
|
}, {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
|
|
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
|
|
"display": "Line Processing Indicator Code"
|
|
} ]
|
|
}
|
|
} ]
|
|
}, {
|
|
"sequence": 7,
|
|
"diagnosisSequence": [ 1 ],
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
|
|
"code": "1",
|
|
"display": "Medical care"
|
|
} ]
|
|
},
|
|
"productOrService": {
|
|
"coding": [ {
|
|
"system": "http://snomed.info/sct",
|
|
"code": "314529007",
|
|
"display": "Medication review due (situation)"
|
|
} ],
|
|
"text": "Medication review due (situation)"
|
|
},
|
|
"servicedPeriod": {
|
|
"start": "2021-08-11T01:31:56+02:00",
|
|
"end": "2021-08-11T01:46:56+02:00"
|
|
},
|
|
"locationCodeableConcept": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
|
|
"code": "19",
|
|
"display": "Off Campus-Outpatient Hospital"
|
|
} ]
|
|
}
|
|
} ],
|
|
"total": [ {
|
|
"category": {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
|
|
"code": "submitted",
|
|
"display": "Submitted Amount"
|
|
} ],
|
|
"text": "Submitted Amount"
|
|
},
|
|
"amount": {
|
|
"value": 816.80,
|
|
"currency": "USD"
|
|
}
|
|
} ],
|
|
"payment": {
|
|
"amount": {
|
|
"value": 544.0,
|
|
"currency": "USD"
|
|
}
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "ExplanationOfBenefit"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0",
|
|
"resource": {
|
|
"resourceType": "Encounter",
|
|
"id": "7813f993-0731-21cf-16e5-ef74cd207ba0",
|
|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ]
|
|
},
|
|
"identifier": [ {
|
|
"use": "official",
|
|
"system": "https://github.com/synthetichealth/synthea",
|
|
"value": "7813f993-0731-21cf-16e5-ef74cd207ba0"
|
|
} ],
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e",
|
|
"display": "Armand155 Wilkinson796"
|
|
},
|
|
"participant": [ {
|
|
"type": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
|
|
"code": "PPRF",
|
|
"display": "primary performer"
|
|
} ],
|
|
"text": "primary performer"
|
|
} ],
|
|
"period": {
|
|
"start": "2021-11-10T00:31:56+01:00",
|
|
"end": "2021-11-10T00:46:56+01:00"
|
|
},
|
|
"individual": {
|
|
"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099",
|
|
"display": "Dr. Pamelia915 Kilback373"
|
|
}
|
|
} ],
|
|
"period": {
|
|
"start": "2021-11-10T00:31:56+01:00",
|
|
"end": "2021-11-10T00:46:56+01:00"
|
|
},
|
|
"location": [ {
|
|
"location": {
|
|
"reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1",
|
|
"display": "ONE CALL HEALTHCARE PLLC"
|
|
}
|
|
} ],
|
|
"serviceProvider": {
|
|
"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3",
|
|
"display": "ONE CALL HEALTHCARE PLLC"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Encounter"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:93d878de-35a4-7782-0558-d2f36296292e",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "93d878de-35a4-7782-0558-d2f36296292e",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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|
},
|
|
"encounter": {
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|
"reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0"
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|
},
|
|
"effectiveDateTime": "2021-11-10T00:31:56+01:00",
|
|
"issued": "2021-11-10T00:31:56.064+01:00",
|
|
"valueQuantity": {
|
|
"value": 70.3,
|
|
"unit": "cm",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "cm"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:15c32099-af2f-058d-2cf0-632ef56f2b09",
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|
"resource": {
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|
"resourceType": "Observation",
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|
"id": "15c32099-af2f-058d-2cf0-632ef56f2b09",
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|
"status": "final",
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|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "vital-signs",
|
|
"display": "Vital signs"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0"
|
|
},
|
|
"effectiveDateTime": "2021-11-10T00:31:56+01:00",
|
|
"issued": "2021-11-10T00:31:56.064+01:00",
|
|
"valueQuantity": {
|
|
"value": 2,
|
|
"unit": "{score}",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "{score}"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:91555edd-7c33-4ead-eb1a-f6b0fb8f2be4",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "91555edd-7c33-4ead-eb1a-f6b0fb8f2be4",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
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|
|
},
|
|
"effectiveDateTime": "2021-11-10T00:31:56+01:00",
|
|
"issued": "2021-11-10T00:31:56.064+01:00",
|
|
"valueQuantity": {
|
|
"value": 9.2,
|
|
"unit": "kg",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:75ae0910-04b6-37b2-50ca-60f01c548f57",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "75ae0910-04b6-37b2-50ca-60f01c548f57",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0"
|
|
},
|
|
"effectiveDateTime": "2021-11-10T00:31:56+01:00",
|
|
"issued": "2021-11-10T00:31:56.064+01:00",
|
|
"valueQuantity": {
|
|
"value": 81.022,
|
|
"unit": "%",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "%"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:05902004-6f17-1e70-267d-b0c5201c92ff",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "05902004-6f17-1e70-267d-b0c5201c92ff",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0"
|
|
},
|
|
"effectiveDateTime": "2021-11-10T00:31:56+01:00",
|
|
"issued": "2021-11-10T00:31:56.064+01:00",
|
|
"valueQuantity": {
|
|
"value": 43.17,
|
|
"unit": "%",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "%"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:8154babf-db4d-e00c-7059-108fb7a1e3b4",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "8154babf-db4d-e00c-7059-108fb7a1e3b4",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0"
|
|
},
|
|
"effectiveDateTime": "2021-11-10T00:31:56+01:00",
|
|
"issued": "2021-11-10T00:31:56.064+01:00",
|
|
"valueQuantity": {
|
|
"value": 44.84,
|
|
"unit": "cm",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "cm"
|
|
}
|
|
},
|
|
"request": {
|
|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
|
|
"fullUrl": "urn:uuid:95351e9d-c461-dfd5-5636-bd977b9d20ae",
|
|
"resource": {
|
|
"resourceType": "Observation",
|
|
"id": "95351e9d-c461-dfd5-5636-bd977b9d20ae",
|
|
"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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
|
|
},
|
|
"encounter": {
|
|
"reference": "urn:uuid:7813f993-0731-21cf-16e5-ef74cd207ba0"
|
|
},
|
|
"effectiveDateTime": "2021-11-10T00:31:56+01:00",
|
|
"issued": "2021-11-10T00:31:56.064+01:00",
|
|
"component": [ {
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "8462-4",
|
|
"display": "Diastolic Blood Pressure"
|
|
} ],
|
|
"text": "Diastolic Blood Pressure"
|
|
},
|
|
"valueQuantity": {
|
|
"value": 77,
|
|
"unit": "mm[Hg]",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "mm[Hg]"
|
|
}
|
|
}, {
|
|
"code": {
|
|
"coding": [ {
|
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"code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
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"display": "mimeType Sufficient"
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}
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"insurance": [ {
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"code": "1",
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"system": "http://snomed.info/sct",
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"display": "Well child visit (procedure)"
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} ],
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"code": "10",
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"text": "IPV"
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"locationCodeableConcept": {
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"system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
