{ "resourceType": "Bundle", "type": "transaction", "entry": [ { "fullUrl": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "resource": { "resourceType": "Patient", "id": "df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient" ] }, "text": { "status": "generated", "div": "
Generated by Synthea.Version identifier: 188ce63\n . Person seed: -1724573829170144049 Population seed: 1687380550931
" }, "extension": [ { "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race", "extension": [ { "url": "ombCategory", "valueCoding": { "system": "urn:oid:2.16.840.1.113883.6.238", "code": "2106-3", "display": "White" } }, { "url": "text", "valueString": "White" } ] }, { "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity", "extension": [ { "url": "ombCategory", "valueCoding": { "system": "urn:oid:2.16.840.1.113883.6.238", "code": "2186-5", "display": "Not Hispanic or Latino" } }, { "url": "text", "valueString": "Not Hispanic or Latino" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName", "valueString": "Vivian245 Hermiston71" }, { "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex", "valueCode": "M" }, { "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace", "valueAddress": { "city": "Gloucester", "state": "Massachusetts", "country": "US" } }, { "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years", "valueDecimal": 0.1986258665886365 }, { "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years", "valueDecimal": 43.801374133411365 } ], "identifier": [ { "system": "https://github.com/synthetichealth/synthea", "value": "df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "MR", "display": "Medical Record Number" } ], "text": "Medical Record Number" }, "system": "http://hospital.smarthealthit.org", "value": "df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "SS", "display": "Social Security Number" } ], "text": "Social Security Number" }, "system": "http://hl7.org/fhir/sid/us-ssn", "value": "999-95-9446" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "DL", "display": "Driver's license number" } ], "text": "Driver's license number" }, "system": "urn:oid:2.16.840.1.113883.4.3.25", "value": "S99958721" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PPN", "display": "Passport Number" } ], "text": "Passport Number" }, "system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber", "value": "X62552578X" } ], "name": [ { "use": "official", "family": "Schmeler639", "given": [ "Aaron697" ], "prefix": [ "Mr." ] } ], "telecom": [ { "system": "phone", "value": "555-705-4709", "use": "home" } ], "gender": "male", "birthDate": "1978-06-05", "address": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/geolocation", "extension": [ { "url": "latitude", "valueDecimal": 42.3171853273536 }, { "url": "longitude", "valueDecimal": -71.33550368120692 } ] } ], "line": [ "681 Trantow Vista Apt 76" ], "city": "Cochituate", "state": "MA", "postalCode": "00000", "country": "US" } ], "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "D", "display": "Divorced" } ], "text": "Divorced" }, "multipleBirthBoolean": false, "communication": [ { "language": { "coding": [ { "system": "urn:ietf:bcp:47", "code": "en-US", "display": "English (United States)" } ], "text": "English (United States)" } } ] }, "request": { "method": "POST", "url": "Patient" } }, { "fullUrl": "urn:uuid:b0fabdc6-e7cf-47cd-cf01-876eaa231d4e", "resource": { "resourceType": "Encounter", "id": "b0fabdc6-e7cf-47cd-cf01-876eaa231d4e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "b0fabdc6-e7cf-47cd-cf01-876eaa231d4e" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1996-09-16T13:45:19-04:00", "end": "1996-09-16T14:43:04-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } } ], "period": { "start": "1996-09-16T13:45:19-04:00", "end": "1996-09-16T14:43:04-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:b5dd1976-9402-4e4a-9b5b-c0a108a2c4f3", "resource": { "resourceType": "Condition", "id": "b5dd1976-9402-4e4a-9b5b-c0a108a2c4f3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "5251000175109", "display": "Received certificate of high school equivalency (finding)" } ], "text": "Received certificate of high school equivalency (finding)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:b0fabdc6-e7cf-47cd-cf01-876eaa231d4e" }, "onsetDateTime": "1996-09-16T14:43:04-04:00", "recordedDate": "1996-09-16T14:43:04-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:42a8985b-d3f6-b785-bf3f-10ef24c4d851", "resource": { "resourceType": "Condition", "id": "42a8985b-d3f6-b785-bf3f-10ef24c4d851", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:b0fabdc6-e7cf-47cd-cf01-876eaa231d4e" }, "onsetDateTime": "1996-09-16T14:43:04-04:00", "abatementDateTime": "1997-09-22T14:41:17-04:00", "recordedDate": "1996-09-16T14:43:04-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:1fd0f059-8f93-45ff-b796-5201011979f7", "resource": { "resourceType": "Condition", "id": "1fd0f059-8f93-45ff-b796-5201011979f7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "422650009", "display": "Social isolation (finding)" } ], "text": "Social isolation (finding)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:b0fabdc6-e7cf-47cd-cf01-876eaa231d4e" }, "onsetDateTime": "1996-09-16T14:43:04-04:00", "recordedDate": "1996-09-16T14:43:04-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:4606e34a-9d4e-0d28-771e-d2355ffaac4b", "resource": { "resourceType": "DiagnosticReport", "id": "4606e34a-9d4e-0d28-771e-d2355ffaac4b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:b0fabdc6-e7cf-47cd-cf01-876eaa231d4e" }, "effectiveDateTime": "1996-09-16T13:45:19-04:00", "issued": "1996-09-16T13:45:19.509-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:4784358d-7d38-3749-ac7d-4f163caf8d5e", "resource": { "resourceType": "DocumentReference", "id": "4784358d-7d38-3749-ac7d-4f163caf8d5e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:4606e34a-9d4e-0d28-771e-d2355ffaac4b" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "1996-09-16T13:45:19.509-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "CjE5OTYtMDktMTYKCiMgQ2hpZWYgQ29tcGxhaW50Ck5vIGNvbXBsYWludHMuCgojIEhpc3Rvcnkgb2YgUHJlc2VudCBJbGxuZXNzCkFhcm9uNjk3CiBpcyBhIDE4IHllYXItb2xkIG5vbmhpc3BhbmljIHdoaXRlIG1hbGUuCgojIFNvY2lhbCBIaXN0b3J5CiBQYXRpZW50IHF1aXQgc21va2luZyBhdCBhZ2UgMTguCiBQYXRpZW50IGlkZW50aWZpZXMgYXMgaGV0ZXJvc2V4dWFsLgoKUGF0aWVudCBjb21lcyBmcm9tIGEgbWlkZGxlIHNvY2lvZWNvbm9taWMgYmFja2dyb3VuZC4KIFBhdGllbnQgaGFzIGEgaGlnaCBzY2hvb2wgZWR1Y2F0aW9uLgpQYXRpZW50IGN1cnJlbnRseSBoYXMgSHVtYW5hLgoKIyBBbGxlcmdpZXMKTm8gS25vd24gQWxsZXJnaWVzLgoKIyBNZWRpY2F0aW9ucwpObyBBY3RpdmUgTWVkaWNhdGlvbnMuCgojIEFzc2Vzc21lbnQgYW5kIFBsYW4KUGF0aWVudCBpcyBwcmVzZW50aW5nIHdpdGggcmVjZWl2ZWQgY2VydGlmaWNhdGUgb2YgaGlnaCBzY2hvb2wgZXF1aXZhbGVuY3kgKGZpbmRpbmcpLCBmdWxsLXRpbWUgZW1wbG95bWVudCAoZmluZGluZyksIHNvY2lhbCBpc29sYXRpb24gKGZpbmRpbmcpLiAKCiMjIFBsYW4KCg==" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:b0fabdc6-e7cf-47cd-cf01-876eaa231d4e" } ], "period": { "start": "1996-09-16T13:45:19-04:00", "end": "1996-09-16T14:43:04-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:a546ce0c-b4a8-ce92-a595-fd2dfa18d079", "resource": { "resourceType": "Claim", "id": "a546ce0c-b4a8-ce92-a595-fd2dfa18d079", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "1996-09-16T13:45:19-04:00", "end": "1996-09-16T14:43:04-04:00" }, "created": "1996-09-16T14:43:04-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:b5dd1976-9402-4e4a-9b5b-c0a108a2c4f3" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:42a8985b-d3f6-b785-bf3f-10ef24c4d851" } }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:1fd0f059-8f93-45ff-b796-5201011979f7" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:b0fabdc6-e7cf-47cd-cf01-876eaa231d4e" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "5251000175109", "display": "Received certificate of high school equivalency (finding)" } ], "text": "Received certificate of high school equivalency (finding)" } }, { "sequence": 3, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" } }, { "sequence": 4, "diagnosisSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "422650009", "display": "Social isolation (finding)" } ], "text": "Social isolation (finding)" } } ], "total": { "value": 704.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:110b37c4-8ac8-285d-9d3b-159b98a26cb6", "resource": { "resourceType": "ExplanationOfBenefit", "id": "110b37c4-8ac8-285d-9d3b-159b98a26cb6", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "a546ce0c-b4a8-ce92-a595-fd2dfa18d079" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "1996-09-16T14:43:04-04:00", "end": "1997-09-16T14:43:04-04:00" }, "created": "1996-09-16T14:43:04-04:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "claim": { "reference": "urn:uuid:a546ce0c-b4a8-ce92-a595-fd2dfa18d079" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:b5dd1976-9402-4e4a-9b5b-c0a108a2c4f3" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:42a8985b-d3f6-b785-bf3f-10ef24c4d851" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 3, "diagnosisReference": { "reference": "urn:uuid:1fd0f059-8f93-45ff-b796-5201011979f7" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "1996-09-16T13:45:19-04:00", "end": "1996-09-16T14:43:04-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:b0fabdc6-e7cf-47cd-cf01-876eaa231d4e" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "5251000175109", "display": "Received certificate of high school equivalency (finding)" } ], "text": "Received certificate of high school equivalency (finding)" }, "servicedPeriod": { "start": "1996-09-16T13:45:19-04:00", "end": "1996-09-16T14:43:04-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 3, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "servicedPeriod": { "start": "1996-09-16T13:45:19-04:00", "end": "1996-09-16T14:43:04-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 4, "diagnosisSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "422650009", "display": "Social isolation (finding)" } ], "text": "Social isolation (finding)" }, "servicedPeriod": { "start": "1996-09-16T13:45:19-04:00", "end": "1996-09-16T14:43:04-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 704.20, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:46c60cce-53a9-ecee-100f-1db9eb60ed26", "resource": { "resourceType": "Encounter", "id": "46c60cce-53a9-ecee-100f-1db9eb60ed26", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "46c60cce-53a9-ecee-100f-1db9eb60ed26" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "1997-09-22T13:45:19-04:00", "end": "1997-09-22T14:41:17-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } } ], "period": { "start": "1997-09-22T13:45:19-04:00", "end": "1997-09-22T14:41:17-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:478021dc-b9f0-59cc-2025-e0577e2e682e", "resource": { "resourceType": "Condition", "id": "478021dc-b9f0-59cc-2025-e0577e2e682e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "423315002", "display": "Limited social contact (finding)" } ], "text": "Limited social contact (finding)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:46c60cce-53a9-ecee-100f-1db9eb60ed26" }, "onsetDateTime": "1997-09-22T14:41:17-04:00", "abatementDateTime": "2020-06-15T14:32:11-04:00", "recordedDate": "1997-09-22T14:41:17-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:749384ab-616d-35c1-9791-6203b7011a27", "resource": { "resourceType": "DiagnosticReport", "id": "749384ab-616d-35c1-9791-6203b7011a27", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:46c60cce-53a9-ecee-100f-1db9eb60ed26" }, "effectiveDateTime": "1997-09-22T13:45:19-04:00", "issued": "1997-09-22T13:45:19.509-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:4d0c76fe-054c-86e6-ec2f-a715f4374992", "resource": { "resourceType": "DocumentReference", "id": "4d0c76fe-054c-86e6-ec2f-a715f4374992", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:749384ab-616d-35c1-9791-6203b7011a27" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "1997-09-22T13:45:19.509-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:46c60cce-53a9-ecee-100f-1db9eb60ed26" } ], "period": { "start": "1997-09-22T13:45:19-04:00", "end": "1997-09-22T14:41:17-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:b629ab27-f6f3-99f6-d496-b1941eb4c98a", "resource": { "resourceType": "Claim", "id": "b629ab27-f6f3-99f6-d496-b1941eb4c98a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "1997-09-22T13:45:19-04:00", "end": "1997-09-22T14:41:17-04:00" }, "created": "1997-09-22T14:41:17-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:478021dc-b9f0-59cc-2025-e0577e2e682e" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:46c60cce-53a9-ecee-100f-1db9eb60ed26" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "423315002", "display": "Limited social contact (finding)" } ], "text": "Limited social contact (finding)" } } ], "total": { "value": 704.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:a0b4c4af-2ce4-5344-0070-72e8bbca565d", "resource": { "resourceType": "ExplanationOfBenefit", "id": "a0b4c4af-2ce4-5344-0070-72e8bbca565d", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "b629ab27-f6f3-99f6-d496-b1941eb4c98a" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "1997-09-22T14:41:17-04:00", "end": "1998-09-22T14:41:17-04:00" }, "created": "1997-09-22T14:41:17-04:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "claim": { "reference": "urn:uuid:b629ab27-f6f3-99f6-d496-b1941eb4c98a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:478021dc-b9f0-59cc-2025-e0577e2e682e" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "1997-09-22T13:45:19-04:00", "end": "1997-09-22T14:41:17-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:46c60cce-53a9-ecee-100f-1db9eb60ed26" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "423315002", "display": "Limited social contact (finding)" } ], "text": "Limited social contact (finding)" }, "servicedPeriod": { "start": "1997-09-22T13:45:19-04:00", "end": "1997-09-22T14:41:17-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 704.20, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:bcfd0116-4d3a-655d-ec45-debbdcd23739", "resource": { "resourceType": "Encounter", "id": "bcfd0116-4d3a-655d-ec45-debbdcd23739", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "bcfd0116-4d3a-655d-ec45-debbdcd23739" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2003-09-29T13:45:19-04:00", "end": "2003-09-29T14:40:38-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } } ], "period": { "start": "2003-09-29T13:45:19-04:00", "end": "2003-09-29T14:40:38-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:24dc1c29-1d80-a2bb-0a9f-b7c95932a7d1", "resource": { "resourceType": "Condition", "id": "24dc1c29-1d80-a2bb-0a9f-b7c95932a7d1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:bcfd0116-4d3a-655d-ec45-debbdcd23739" }, "onsetDateTime": "2003-09-29T14:40:38-04:00", "abatementDateTime": "2006-10-02T14:32:21-04:00", "recordedDate": "2003-09-29T14:40:38-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:13cee4fd-e4f4-663d-905b-a95da09f70ef", "resource": { "resourceType": "DiagnosticReport", "id": "13cee4fd-e4f4-663d-905b-a95da09f70ef", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:bcfd0116-4d3a-655d-ec45-debbdcd23739" }, "effectiveDateTime": "2003-09-29T13:45:19-04:00", "issued": "2003-09-29T13:45:19.509-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:14ad450a-4492-57ff-6d02-d8eeaab555dc", "resource": { "resourceType": "DocumentReference", "id": "14ad450a-4492-57ff-6d02-d8eeaab555dc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:13cee4fd-e4f4-663d-905b-a95da09f70ef" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "2003-09-29T13:45:19.509-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:bcfd0116-4d3a-655d-ec45-debbdcd23739" } ], "period": { "start": "2003-09-29T13:45:19-04:00", "end": "2003-09-29T14:40:38-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:e181f4e7-7d85-11d6-56b8-09458850764a", "resource": { "resourceType": "Claim", "id": "e181f4e7-7d85-11d6-56b8-09458850764a", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "2003-09-29T13:45:19-04:00", "end": "2003-09-29T14:40:38-04:00" }, "created": "2003-09-29T14:40:38-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:24dc1c29-1d80-a2bb-0a9f-b7c95932a7d1" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:bcfd0116-4d3a-655d-ec45-debbdcd23739" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" } } ], "total": { "value": 704.20, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:827ce1dc-3f15-8733-e051-ba77854646aa", "resource": { "resourceType": "ExplanationOfBenefit", "id": "827ce1dc-3f15-8733-e051-ba77854646aa", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e181f4e7-7d85-11d6-56b8-09458850764a" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "2003-09-29T14:40:38-04:00", "end": "2004-09-29T14:40:38-04:00" }, "created": "2003-09-29T14:40:38-04:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "claim": { "reference": "urn:uuid:e181f4e7-7d85-11d6-56b8-09458850764a" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:24dc1c29-1d80-a2bb-0a9f-b7c95932a7d1" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2003-09-29T13:45:19-04:00", "end": "2003-09-29T14:40:38-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:bcfd0116-4d3a-655d-ec45-debbdcd23739" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "servicedPeriod": { "start": "2003-09-29T13:45:19-04:00", "end": "2003-09-29T14:40:38-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 704.20, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:cc086787-9a86-e3f4-deb0-acf85a15a8ea", "resource": { "resourceType": "Encounter", "id": "cc086787-9a86-e3f4-deb0-acf85a15a8ea", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "cc086787-9a86-e3f4-deb0-acf85a15a8ea" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "EMER" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "50849002", "display": "Emergency room admission (procedure)" } ], "text": "Emergency room admission (procedure)" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2009-05-18T13:45:19-04:00", "end": "2009-05-18T14:45:19-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883199", "display": "Dr. Anderson154 Kunze215" } } ], "period": { "start": "2009-05-18T13:45:19-04:00", "end": "2009-05-18T14:45:19-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|241b0f72-2cf6-3954-8a5b-c3a903c6bf4c", "display": "NEWTON WELLESLEY CENTER FOR ALZHEIMER'S CARE" } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|19439108-9835-38fe-8ee2-1226a355cfba", "display": "NEWTON WELLESLEY CENTER FOR ALZHEIMER'S CARE" } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:31de59de-7c1d-d910-d695-7fc9e31cc376", "resource": { "resourceType": "Condition", "id": "31de59de-7c1d-d910-d695-7fc9e31cc376", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:cc086787-9a86-e3f4-deb0-acf85a15a8ea" }, "onsetDateTime": "2009-05-18T14:40:21-04:00", "recordedDate": "2009-05-18T14:40:21-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:afa0a15e-b0a7-2244-0f5c-4c696323af09", "resource": { "resourceType": "DiagnosticReport", "id": "afa0a15e-b0a7-2244-0f5c-4c696323af09", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:cc086787-9a86-e3f4-deb0-acf85a15a8ea" }, "effectiveDateTime": "2009-05-18T13:45:19-04:00", "issued": "2009-05-18T13:45:19.509-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883199", "display": "Dr. Anderson154 Kunze215" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:a4df938c-6961-30e1-8945-b68a46b98675", "resource": { "resourceType": "DocumentReference", "id": "a4df938c-6961-30e1-8945-b68a46b98675", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:afa0a15e-b0a7-2244-0f5c-4c696323af09" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "2009-05-18T13:45:19.509-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883199", "display": "Dr. Anderson154 Kunze215" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|19439108-9835-38fe-8ee2-1226a355cfba", "display": "NEWTON WELLESLEY CENTER FOR ALZHEIMER'S CARE" }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:cc086787-9a86-e3f4-deb0-acf85a15a8ea" } ], "period": { "start": "2009-05-18T13:45:19-04:00", "end": "2009-05-18T14:45:19-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:9e69ad31-e310-565d-062d-ae6292d28141", "resource": { "resourceType": "Claim", "id": "9e69ad31-e310-565d-062d-ae6292d28141", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "2009-05-18T13:45:19-04:00", "end": "2009-05-18T14:45:19-04:00" }, "created": "2009-05-18T14:45:19-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|19439108-9835-38fe-8ee2-1226a355cfba", "display": "NEWTON WELLESLEY CENTER FOR ALZHEIMER'S CARE" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|241b0f72-2cf6-3954-8a5b-c3a903c6bf4c", "display": "NEWTON WELLESLEY CENTER FOR ALZHEIMER'S CARE" }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:31de59de-7c1d-d910-d695-7fc9e31cc376" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "50849002", "display": "Emergency room admission (procedure)" } ], "text": "Emergency room admission (procedure)" }, "encounter": [ { "reference": "urn:uuid:cc086787-9a86-e3f4-deb0-acf85a15a8ea" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" } } ], "total": { "value": 1220.43, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:be399156-f222-8930-3d28-4f9709529592", "resource": { "resourceType": "ExplanationOfBenefit", "id": "be399156-f222-8930-3d28-4f9709529592", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883199" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883199" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "9e69ad31-e310-565d-062d-ae6292d28141" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "2009-05-18T14:45:19-04:00", "end": "2010-05-18T14:45:19-04:00" }, "created": "2009-05-18T14:45:19-04:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883199" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|241b0f72-2cf6-3954-8a5b-c3a903c6bf4c", "display": "NEWTON WELLESLEY CENTER FOR ALZHEIMER'S CARE" }, "claim": { "reference": "urn:uuid:9e69ad31-e310-565d-062d-ae6292d28141" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999883199" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:31de59de-7c1d-d910-d695-7fc9e31cc376" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "50849002", "display": "Emergency room admission (procedure)" } ], "text": "Emergency room admission (procedure)" }, "servicedPeriod": { "start": "2009-05-18T13:45:19-04:00", "end": "2009-05-18T14:45:19-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] }, "encounter": [ { "reference": "urn:uuid:cc086787-9a86-e3f4-deb0-acf85a15a8ea" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "160903007", "display": "Full-time employment (finding)" } ], "text": "Full-time employment (finding)" }, "servicedPeriod": { "start": "2009-05-18T13:45:19-04:00", "end": "2009-05-18T14:45:19-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "20", "display": "Urgent Care Facility" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 