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"code": "19",
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"display": "Off Campus-Outpatient Hospital"
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} ]
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},
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"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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"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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"currency": "USD"
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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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"category": {
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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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"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": {
|
|
"coding": [ {
|
|
"system": "http://hl7.org/fhir/sid/cvx",
|
|
"code": "140",
|
|
"display": "Influenza, seasonal, injectable, preservative free"
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|
} ],
|
|
"text": "Influenza, seasonal, injectable, preservative free"
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|
},
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|
"servicedPeriod": {
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|
"start": "2021-11-10T00:31:56+01:00",
|
|
"end": "2021-11-10T00:46:56+01:00"
|
|
},
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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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|
"code": "410620009",
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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|9999949099",
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|
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"display": "ONE CALL HEALTHCARE PLLC"
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"serviceProvider": {
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"reference": "Organization?identifier=https://github.com/synthetichealth/synthea|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3",
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"display": "ONE CALL HEALTHCARE PLLC"
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}
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"request": {
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"method": "POST",
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"url": "Encounter"
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"fullUrl": "urn:uuid:9d4cd8c2-9ea9-d12e-db08-42e018e48604",
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"id": "9d4cd8c2-9ea9-d12e-db08-42e018e48604",
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},
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"status": "final",
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"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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"code": "vital-signs",
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|
"display": "Vital signs"
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"code": {
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|
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"system": "http://loinc.org",
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|
"code": "8302-2",
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|
"display": "Body Height"
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|
} ],
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"text": "Body Height"
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|
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|
"code": "314529007",
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|
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|
} ],
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} ]
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|
"code": "430193006",
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|
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|
} ],
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"text": "Medication Reconciliation (procedure)"
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},
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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}
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"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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}
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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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"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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} ],
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} ],
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}
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}
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},
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},
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"payor": [ {
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"display": "Humana"
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|
} ]
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} ],
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"identifier": [ {
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"system": "https://bluebutton.cms.gov/resources/variables/clm_id",
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"value": "9f553073-eb20-f48d-4b93-6751c988fbf2"
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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:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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},
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"billablePeriod": {
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"end": "2023-08-10T01:46:56+02:00"
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},
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"created": "2022-08-10T01:46:56+02:00",
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"insurer": {
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"display": "Humana"
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},
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"provider": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099"
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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|f3f1618f-da04-3617-976f-68a8e0bd41b1",
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"display": "ONE CALL HEALTHCARE PLLC"
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},
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"claim": {
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"reference": "urn:uuid:9f553073-eb20-f48d-4b93-6751c988fbf2"
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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|9999949099"
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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:f7f0dc6f-ada8-2564-21e1-7cea87d1eff2"
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},
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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": "Humana"
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}
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} ],
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"item": [ {
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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": "2022-08-10T01:31:56+02:00",
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"end": "2022-08-10T01:46:56+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:fd2afbea-81c5-9545-be6c-07b54c91111d"
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} ]