1220.43, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb", "resource": { "resourceType": "Encounter", "id": "5829398c-1d46-bab2-7adf-554a551eaddb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "5829398c-1d46-bab2-7adf-554a551eaddb" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } } ], "period": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:7a8bde87-683e-05cf-7120-24d1d7f949f6", "resource": { "resourceType": "Condition", "id": "7a8bde87-683e-05cf-7120-24d1d7f949f6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "onsetDateTime": "2015-10-12T13:45:19-04:00", "abatementDateTime": "2018-06-11T13:45:19-04:00", "recordedDate": "2015-10-12T13:45:19-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:e38922bd-6a77-c050-d80b-4109a1c9a105", "resource": { "resourceType": "Observation", "id": "e38922bd-6a77-c050-d80b-4109a1c9a105", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueQuantity": { "value": 174.3, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3a637b70-89bc-bf53-bb3d-7312c33a3cc4", "resource": { "resourceType": "Observation", "id": "3a637b70-89bc-bf53-bb3d-7312c33a3cc4", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:46df47f0-878e-ba68-d445-32f187dc351c", "resource": { "resourceType": "Observation", "id": "46df47f0-878e-ba68-d445-32f187dc351c", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueQuantity": { "value": 89.1, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2f1d5bb3-57cc-0cba-04f3-3dd2458670c9", "resource": { "resourceType": "Observation", "id": "2f1d5bb3-57cc-0cba-04f3-3dd2458670c9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueQuantity": { "value": 29.34, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:de1339b2-f662-fbfe-0218-1fc96cf99449", "resource": { "resourceType": "Observation", "id": "de1339b2-f662-fbfe-0218-1fc96cf99449", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 71, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 117, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:318ac40f-0957-5b2d-933e-b072c7cc1511", "resource": { "resourceType": "Observation", "id": "318ac40f-0957-5b2d-933e-b072c7cc1511", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueQuantity": { "value": 81, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0c660630-000f-14d0-661b-edceddd21975", "resource": { "resourceType": "Observation", "id": "0c660630-000f-14d0-661b-edceddd21975", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueQuantity": { "value": 15, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e6b66ab3-3b82-edc5-922b-e4a980d5974f", "resource": { "resourceType": "Observation", "id": "e6b66ab3-3b82-edc5-922b-e4a980d5974f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2093-3", "display": "Cholesterol [Mass/volume] in Serum or Plasma" } ], "text": "Cholesterol [Mass/volume] in Serum or Plasma" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueQuantity": { "value": 279.99, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5f34a96e-5267-de4d-985b-0584042c8ea9", "resource": { "resourceType": "Observation", "id": "5f34a96e-5267-de4d-985b-0584042c8ea9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2571-8", "display": "Triglycerides" } ], "text": "Triglycerides" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueQuantity": { "value": 108.34, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9fda4e41-774f-7063-1ea9-f2a81925ed6d", "resource": { "resourceType": "Observation", "id": "9fda4e41-774f-7063-1ea9-f2a81925ed6d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "18262-6", "display": "Low Density Lipoprotein Cholesterol" } ], "text": "Low Density Lipoprotein Cholesterol" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueQuantity": { "value": 206.65, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7abc523e-b379-eb7b-6415-0412ec3b0a59", "resource": { "resourceType": "Observation", "id": "7abc523e-b379-eb7b-6415-0412ec3b0a59", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2085-9", "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" } ], "text": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueQuantity": { "value": 51.68, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5cfc622c-1e42-e9b2-48f4-4b2c1cbb2152", "resource": { "resourceType": "Observation", "id": "5cfc622c-1e42-e9b2-48f4-4b2c1cbb2152", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "8517006", "display": "Ex-smoker (finding)" } ], "text": "Ex-smoker (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1f65cd96-dc81-da0d-7d81-bfcf83c9f23b", "resource": { "resourceType": "Observation", "id": "1f65cd96-dc81-da0d-7d81-bfcf83c9f23b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T14:43:59-04:00", "issued": "2015-10-12T14:43:59.509-04:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30132-7", "display": "5 or more times a week" } ], "text": "5 or more times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 827050, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6350-8", "display": "Private insurance" } ], "text": "Private insurance" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30136-8", "display": "Full-time work" } ], "text": "Full-time work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "681 Trantow Vista Apt 76" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 7, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b8156fcc-3258-8fab-6a99-504ab6b0e48b", "resource": { "resourceType": "Observation", "id": "b8156fcc-3258-8fab-6a99-504ab6b0e48b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82667-7", "display": "Total score [DAST-10]" } ], "text": "Total score [DAST-10]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T15:17:30-04:00", "issued": "2015-10-12T15:17:30.509-04:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ced12cea-5e69-15b6-30b7-c92a83fe563a", "resource": { "resourceType": "Procedure", "id": "ced12cea-5e69-15b6-30b7-c92a83fe563a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "performedPeriod": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:66820935-2a1d-ea5f-8a4a-58c3c05627ed", "resource": { "resourceType": "Procedure", "id": "66820935-2a1d-ea5f-8a4a-58c3c05627ed", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "performedPeriod": { "start": "2015-10-12T14:43:59-04:00", "end": "2015-10-12T14:57:22-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:27842654-16a3-1ec6-55ad-9d0111727a55", "resource": { "resourceType": "Procedure", "id": "27842654-16a3-1ec6-55ad-9d0111727a55", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "performedPeriod": { "start": "2015-10-12T14:57:22-04:00", "end": "2015-10-12T15:17:30-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:c614611e-daa9-6414-e98f-f68357e53342", "resource": { "resourceType": "Immunization", "id": "c614611e-daa9-6414-e98f-f68357e53342", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "occurrenceDateTime": "2015-10-12T13:45:19-04:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:827e357d-607c-cbc5-864c-276a147f37e0", "resource": { "resourceType": "DiagnosticReport", "id": "827e357d-607c-cbc5-864c-276a147f37e0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "57698-3", "display": "Lipid panel with direct LDL - Serum or Plasma" } ], "text": "Lipid panel with direct LDL - Serum or Plasma" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } ], "result": [ { "reference": "urn:uuid:e6b66ab3-3b82-edc5-922b-e4a980d5974f", "display": "Cholesterol [Mass/volume] in Serum or Plasma" }, { "reference": "urn:uuid:5f34a96e-5267-de4d-985b-0584042c8ea9", "display": "Triglycerides" }, { "reference": "urn:uuid:9fda4e41-774f-7063-1ea9-f2a81925ed6d", "display": "Low Density Lipoprotein Cholesterol" }, { "reference": "urn:uuid:7abc523e-b379-eb7b-6415-0412ec3b0a59", "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:fc9e973d-a22c-b05d-35ec-7287019ddac5", "resource": { "resourceType": "DiagnosticReport", "id": "fc9e973d-a22c-b05d-35ec-7287019ddac5", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T15:17:30-04:00", "issued": "2015-10-12T15:17:30.509-04:00", "result": [ { "reference": "urn:uuid:b8156fcc-3258-8fab-6a99-504ab6b0e48b", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:8c2056a5-1ade-cae5-8395-b7fb6a706371", "resource": { "resourceType": "DiagnosticReport", "id": "8c2056a5-1ade-cae5-8395-b7fb6a706371", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, "effectiveDateTime": "2015-10-12T13:45:19-04:00", "issued": "2015-10-12T13:45:19.509-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:7000d434-cb24-9464-fcc5-33f0762f46e0", "resource": { "resourceType": "DocumentReference", "id": "7000d434-cb24-9464-fcc5-33f0762f46e0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:8c2056a5-1ade-cae5-8395-b7fb6a706371" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "2015-10-12T13:45:19.509-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" } ], "period": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:dc3aee27-5d33-b9bc-7283-d52c3d63324c", "resource": { "resourceType": "Claim", "id": "dc3aee27-5d33-b9bc-7283-d52c3d63324c", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "created": "2015-10-12T14:43:59-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:c614611e-daa9-6414-e98f-f68357e53342" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:7a8bde87-683e-05cf-7120-24d1d7f949f6" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:ced12cea-5e69-15b6-30b7-c92a83fe563a" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:66820935-2a1d-ea5f-8a4a-58c3c05627ed" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:27842654-16a3-1ec6-55ad-9d0111727a55" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 4, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "57698-3", "display": "Lipid panel with direct LDL - Serum or Plasma" } ], "text": "Lipid panel with direct LDL - Serum or Plasma" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 5, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 6, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 778.78, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:443f6ef3-70c0-baca-e0a2-7aeae6ca3fad", "resource": { "resourceType": "ExplanationOfBenefit", "id": "443f6ef3-70c0-baca-e0a2-7aeae6ca3fad", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "dc3aee27-5d33-b9bc-7283-d52c3d63324c" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "2015-10-12T14:43:59-04:00", "end": "2016-10-12T14:43:59-04:00" }, "created": "2015-10-12T14:43:59-04:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "claim": { "reference": "urn:uuid:dc3aee27-5d33-b9bc-7283-d52c3d63324c" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:7a8bde87-683e-05cf-7120-24d1d7f949f6" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 4, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "57698-3", "display": "Lipid panel with direct LDL - Serum or Plasma" } ], "text": "Lipid panel with direct LDL - Serum or Plasma" }, "servicedPeriod": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "servicedPeriod": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "servicedPeriod": { "start": "2015-10-12T13:45:19-04:00", "end": "2015-10-12T14:43:59-04:00" }, "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": 778.78, "currency": "USD" } } ], "payment": { "amount": { "value": 1263.488, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb", "resource": { "resourceType": "Encounter", "id": "05b95eb2-277c-36c5-19bd-b07839b3f2cb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "05b95eb2-277c-36c5-19bd-b07839b3f2cb" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } } ], "period": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:9c423796-39e9-18cb-c56a-d93a8186ae37", "resource": { "resourceType": "Condition", "id": "9c423796-39e9-18cb-c56a-d93a8186ae37", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "162864005", "display": "Body