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"system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
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"code": "1",
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"display": "Medical care"
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} ]
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},
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"productOrService": {
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"coding": [ {
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"system": "http://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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"start": "2022-08-10T01:31:56+02:00",
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"end": "2022-08-10T01:46:56+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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"category": {
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"coding": [ {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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"code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
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"display": "Line Beneficiary Coinsurance Amount"
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|
} ]
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},
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"amount": {
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"value": 27.200000000000003,
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"currency": "USD"
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"code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
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"display": "Line Provider Payment Amount"
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} ]
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},
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"amount": {
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"value": 108.80000000000001,
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"code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
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"display": "Line Submitted Charge Amount"
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} ]
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},
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"amount": {
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"value": 136.00,
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"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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"display": "Line Processing Indicator Code"
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} ]
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}
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} ]
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}, {
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|
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} ],
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"text": "Medication review due (situation)"
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} ],
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"request": {
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"individual": {
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|
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"system": "http://loinc.org",
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|
"code": "8302-2",
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|
"display": "Body Height"
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|
} ],
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|
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|
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|
|
"code": "72514-3",
|
|
"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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"valueQuantity": {
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|
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|
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"id": "21d6a26d-1a7e-44f0-ef18-fecb5498c187",
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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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"code": {
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|
"coding": [ {
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|
"system": "http://loinc.org",
|
|
"code": "29463-7",
|
|
"display": "Body Weight"
|
|
} ],
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|
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|
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|
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|
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|
"issued": "2023-02-08T00:31:56.064+01:00",
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|
"valueQuantity": {
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|
"value": 12.8,
|
|
"unit": "kg",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "kg"
|
|
}
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|
},
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|
"request": {
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|
"method": "POST",
|
|
"url": "Observation"
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|
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|
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|
"fullUrl": "urn:uuid:3f3c0af7-a18d-5313-e7d8-55f5e623a546",
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|
"id": "3f3c0af7-a18d-5313-e7d8-55f5e623a546",
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|
"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"
|
|
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|
|
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|
"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"
|
|
},
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|
"subject": {
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|
"reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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"display": "Line Beneficiary Coinsurance Amount"
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"display": "Line Provider Payment 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_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": 448.40,
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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_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": 448.40,
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}
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}, {
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"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
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|
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
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|
"display": "Line Beneficiary Part B Deductible Amount"
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|
} ]
|
|
},
|
|
"amount": {
|
|
"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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"total": [ {
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"category": {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/adjudication",
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"code": "submitted",
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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": {
|
|
"value": 721.20,
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|
"currency": "USD"
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}
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} ],
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"payment": {
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"amount": {
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"value": 467.52000000000004,
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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:161389b2-47ab-0b3e-196c-d19c9f23e9ff",
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"resource": {
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"resourceType": "Encounter",
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},
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"value": "161389b2-47ab-0b3e-196c-d19c9f23e9ff"
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} ],
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"status": "finished",
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"code": "AMB"
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},
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"type": [ {
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"coding": [ {
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"system": "http://snomed.info/sct",
|
|
"code": "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:4b633a8e-a312-8675-4af4-3519bfa6b00e",
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"display": "Armand155 Wilkinson796"
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},
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"type": [ {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
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"code": "PPRF",
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"display": "primary performer"
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} ],
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"text": "primary performer"
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} ],
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"end": "2023-08-09T01:46:56+02:00"
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},
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"individual": {
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"reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999949099",
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"display": "Dr. Pamelia915 Kilback373"
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}
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} ],
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"period": {
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"start": "2023-08-09T01:31:56+02:00",
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},
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"location": [ {
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"location": {
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"reference": "Location?identifier=https://github.com/synthetichealth/synthea|f3f1618f-da04-3617-976f-68a8e0bd41b1",
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"display": "ONE CALL HEALTHCARE PLLC"
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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|9fdce5d5-d4d0-3156-a8d5-8757bfe4e9b3",
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|
"display": "ONE CALL HEALTHCARE PLLC"
|
|
}
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|
},
|
|
"request": {
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|
"method": "POST",
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|
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}
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}, {
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|
"fullUrl": "urn:uuid:da5cc37d-eb07-b394-1f60-40ee17d51ec0",
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"resourceType": "Condition",
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"meta": {
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"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ]
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},
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"clinicalStatus": {
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"code": "resolved"
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} ]
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},
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
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"code": "confirmed"
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} ]
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},
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"category": [ {
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"coding": [ {
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"system": "http://terminology.hl7.org/CodeSystem/condition-category",
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"code": "encounter-diagnosis",
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|
"display": "Encounter Diagnosis"
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} ]
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|
} ],
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"code": {
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|
"coding": [ {
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|
"system": "http://snomed.info/sct",
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|
"code": "314529007",
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|
"display": "Medication review due (situation)"
|
|
} ],
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"text": "Medication review due (situation)"
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},
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|
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|
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},
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"recordedDate": "2023-08-09T01:31:56+02:00"
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},
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"request": {
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}
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"id": "165d01d1-17d1-9fde-ce96-17af7a6b2ac0",
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|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height" ]
|
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},
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|
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"code": "vital-signs",
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} ]
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} ],
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"code": {
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|
"coding": [ {
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|
"system": "http://loinc.org",
|
|
"code": "8302-2",
|
|
"display": "Body Height"
|
|
} ],
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"text": "Body Height"
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},
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|
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"code": "cm"
|
|
}
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|
},
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}
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} ],
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|
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|
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|
"code": "72514-3",
|
|
"display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
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|
} ],
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|
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},
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"issued": "2023-08-09T01:31:56.064+02:00",
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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": "29463-7",
|
|
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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/pediatric-weight-for-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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|