mass index 30+ - obesity (finding)" } ], "text": "Body mass index 30+ - obesity (finding)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "onsetDateTime": "2018-06-11T13:45:19-04:00", "recordedDate": "2018-06-11T13:45:19-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:c6da5831-0b9f-0033-3081-0862edad6ad5", "resource": { "resourceType": "Condition", "id": "c6da5831-0b9f-0033-3081-0862edad6ad5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "onsetDateTime": "2018-06-11T14:33:45-04:00", "abatementDateTime": "2020-06-15T14:32:11-04:00", "recordedDate": "2018-06-11T14:33:45-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:f75eb560-275c-1904-c6b7-6fb98e0bc86f", "resource": { "resourceType": "Observation", "id": "f75eb560-275c-1904-c6b7-6fb98e0bc86f", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 174.3, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2827b707-af4f-9bfd-77b5-351ed6a62ce5", "resource": { "resourceType": "Observation", "id": "2827b707-af4f-9bfd-77b5-351ed6a62ce5", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2c278663-be81-919f-ecc0-82655da19061", "resource": { "resourceType": "Observation", "id": "2c278663-be81-919f-ecc0-82655da19061", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 91.8, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:34abaa70-7fbd-9eb4-fae4-5edd693eaa7a", "resource": { "resourceType": "Observation", "id": "34abaa70-7fbd-9eb4-fae4-5edd693eaa7a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 30.22, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:30ffe145-b90b-6f66-b5b1-66a0907dd5c4", "resource": { "resourceType": "Observation", "id": "30ffe145-b90b-6f66-b5b1-66a0907dd5c4", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 69, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 127, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f8d4ed7a-e111-3af5-a7c5-6b91b4034afa", "resource": { "resourceType": "Observation", "id": "f8d4ed7a-e111-3af5-a7c5-6b91b4034afa", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 92, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:67e0ff54-135b-b329-906a-94aaed22a3a7", "resource": { "resourceType": "Observation", "id": "67e0ff54-135b-b329-906a-94aaed22a3a7", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 15, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2be37bc0-a666-04d0-2153-33047e5f0cc6", "resource": { "resourceType": "Observation", "id": "2be37bc0-a666-04d0-2153-33047e5f0cc6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "6690-2", "display": "Leukocytes [#/volume] in Blood by Automated count" } ], "text": "Leukocytes [#/volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 6.5443, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:00e9230d-8bbe-4c46-c984-8444ae6e5731", "resource": { "resourceType": "Observation", "id": "00e9230d-8bbe-4c46-c984-8444ae6e5731", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "789-8", "display": "Erythrocytes [#/volume] in Blood by Automated count" } ], "text": "Erythrocytes [#/volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 4.9264, "unit": "10*6/uL", "system": "http://unitsofmeasure.org", "code": "10*6/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:72edfd7f-abcb-f645-c4e5-b13e61f345f3", "resource": { "resourceType": "Observation", "id": "72edfd7f-abcb-f645-c4e5-b13e61f345f3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "718-7", "display": "Hemoglobin [Mass/volume] in Blood" } ], "text": "Hemoglobin [Mass/volume] in Blood" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 14.667, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:75f04b0e-5f74-9455-a74b-2f8c3f7f1c4f", "resource": { "resourceType": "Observation", "id": "75f04b0e-5f74-9455-a74b-2f8c3f7f1c4f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "4544-3", "display": "Hematocrit [Volume Fraction] of Blood by Automated count" } ], "text": "Hematocrit [Volume Fraction] of Blood by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 47.768, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:8a7f56f1-906b-4113-1493-21310000b79e", "resource": { "resourceType": "Observation", "id": "8a7f56f1-906b-4113-1493-21310000b79e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "787-2", "display": "MCV [Entitic volume] by Automated count" } ], "text": "MCV [Entitic volume] by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 80.995, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:3a2c25b9-f799-8d1f-cccd-86a78762fd39", "resource": { "resourceType": "Observation", "id": "3a2c25b9-f799-8d1f-cccd-86a78762fd39", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "785-6", "display": "MCH [Entitic mass] by Automated count" } ], "text": "MCH [Entitic mass] by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 29.764, "unit": "pg", "system": "http://unitsofmeasure.org", "code": "pg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:472171ba-d768-57a2-8373-37297896e420", "resource": { "resourceType": "Observation", "id": "472171ba-d768-57a2-8373-37297896e420", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "786-4", "display": "MCHC [Mass/volume] by Automated count" } ], "text": "MCHC [Mass/volume] by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 35.887, "unit": "g/dL", "system": "http://unitsofmeasure.org", "code": "g/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:149a8af9-5326-9da7-4eca-b5e5e8ebe45d", "resource": { "resourceType": "Observation", "id": "149a8af9-5326-9da7-4eca-b5e5e8ebe45d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "21000-5", "display": "Erythrocyte distribution width [Entitic volume] by Automated count" } ], "text": "Erythrocyte distribution width [Entitic volume] by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 45.127, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c5e3c6d9-6d30-b1b6-6637-045d6bc60656", "resource": { "resourceType": "Observation", "id": "c5e3c6d9-6d30-b1b6-6637-045d6bc60656", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "777-3", "display": "Platelets [#/volume] in Blood by Automated count" } ], "text": "Platelets [#/volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 337.61, "unit": "10*3/uL", "system": "http://unitsofmeasure.org", "code": "10*3/uL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b26b8937-2615-817a-f433-51188773ba8b", "resource": { "resourceType": "Observation", "id": "b26b8937-2615-817a-f433-51188773ba8b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "32207-3", "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" } ], "text": "Platelet distribution width [Entitic volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 403.91, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:dbd663c0-a343-2158-1551-2771da9b1e6f", "resource": { "resourceType": "Observation", "id": "dbd663c0-a343-2158-1551-2771da9b1e6f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "32623-1", "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" } ], "text": "Platelet mean volume [Entitic volume] in Blood by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueQuantity": { "value": 11.219, "unit": "fL", "system": "http://unitsofmeasure.org", "code": "fL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1e3d6032-0289-ed61-0bf9-ae187bca1040", "resource": { "resourceType": "Observation", "id": "1e3d6032-0289-ed61-0bf9-ae187bca1040", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "8517006", "display": "Ex-smoker (finding)" } ], "text": "Ex-smoker (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2ae068ed-599c-45be-9db8-54b44d5de11c", "resource": { "resourceType": "Observation", "id": "2ae068ed-599c-45be-9db8-54b44d5de11c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T14:33:45-04:00", "issued": "2018-06-11T14:33:45.509-04:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA13863-8", "display": "A little bit" } ], "text": "A little bit" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30131-9", "display": "3 to 5 times a week" } ], "text": "3 to 5 times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30128-5", "display": "Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)" } ], "text": "Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 827050, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6350-8", "display": "Private insurance" } ], "text": "Private insurance" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30136-8", "display": "Full-time work" } ], "text": "Full-time work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "681 Trantow Vista Apt 76" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 7, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c26f21db-bc7a-8a7f-c2c0-f7d8b79b78e3", "resource": { "resourceType": "Observation", "id": "c26f21db-bc7a-8a7f-c2c0-f7d8b79b78e3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "70274-6", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ], "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T14:57:55-04:00", "issued": "2018-06-11T14:57:55.509-04:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:4e494637-c922-5a16-5ca9-86994d99ab8c", "resource": { "resourceType": "Observation", "id": "4e494637-c922-5a16-5ca9-86994d99ab8c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "76504-0", "display": "Total score [HARK]" } ], "text": "Total score [HARK]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T15:40:17-04:00", "issued": "2018-06-11T15:40:17.509-04:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f99978fa-2029-3ee4-a909-44415c9f93a4", "resource": { "resourceType": "Observation", "id": "f99978fa-2029-3ee4-a909-44415c9f93a4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T16:21:52-04:00", "issued": "2018-06-11T16:21:52.509-04:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a4efb9e2-3db1-c920-67c6-309aa8b8ae95", "resource": { "resourceType": "Observation", "id": "a4efb9e2-3db1-c920-67c6-309aa8b8ae95", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82667-7", "display": "Total score [DAST-10]" } ], "text": "Total score [DAST-10]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T17:00:25-04:00", "issued": "2018-06-11T17:00:25.509-04:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:edc9c588-3b0f-0446-6887-eae326e1a47b", "resource": { "resourceType": "Procedure", "id": "edc9c588-3b0f-0446-6887-eae326e1a47b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "performedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:00:19-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:9edca4bd-5a27-d402-d92b-d42d6e6424f4", "resource": { "resourceType": "Procedure", "id": "9edca4bd-5a27-d402-d92b-d42d6e6424f4", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "performedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:a9bf808e-4481-add0-1164-e56b84303672", "resource": { "resourceType": "Procedure", "id": "a9bf808e-4481-add0-1164-e56b84303672", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "performedPeriod": { "start": "2018-06-11T14:33:45-04:00", "end": "2018-06-11T14:57:55-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:74212e23-8307-7399-0514-0ecd2cc0b643", "resource": { "resourceType": "Procedure", "id": "74212e23-8307-7399-0514-0ecd2cc0b643", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "performedPeriod": { "start": "2018-06-11T14:57:55-04:00", "end": "2018-06-11T15:40:17-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0fd8a571-f376-0bdd-01ac-77f994427c69", "resource": { "resourceType": "Procedure", "id": "0fd8a571-f376-0bdd-01ac-77f994427c69", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "performedPeriod": { "start": "2018-06-11T15:40:17-04:00", "end": "2018-06-11T15:54:04-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:3dfbe2bd-1bb9-e233-4ab6-3b3765efdcc1", "resource": { "resourceType": "Procedure", "id": "3dfbe2bd-1bb9-e233-4ab6-3b3765efdcc1", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "performedPeriod": { "start": "2018-06-11T15:54:04-04:00", "end": "2018-06-11T16:21:52-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:632f70a7-5d67-847f-7cab-408a5d9d3dd0", "resource": { "resourceType": "Procedure", "id": "632f70a7-5d67-847f-7cab-408a5d9d3dd0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "performedPeriod": { "start": "2018-06-11T16:21:52-04:00", "end": "2018-06-11T16:34:20-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b6ffe42b-1361-d4da-9db8-759dbefedd7d", "resource": { "resourceType": "Procedure", "id": "b6ffe42b-1361-d4da-9db8-759dbefedd7d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "performedPeriod": { "start": "2018-06-11T16:34:20-04:00", "end": "2018-06-11T17:00:25-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:16842539-dde7-4dce-b1de-e2ce74310dfb", "resource": { "resourceType": "Immunization", "id": "16842539-dde7-4dce-b1de-e2ce74310dfb", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "occurrenceDateTime": "2018-06-11T13:45:19-04:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:bdf43caf-44dc-2b45-e29e-31a14b464661", "resource": { "resourceType": "Immunization", "id": "bdf43caf-44dc-2b45-e29e-31a14b464661", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "52", "display": "Hep A, adult" } ], "text": "Hep A, adult" }, "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "occurrenceDateTime": "2018-06-11T13:45:19-04:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:9e6c4939-042d-603c-cefa-a19c59ecd639", "resource": { "resourceType": "DiagnosticReport", "id": "9e6c4939-042d-603c-cefa-a19c59ecd639", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } ], "result": [ { "reference": "urn:uuid:2be37bc0-a666-04d0-2153-33047e5f0cc6", "display": "Leukocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:00e9230d-8bbe-4c46-c984-8444ae6e5731", "display": "Erythrocytes [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:72edfd7f-abcb-f645-c4e5-b13e61f345f3", "display": "Hemoglobin [Mass/volume] in Blood" }, { "reference": "urn:uuid:75f04b0e-5f74-9455-a74b-2f8c3f7f1c4f", "display": "Hematocrit [Volume Fraction] of Blood by Automated count" }, { "reference": "urn:uuid:8a7f56f1-906b-4113-1493-21310000b79e", "display": "MCV [Entitic volume] by Automated count" }, { "reference": "urn:uuid:3a2c25b9-f799-8d1f-cccd-86a78762fd39", "display": "MCH [Entitic mass] by Automated count" }, { "reference": "urn:uuid:472171ba-d768-57a2-8373-37297896e420", "display": "MCHC [Mass/volume] by Automated count" }, { "reference": "urn:uuid:149a8af9-5326-9da7-4eca-b5e5e8ebe45d", "display": "Erythrocyte distribution width [Entitic volume] by Automated count" }, { "reference": "urn:uuid:c5e3c6d9-6d30-b1b6-6637-045d6bc60656", "display": "Platelets [#/volume] in Blood by Automated count" }, { "reference": "urn:uuid:b26b8937-2615-817a-f433-51188773ba8b", "display": "Platelet distribution width [Entitic volume] in Blood by Automated count" }, { "reference": "urn:uuid:dbd663c0-a343-2158-1551-2771da9b1e6f", "display": "Platelet mean volume [Entitic volume] in Blood by Automated count" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:963363a7-c459-d8e5-1838-2ce1c80c111d", "resource": { "resourceType": "DiagnosticReport", "id": "963363a7-c459-d8e5-1838-2ce1c80c111d", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T14:57:55-04:00", "issued": "2018-06-11T14:57:55.509-04:00", "result": [ { "reference": "urn:uuid:c26f21db-bc7a-8a7f-c2c0-f7d8b79b78e3", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:7ead457b-c9f0-6e6f-2348-0501c73fe2d9", "resource": { "resourceType": "DiagnosticReport", "id": "7ead457b-c9f0-6e6f-2348-0501c73fe2d9", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T15:40:17-04:00", "issued": "2018-06-11T15:40:17.509-04:00", "result": [ { "reference": "urn:uuid:4e494637-c922-5a16-5ca9-86994d99ab8c", "display": "Total score [HARK]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:3aee4ead-bd9c-317c-7097-b13442b8d5f7", "resource": { "resourceType": "DiagnosticReport", "id": "3aee4ead-bd9c-317c-7097-b13442b8d5f7", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T16:21:52-04:00", "issued": "2018-06-11T16:21:52.509-04:00", "result": [ { "reference": "urn:uuid:f99978fa-2029-3ee4-a909-44415c9f93a4", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:df7deb82-9d8e-937c-da9d-94641b2b83b3", "resource": { "resourceType": "DiagnosticReport", "id": "df7deb82-9d8e-937c-da9d-94641b2b83b3", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T17:00:25-04:00", "issued": "2018-06-11T17:00:25.509-04:00", "result": [ { "reference": "urn:uuid:a4efb9e2-3db1-c920-67c6-309aa8b8ae95", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:626a5795-643a-62bd-c763-711e23b1b8d2", "resource": { "resourceType": "DiagnosticReport", "id": "626a5795-643a-62bd-c763-711e23b1b8d2", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, "effectiveDateTime": "2018-06-11T13:45:19-04:00", "issued": "2018-06-11T13:45:19.509-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:424261cc-2a57-5651-fcf3-0cf3f3239c4c", "resource": { "resourceType": "DocumentReference", "id": "424261cc-2a57-5651-fcf3-0cf3f3239c4c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:626a5795-643a-62bd-c763-711e23b1b8d2" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "2018-06-11T13:45:19.509-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" } ], "period": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:8d1e4a5c-9a66-07b3-f877-ae9826f519eb", "resource": { "resourceType": "Claim", "id": "8d1e4a5c-9a66-07b3-f877-ae9826f519eb", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "created": "2018-06-11T14:33:45-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:16842539-dde7-4dce-b1de-e2ce74310dfb" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:bdf43caf-44dc-2b45-e29e-31a14b464661" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 6, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 7, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:9c423796-39e9-18cb-c56a-d93a8186ae37" } }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:c6da5831-0b9f-0033-3081-0862edad6ad5" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:edc9c588-3b0f-0446-6887-eae326e1a47b" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:9edca4bd-5a27-d402-d92b-d42d6e6424f4" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:a9bf808e-4481-add0-1164-e56b84303672" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:74212e23-8307-7399-0514-0ecd2cc0b643" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:0fd8a571-f376-0bdd-01ac-77f994427c69" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:3dfbe2bd-1bb9-e233-4ab6-3b3765efdcc1" } }, { "sequence": 7, "procedureReference": { "reference": "urn:uuid:632f70a7-5d67-847f-7cab-408a5d9d3dd0" } }, { "sequence": 8, "procedureReference": { "reference": "urn:uuid:b6ffe42b-1361-d4da-9db8-759dbefedd7d" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "52", "display": "Hep A, adult" } ], "text": "Hep A, adult" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 4, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 554.04, "currency": "USD" } }, { "sequence": 5, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162864005", "display": "Body mass index 30+ - obesity (finding)" } ], "text": "Body mass index 30+ - obesity (finding)" } }, { "sequence": 6, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "diagnosisSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" } }, { "sequence": 9, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 13, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 14, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 15, "informationSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 16, "procedureSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 17, "procedureSequence": [ 8 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 18, "informationSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1468.82, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:cfe7032f-ee75-767b-6c79-e7f5066462a2", "resource": { "resourceType": "ExplanationOfBenefit", "id": "cfe7032f-ee75-767b-6c79-e7f5066462a2", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "8d1e4a5c-9a66-07b3-f877-ae9826f519eb" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "2018-06-11T14:33:45-04:00", "end": "2019-06-11T14:33:45-04:00" }, "created": "2018-06-11T14:33:45-04:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "claim": { "reference": "urn:uuid:8d1e4a5c-9a66-07b3-f877-ae9826f519eb" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:9c423796-39e9-18cb-c56a-d93a8186ae37" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] }, { "sequence": 2, "diagnosisReference": { "reference": "urn:uuid:c6da5831-0b9f-0033-3081-0862edad6ad5" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "52", "display": "Hep A, adult" } ], "text": "Hep A, adult" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 554.04, "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": 110.80799999999999, "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": 443.23199999999997, "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": 554.04, "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": 554.04, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162864005", "display": "Body mass index 30+ - obesity (finding)" } ], "text": "Body mass index 30+ - obesity (finding)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 6, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "58410-2", "display": "CBC panel - Blood by Automated count" } ], "text": "CBC panel - Blood by Automated count" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "diagnosisSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "73595000", "display": "Stress (finding)" } ], "text": "Stress (finding)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "866148006", "display": "Screening for domestic abuse (procedure)" } ], "text": "Screening for domestic abuse (procedure)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "informationSequence": [ 5 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "76499-3", "display": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" } ], "text": "Humiliation, Afraid, Rape, and Kick questionnaire [HARK]" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 13, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 14, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 15, "informationSequence": [ 6 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 16, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 17, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 18, "informationSequence": [ 7 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "servicedPeriod": { "start": "2018-06-11T13:45:19-04:00", "end": "2018-06-11T14:33:45-04:00" }, "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": 1468.82, "currency": "USD" } } ], "payment": { "amount": { "value": 3374.992, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52", "resource": { "resourceType": "Encounter", "id": "e17cd50f-0fbe-ec59-84f5-8accebac0f52", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "e17cd50f-0fbe-ec59-84f5-8accebac0f52" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } } ], "period": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:9cfb5a95-6147-726d-f85f-c91ab4b5bf73", "resource": { "resourceType": "Condition", "id": "9cfb5a95-6147-726d-f85f-c91ab4b5bf73", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "onsetDateTime": "2020-06-15T13:45:19-04:00", "abatementDateTime": "2022-06-20T13:45:19-04:00", "recordedDate": "2020-06-15T13:45:19-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:90fa79e7-bdb3-e6d4-a663-13d8c5667496", "resource": { "resourceType": "Observation", "id": "90fa79e7-bdb3-e6d4-a663-13d8c5667496", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueQuantity": { "value": 