"code": "vital-signs",
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|
"display": "Vital signs"
|
|
} ]
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|
} ],
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"code": {
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|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "77606-2",
|
|
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|
|
} ],
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|
"text": "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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|
"system": "http://unitsofmeasure.org",
|
|
"code": "%"
|
|
}
|
|
},
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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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|
"fullUrl": "urn:uuid:2fa9bcc6-f0c9-a973-09d9-1d2368847a73",
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"resource": {
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|
"id": "2fa9bcc6-f0c9-a973-09d9-1d2368847a73",
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|
"meta": {
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|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile" ]
|
|
},
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|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "vital-signs",
|
|
"display": "Vital signs"
|
|
} ]
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|
} ],
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|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "8289-1",
|
|
"display": "Head Occipital-frontal circumference Percentile"
|
|
} ],
|
|
"text": "Head Occipital-frontal circumference Percentile"
|
|
},
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|
"subject": {
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|
"reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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|
},
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|
"encounter": {
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|
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|
},
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|
"effectiveDateTime": "2023-08-09T01:31:56+02:00",
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|
"issued": "2023-08-09T01:31:56.064+02:00",
|
|
"valueQuantity": {
|
|
"value": 43.17,
|
|
"unit": "%",
|
|
"system": "http://unitsofmeasure.org",
|
|
"code": "%"
|
|
}
|
|
},
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|
"request": {
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|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
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|
"fullUrl": "urn:uuid:7b5e31c5-4f05-0a1c-ef8b-e94b84be2865",
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"resource": {
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"resourceType": "Observation",
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|
"id": "7b5e31c5-4f05-0a1c-ef8b-e94b84be2865",
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|
"meta": {
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|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference" ]
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|
},
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|
"status": "final",
|
|
"category": [ {
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|
"coding": [ {
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|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
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|
"code": "vital-signs",
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|
"display": "Vital signs"
|
|
} ]
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|
} ],
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|
"code": {
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|
"coding": [ {
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|
"system": "http://loinc.org",
|
|
"code": "9843-4",
|
|
"display": "Head Occipital-frontal circumference"
|
|
} ],
|
|
"text": "Head Occipital-frontal circumference"
|
|
},
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|
"subject": {
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|
"reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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},
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"effectiveDateTime": "2023-08-09T01:31:56+02:00",
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|
"issued": "2023-08-09T01:31:56.064+02:00",
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|
"valueQuantity": {
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|
"value": 48.96,
|
|
"unit": "cm",
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|
"system": "http://unitsofmeasure.org",
|
|
"code": "cm"
|
|
}
|
|
},
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|
"request": {
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|
"method": "POST",
|
|
"url": "Observation"
|
|
}
|
|
}, {
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|
"fullUrl": "urn:uuid:16a84deb-35af-eed9-709c-f4ae3d48fbd8",
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"resource": {
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"resourceType": "Observation",
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|
"id": "16a84deb-35af-eed9-709c-f4ae3d48fbd8",
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|
"meta": {
|
|
"profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ]
|
|
},
|
|
"status": "final",
|
|
"category": [ {
|
|
"coding": [ {
|
|
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
|
|
"code": "vital-signs",
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|
"display": "Vital signs"
|
|
} ]
|
|
} ],
|
|
"code": {
|
|
"coding": [ {
|
|
"system": "http://loinc.org",
|
|
"code": "39156-5",
|
|
"display": "Body mass index (BMI) [Ratio]"
|
|
} ],
|
|
"text": "Body mass index (BMI) [Ratio]"
|
|
},
|
|
"subject": {
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|
"reference": "urn:uuid:4b633a8e-a312-8675-4af4-3519bfa6b00e"
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},
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"encounter": {
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|
"reference": "urn:uuid:161389b2-47ab-0b3e-196c-d19c9f23e9ff"
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|
},
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"display": "Line Beneficiary Coinsurance Amount"
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} ]
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},
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"amount": {
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"value": 94.29400000000001,
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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": 377.17600000000004,
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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": 471.47,
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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": 471.47,
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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_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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"coding": [ {
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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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"value": 744.27,
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}
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} ],
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"value": 485.97600000000006,
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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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}
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