174.3, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:1ac83a2b-bfe9-0d63-aae4-5ec78438a867", "resource": { "resourceType": "Observation", "id": "1ac83a2b-bfe9-0d63-aae4-5ec78438a867", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:038dd596-6bd9-81c8-2edd-35228d5c95c9", "resource": { "resourceType": "Observation", "id": "038dd596-6bd9-81c8-2edd-35228d5c95c9", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueQuantity": { "value": 91.8, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ec23a3fa-48ff-1de0-346e-db6ca072ffc5", "resource": { "resourceType": "Observation", "id": "ec23a3fa-48ff-1de0-346e-db6ca072ffc5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueQuantity": { "value": 30.22, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b6e1254d-0227-26d9-b881-e000cc061187", "resource": { "resourceType": "Observation", "id": "b6e1254d-0227-26d9-b881-e000cc061187", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 67, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 120, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7e612fc0-bf1e-96a5-e4a6-2404f9753162", "resource": { "resourceType": "Observation", "id": "7e612fc0-bf1e-96a5-e4a6-2404f9753162", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueQuantity": { "value": 66, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:7801c2cb-7d5f-b95b-b9fd-8d0fed650ffa", "resource": { "resourceType": "Observation", "id": "7801c2cb-7d5f-b95b-b9fd-8d0fed650ffa", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueQuantity": { "value": 14, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:d08cf092-1ee3-5ad3-06ff-86ef2820df3a", "resource": { "resourceType": "Observation", "id": "d08cf092-1ee3-5ad3-06ff-86ef2820df3a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2093-3", "display": "Cholesterol [Mass/volume] in Serum or Plasma" } ], "text": "Cholesterol [Mass/volume] in Serum or Plasma" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueQuantity": { "value": 280.85, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:dc5b6dbb-981e-76ab-a504-066c0148de2a", "resource": { "resourceType": "Observation", "id": "dc5b6dbb-981e-76ab-a504-066c0148de2a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2571-8", "display": "Triglycerides" } ], "text": "Triglycerides" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueQuantity": { "value": 142.19, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2ef9b892-6f77-fb8a-e653-249ea662ef99", "resource": { "resourceType": "Observation", "id": "2ef9b892-6f77-fb8a-e653-249ea662ef99", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "18262-6", "display": "Low Density Lipoprotein Cholesterol" } ], "text": "Low Density Lipoprotein Cholesterol" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueQuantity": { "value": 194.95, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:b40a8590-a4dd-778a-fe87-6a2f339edd17", "resource": { "resourceType": "Observation", "id": "b40a8590-a4dd-778a-fe87-6a2f339edd17", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "2085-9", "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" } ], "text": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueQuantity": { "value": 57.47, "unit": "mg/dL", "system": "http://unitsofmeasure.org", "code": "mg/dL" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:2c878b03-17fb-5d8b-91e7-bf85a1030c24", "resource": { "resourceType": "Observation", "id": "2c878b03-17fb-5d8b-91e7-bf85a1030c24", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "8517006", "display": "Ex-smoker (finding)" } ], "text": "Ex-smoker (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:a75293b1-a97d-7576-12f2-060aae36223a", "resource": { "resourceType": "Observation", "id": "a75293b1-a97d-7576-12f2-060aae36223a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T14:32:11-04:00", "issued": "2020-06-15T14:32:11.509-04:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30132-7", "display": "5 or more times a week" } ], "text": "5 or more times a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 827050, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6350-8", "display": "Private insurance" } ], "text": "Private insurance" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30136-8", "display": "Full-time work" } ], "text": "Full-time work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "681 Trantow Vista Apt 76" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 7, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:913d1c8c-4eac-cbff-6dd9-9973bb9a7d5b", "resource": { "resourceType": "Observation", "id": "913d1c8c-4eac-cbff-6dd9-9973bb9a7d5b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "75626-2", "display": "Total score [AUDIT-C]" } ], "text": "Total score [AUDIT-C]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T15:12:25-04:00", "issued": "2020-06-15T15:12:25.509-04:00", "valueQuantity": { "value": 3, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:80b28e32-6404-88d3-4cdb-5bbf64d660a6", "resource": { "resourceType": "Procedure", "id": "80b28e32-6404-88d3-4cdb-5bbf64d660a6", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "performedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:597823a2-8357-abfd-1a40-d7d1888221bc", "resource": { "resourceType": "Procedure", "id": "597823a2-8357-abfd-1a40-d7d1888221bc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "performedPeriod": { "start": "2020-06-15T14:32:11-04:00", "end": "2020-06-15T14:44:03-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:0371a707-7f04-bd87-6037-59a9d084ec2d", "resource": { "resourceType": "Procedure", "id": "0371a707-7f04-bd87-6037-59a9d084ec2d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "performedPeriod": { "start": "2020-06-15T14:44:03-04:00", "end": "2020-06-15T15:12:25-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:cf2495b6-8998-1389-6876-f89a04b029bc", "resource": { "resourceType": "Immunization", "id": "cf2495b6-8998-1389-6876-f89a04b029bc", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "occurrenceDateTime": "2020-06-15T13:45:19-04:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:a35e0787-1c0c-c67e-710e-6eb9cff39a6b", "resource": { "resourceType": "Immunization", "id": "a35e0787-1c0c-c67e-710e-6eb9cff39a6b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "113", "display": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" } ], "text": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" }, "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "occurrenceDateTime": "2020-06-15T13:45:19-04:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:27f29ea7-66a0-d58b-c242-2c61ce8cb3a0", "resource": { "resourceType": "Immunization", "id": "27f29ea7-66a0-d58b-c242-2c61ce8cb3a0", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "52", "display": "Hep A, adult" } ], "text": "Hep A, adult" }, "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "occurrenceDateTime": "2020-06-15T13:45:19-04:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:a63402b7-f9e7-d42b-97ff-0e3ec5bef613", "resource": { "resourceType": "DiagnosticReport", "id": "a63402b7-f9e7-d42b-97ff-0e3ec5bef613", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "57698-3", "display": "Lipid panel with direct LDL - Serum or Plasma" } ], "text": "Lipid panel with direct LDL - Serum or Plasma" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "performer": [ { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } ], "result": [ { "reference": "urn:uuid:d08cf092-1ee3-5ad3-06ff-86ef2820df3a", "display": "Cholesterol [Mass/volume] in Serum or Plasma" }, { "reference": "urn:uuid:dc5b6dbb-981e-76ab-a504-066c0148de2a", "display": "Triglycerides" }, { "reference": "urn:uuid:2ef9b892-6f77-fb8a-e653-249ea662ef99", "display": "Low Density Lipoprotein Cholesterol" }, { "reference": "urn:uuid:b40a8590-a4dd-778a-fe87-6a2f339edd17", "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:bb05abcf-d61d-3cc4-b818-096c10d4798b", "resource": { "resourceType": "DiagnosticReport", "id": "bb05abcf-d61d-3cc4-b818-096c10d4798b", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T15:12:25-04:00", "issued": "2020-06-15T15:12:25.509-04:00", "result": [ { "reference": "urn:uuid:913d1c8c-4eac-cbff-6dd9-9973bb9a7d5b", "display": "Total score [AUDIT-C]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:b831587d-fefa-0b44-eb42-d76cab24d536", "resource": { "resourceType": "DiagnosticReport", "id": "b831587d-fefa-0b44-eb42-d76cab24d536", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, "effectiveDateTime": "2020-06-15T13:45:19-04:00", "issued": "2020-06-15T13:45:19.509-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:bdcbd4f7-7062-40a8-141b-668ffc59b60a", "resource": { "resourceType": "DocumentReference", "id": "bdcbd4f7-7062-40a8-141b-668ffc59b60a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:b831587d-fefa-0b44-eb42-d76cab24d536" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "2020-06-15T13:45:19.509-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" } ], "period": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:3a37b874-2e0f-9005-4b21-a5f9f5b05f09", "resource": { "resourceType": "Claim", "id": "3a37b874-2e0f-9005-4b21-a5f9f5b05f09", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "created": "2020-06-15T14:32:11-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:cf2495b6-8998-1389-6876-f89a04b029bc" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:a35e0787-1c0c-c67e-710e-6eb9cff39a6b" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:27f29ea7-66a0-d58b-c242-2c61ce8cb3a0" } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:9cfb5a95-6147-726d-f85f-c91ab4b5bf73" } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:80b28e32-6404-88d3-4cdb-5bbf64d660a6" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:597823a2-8357-abfd-1a40-d7d1888221bc" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:0371a707-7f04-bd87-6037-59a9d084ec2d" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "113", "display": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" } ], "text": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 4, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "52", "display": "Hep A, adult" } ], "text": "Hep A, adult" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 5, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" } }, { "sequence": 6, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "57698-3", "display": "Lipid panel with direct LDL - Serum or Plasma" } ], "text": "Lipid panel with direct LDL - Serum or Plasma" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 10, "informationSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1050.78, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:3d791269-dc92-0bec-c425-c90af55509c9", "resource": { "resourceType": "ExplanationOfBenefit", "id": "3d791269-dc92-0bec-c425-c90af55509c9", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "3a37b874-2e0f-9005-4b21-a5f9f5b05f09" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "2020-06-15T14:32:11-04:00", "end": "2021-06-15T14:32:11-04:00" }, "created": "2020-06-15T14:32:11-04:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "claim": { "reference": "urn:uuid:3a37b874-2e0f-9005-4b21-a5f9f5b05f09" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:9cfb5a95-6147-726d-f85f-c91ab4b5bf73" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "113", "display": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" } ], "text": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed" }, "servicedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "52", "display": "Hep A, adult" } ], "text": "Hep A, adult" }, "servicedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "314529007", "display": "Medication review due (situation)" } ], "text": "Medication review due (situation)" }, "servicedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] } }, { "sequence": 6, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "57698-3", "display": "Lipid panel with direct LDL - Serum or Plasma" } ], "text": "Lipid panel with direct LDL - Serum or Plasma" }, "servicedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "763302001", "display": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" } ], "text": "Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)" }, "servicedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "informationSequence": [ 5 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "text": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" }, "servicedPeriod": { "start": "2020-06-15T13:45:19-04:00", "end": "2020-06-15T14:32:11-04:00" }, "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": 1050.78, "currency": "USD" } } ], "payment": { "amount": { "value": 1481.088, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:21490684-55e2-0d76-ffdc-e77adc7e5056", "resource": { "resourceType": "Encounter", "id": "21490684-55e2-0d76-ffdc-e77adc7e5056", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "21490684-55e2-0d76-ffdc-e77adc7e5056" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-02-01T12:45:19-05:00", "end": "2021-02-01T13:00:19-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" } } ], "period": { "start": "2021-02-01T12:45:19-05:00", "end": "2021-02-01T13:00:19-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:302afc8c-ae88-2bd2-d1ba-6f49ead28a7b", "resource": { "resourceType": "Immunization", "id": "302afc8c-ae88-2bd2-d1ba-6f49ead28a7b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "207", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" }, "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:21490684-55e2-0d76-ffdc-e77adc7e5056" }, "occurrenceDateTime": "2021-02-01T12:45:19-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:1a4f1790-b8d5-baf5-e31b-5d8c7386661c", "resource": { "resourceType": "DiagnosticReport", "id": "1a4f1790-b8d5-baf5-e31b-5d8c7386661c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:21490684-55e2-0d76-ffdc-e77adc7e5056" }, "effectiveDateTime": "2021-02-01T12:45:19-05:00", "issued": "2021-02-01T12:45:19.509-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:178d6f8f-5106-d100-9ce6-add5b336aed5", "resource": { "resourceType": "DocumentReference", "id": "178d6f8f-5106-d100-9ce6-add5b336aed5", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:1a4f1790-b8d5-baf5-e31b-5d8c7386661c" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "2021-02-01T12:45:19.509-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:21490684-55e2-0d76-ffdc-e77adc7e5056" } ], "period": { "start": "2021-02-01T12:45:19-05:00", "end": "2021-02-01T13:00:19-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:faee8869-8983-d014-a738-6fa98a6de67b", "resource": { "resourceType": "Claim", "id": "faee8869-8983-d014-a738-6fa98a6de67b", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "2021-02-01T12:45:19-05:00", "end": "2021-02-01T13:00:19-05:00" }, "created": "2021-02-01T13:00:19-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:302afc8c-ae88-2bd2-d1ba-6f49ead28a7b" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" }, "encounter": [ { "reference": "urn:uuid:21490684-55e2-0d76-ffdc-e77adc7e5056" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "207", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" }, "net": { "value": 136.00, "currency": "USD" } } ], "total": { "value": 278.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:7501454e-6001-2f99-37ff-22d5a16b7132", "resource": { "resourceType": "ExplanationOfBenefit", "id": "7501454e-6001-2f99-37ff-22d5a16b7132", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "faee8869-8983-d014-a738-6fa98a6de67b" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "2021-02-01T13:00:19-05:00", "end": "2022-02-01T13:00:19-05:00" }, "created": "2021-02-01T13:00:19-05:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "claim": { "reference": "urn:uuid:faee8869-8983-d014-a738-6fa98a6de67b" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" }, "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": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" }, "servicedPeriod": { "start": "2021-02-01T12:45:19-05:00", "end": "2021-02-01T13:00:19-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:21490684-55e2-0d76-ffdc-e77adc7e5056" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "207", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" }, "servicedPeriod": { "start": "2021-02-01T12:45:19-05:00", "end": "2021-02-01T13:00:19-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 278.58, "currency": "USD" } } ], "payment": { "amount": { "value": 108.80000000000001, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d87b3639-58ca-6a40-4336-f6093e80773e", "resource": { "resourceType": "Encounter", "id": "d87b3639-58ca-6a40-4336-f6093e80773e", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "d87b3639-58ca-6a40-4336-f6093e80773e" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2021-03-01T12:45:19-05:00", "end": "2021-03-01T13:00:19-05:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" } } ], "period": { "start": "2021-03-01T12:45:19-05:00", "end": "2021-03-01T13:00:19-05:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:c49cb70d-9f9d-7f78-b851-5d146ed7849a", "resource": { "resourceType": "Immunization", "id": "c49cb70d-9f9d-7f78-b851-5d146ed7849a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "207", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" }, "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:d87b3639-58ca-6a40-4336-f6093e80773e" }, "occurrenceDateTime": "2021-03-01T12:45:19-05:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:74eef158-5ea1-e879-97ec-ceb0b435ccdf", "resource": { "resourceType": "DiagnosticReport", "id": "74eef158-5ea1-e879-97ec-ceb0b435ccdf", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:d87b3639-58ca-6a40-4336-f6093e80773e" }, "effectiveDateTime": "2021-03-01T12:45:19-05:00", "issued": "2021-03-01T12:45:19.509-05:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:f2a237fe-b49e-7bcf-91c5-6816a3893e7c", "resource": { "resourceType": "DocumentReference", "id": "f2a237fe-b49e-7bcf-91c5-6816a3893e7c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:74eef158-5ea1-e879-97ec-ceb0b435ccdf" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "2021-03-01T12:45:19.509-05:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:d87b3639-58ca-6a40-4336-f6093e80773e" } ], "period": { "start": "2021-03-01T12:45:19-05:00", "end": "2021-03-01T13:00:19-05:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:c59f0d6c-8557-7b38-fa2e-41e14b0b7d38", "resource": { "resourceType": "Claim", "id": "c59f0d6c-8557-7b38-fa2e-41e14b0b7d38", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "2021-03-01T12:45:19-05:00", "end": "2021-03-01T13:00:19-05:00" }, "created": "2021-03-01T13:00:19-05:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:c49cb70d-9f9d-7f78-b851-5d146ed7849a" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" }, "encounter": [ { "reference": "urn:uuid:d87b3639-58ca-6a40-4336-f6093e80773e" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "207", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" }, "net": { "value": 136.00, "currency": "USD" } } ], "total": { "value": 278.58, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:263bac23-fbea-60ef-e1ec-96920c5d794e", "resource": { "resourceType": "ExplanationOfBenefit", "id": "263bac23-fbea-60ef-e1ec-96920c5d794e", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c59f0d6c-8557-7b38-fa2e-41e14b0b7d38" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "2021-03-01T13:00:19-05:00", "end": "2022-03-01T13:00:19-05:00" }, "created": "2021-03-01T13:00:19-05:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "claim": { "reference": "urn:uuid:c59f0d6c-8557-7b38-fa2e-41e14b0b7d38" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" }, "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": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "33879002", "display": "Administration of vaccine to produce active immunity (procedure)" } ], "text": "Administration of vaccine to produce active immunity (procedure)" }, "servicedPeriod": { "start": "2021-03-01T12:45:19-05:00", "end": "2021-03-01T13:00:19-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:d87b3639-58ca-6a40-4336-f6093e80773e" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "207", "display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" } ], "text": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 100 mcg/0.5mL dose" }, "servicedPeriod": { "start": "2021-03-01T12:45:19-05:00", "end": "2021-03-01T13:00:19-05:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 278.58, "currency": "USD" } } ], "payment": { "amount": { "value": 108.80000000000001, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98", "resource": { "resourceType": "Encounter", "id": "632dec1c-5a26-1dcc-4cfd-42637bef0a98", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "632dec1c-5a26-1dcc-4cfd-42637bef0a98" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } } ], "period": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:c69dd53e-c1dd-af36-0bad-4c3d022174d7", "resource": { "resourceType": "Observation", "id": "c69dd53e-c1dd-af36-0bad-4c3d022174d7", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T13:45:19-04:00", "issued": "2022-06-20T13:45:19.509-04:00", "valueQuantity": { "value": 174.3, "unit": "cm", "system": "http://unitsofmeasure.org", "code": "cm" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:fb7296c7-52fa-90fa-7fec-de4a67a0b621", "resource": { "resourceType": "Observation", "id": "fb7296c7-52fa-90fa-7fec-de4a67a0b621", "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72514-3", "display": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" } ], "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T13:45:19-04:00", "issued": "2022-06-20T13:45:19.509-04:00", "valueQuantity": { "value": 2, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e5a0f4ba-8c7d-f792-954f-7dcb47e21e77", "resource": { "resourceType": "Observation", "id": "e5a0f4ba-8c7d-f792-954f-7dcb47e21e77", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T13:45:19-04:00", "issued": "2022-06-20T13:45:19.509-04:00", "valueQuantity": { "value": 91.8, "unit": "kg", "system": "http://unitsofmeasure.org", "code": "kg" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:0ffda297-d16f-bd12-13bd-2be91b6e5ef9", "resource": { "resourceType": "Observation", "id": "0ffda297-d16f-bd12-13bd-2be91b6e5ef9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "39156-5", "display": "Body mass index (BMI) [Ratio]" } ], "text": "Body mass index (BMI) [Ratio]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T13:45:19-04:00", "issued": "2022-06-20T13:45:19.509-04:00", "valueQuantity": { "value": 30.22, "unit": "kg/m2", "system": "http://unitsofmeasure.org", "code": "kg/m2" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ae1adbc7-db81-38ec-5f0f-1b4e2e2670ef", "resource": { "resourceType": "Observation", "id": "ae1adbc7-db81-38ec-5f0f-1b4e2e2670ef", "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:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T13:45:19-04:00", "issued": "2022-06-20T13:45:19.509-04:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure" }, "valueQuantity": { "value": 66, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure" }, "valueQuantity": { "value": 124, "unit": "mm[Hg]", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:c16fecef-45b5-b30f-dcb6-5356c4678c32", "resource": { "resourceType": "Observation", "id": "c16fecef-45b5-b30f-dcb6-5356c4678c32", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8867-4", "display": "Heart rate" } ], "text": "Heart rate" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T13:45:19-04:00", "issued": "2022-06-20T13:45:19.509-04:00", "valueQuantity": { "value": 93, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:5f538484-e454-25a5-13f8-14b5fa2f4d07", "resource": { "resourceType": "Observation", "id": "5f538484-e454-25a5-13f8-14b5fa2f4d07", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs", "display": "Vital signs" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "9279-1", "display": "Respiratory rate" } ], "text": "Respiratory rate" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T13:45:19-04:00", "issued": "2022-06-20T13:45:19.509-04:00", "valueQuantity": { "value": 16, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:f0e746b4-ebff-e0a2-7fb4-d70e18172f5c", "resource": { "resourceType": "Observation", "id": "f0e746b4-ebff-e0a2-7fb4-d70e18172f5c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-social-history" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social history" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status" } ], "text": "Tobacco smoking status" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T13:45:19-04:00", "issued": "2022-06-20T13:45:19.509-04:00", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "8517006", "display": "Ex-smoker (finding)" } ], "text": "Ex-smoker (finding)" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:9ea0c7ae-a444-6c7e-e0b8-7c212fd1ffad", "resource": { "resourceType": "Observation", "id": "9ea0c7ae-a444-6c7e-e0b8-7c212fd1ffad", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sdoh-assessment", "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "93025-5", "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" } ], "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T14:29:06-04:00", "issued": "2022-06-20T14:29:06.509-04:00", "component": [ { "code": { "coding": [ { "system": "http://loinc.org", "code": "76501-6", "display": "Within the last year, have you been afraid of your partner or ex-partner?" } ], "text": "Within the last year, have you been afraid of your partner or ex-partner?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93026-3", "display": "Do you feel physically and emotionally safe where you currently live?" } ], "text": "Do you feel physically and emotionally safe where you currently live?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } ], "text": "Yes" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93027-1", "display": "Are you a refugee?" } ], "text": "Are you a refugee?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93028-9", "display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" } ], "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93038-8", "display": "Stress level" } ], "text": "Stress level" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6568-5", "display": "Not at all" } ], "text": "Not at all" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93029-7", "display": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" } ], "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA27722-0", "display": "Less than once a week" } ], "text": "Less than once a week" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93030-5", "display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" } ], "text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93031-3", "display": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" } ], "text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30122-8", "display": "I choose not to answer this question" } ], "text": "I choose not to answer this question" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63586-2", "display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" } ], "text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?" }, "valueQuantity": { "value": 827050, "unit": "/a", "system": "http://unitsofmeasure.org", "code": "/a" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "76437-3", "display": "Primary insurance" } ], "text": "Primary insurance" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA6350-8", "display": "Private insurance" } ], "text": "Private insurance" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "67875-5", "display": "Employment status - current" } ], "text": "Employment status - current" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30136-8", "display": "Full-time work" } ], "text": "Full-time work" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ], "text": "Highest level of education" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30192-1", "display": "High school diploma or GED" } ], "text": "High school diploma or GED" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56799-0", "display": "Address" } ], "text": "Address" }, "valueString": "681 Trantow Vista Apt 76" }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93033-9", "display": "Are you worried about losing your housing?" } ], "text": "Are you worried about losing your housing?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "71802-3", "display": "Housing status" } ], "text": "Housing status" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA30189-7", "display": "I have housing" } ], "text": "I have housing" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "63512-8", "display": "How many people are living or staying at this address?" } ], "text": "How many people are living or staying at this address?" }, "valueQuantity": { "value": 7, "unit": "{#}", "system": "http://unitsofmeasure.org", "code": "{#}" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "54899-0", "display": "Preferred language" } ], "text": "Preferred language" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA43-5", "display": "English" } ], "text": "English" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93034-7", "display": "Have you been discharged from the armed forces of the United States?" } ], "text": "Have you been discharged from the armed forces of the United States?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "93035-4", "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" } ], "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "32624-9", "display": "Race" } ], "text": "Race" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA4457-3", "display": "White" } ], "text": "White" } }, { "code": { "coding": [ { "system": "http://loinc.org", "code": "56051-6", "display": "Do you consider yourself Hispanic/Latino?" } ], "text": "Do you consider yourself Hispanic/Latino?" }, "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } ], "text": "No" } } ] }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:cd7b0c8e-e9ee-e620-b1ff-c1fd178376a9", "resource": { "resourceType": "Observation", "id": "cd7b0c8e-e9ee-e620-b1ff-c1fd178376a9", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "70274-6", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ], "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T14:56:25-04:00", "issued": "2022-06-20T14:56:25.509-04:00", "valueQuantity": { "value": 0, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:72b332c6-8a45-6c94-a194-a596d6c4244f", "resource": { "resourceType": "Observation", "id": "72b332c6-8a45-6c94-a194-a596d6c4244f", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "55758-7", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T15:35:12-04:00", "issued": "2022-06-20T15:35:12.509-04:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:e54325c5-ac4b-f5c3-90d5-e4b21b9d9ccd", "resource": { "resourceType": "Observation", "id": "e54325c5-ac4b-f5c3-90d5-e4b21b9d9ccd", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82667-7", "display": "Total score [DAST-10]" } ], "text": "Total score [DAST-10]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T16:17:08-04:00", "issued": "2022-06-20T16:17:08.509-04:00", "valueQuantity": { "value": 1, "unit": "{score}", "system": "http://unitsofmeasure.org", "code": "{score}" } }, "request": { "method": "POST", "url": "Observation" } }, { "fullUrl": "urn:uuid:ba06a96e-c50e-fa81-32da-2297d8d76fff", "resource": { "resourceType": "Procedure", "id": "ba06a96e-c50e-fa81-32da-2297d8d76fff", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "performedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:00:19-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:f4c1d665-82a7-1843-5b5b-237dc8638004", "resource": { "resourceType": "Procedure", "id": "f4c1d665-82a7-1843-5b5b-237dc8638004", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "performedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:814d3fc7-3b5f-f68d-64e4-bfbe35a2555a", "resource": { "resourceType": "Procedure", "id": "814d3fc7-3b5f-f68d-64e4-bfbe35a2555a", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "performedPeriod": { "start": "2022-06-20T14:29:06-04:00", "end": "2022-06-20T14:56:25-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:b662d05a-dcd0-f0c1-7444-edf236135793", "resource": { "resourceType": "Procedure", "id": "b662d05a-dcd0-f0c1-7444-edf236135793", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "performedPeriod": { "start": "2022-06-20T14:56:25-04:00", "end": "2022-06-20T15:07:55-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:1fdab471-072e-233d-1aa8-e6e4efec3f92", "resource": { "resourceType": "Procedure", "id": "1fdab471-072e-233d-1aa8-e6e4efec3f92", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "performedPeriod": { "start": "2022-06-20T15:07:55-04:00", "end": "2022-06-20T15:35:12-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:e33cbae5-2c3c-ddff-a702-31b5a717686d", "resource": { "resourceType": "Procedure", "id": "e33cbae5-2c3c-ddff-a702-31b5a717686d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "performedPeriod": { "start": "2022-06-20T15:35:12-04:00", "end": "2022-06-20T15:49:19-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:3fa6567a-3647-800c-7f72-323895c66b9d", "resource": { "resourceType": "Procedure", "id": "3fa6567a-3647-800c-7f72-323895c66b9d", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure" ] }, "status": "completed", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "performedPeriod": { "start": "2022-06-20T15:49:19-04:00", "end": "2022-06-20T16:17:08-04:00" }, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Procedure" } }, { "fullUrl": "urn:uuid:87b2dd82-a224-baf7-aaa5-6ff7e56f993c", "resource": { "resourceType": "Immunization", "id": "87b2dd82-a224-baf7-aaa5-6ff7e56f993c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization" ] }, "status": "completed", "vaccineCode": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "occurrenceDateTime": "2022-06-20T13:45:19-04:00", "primarySource": true, "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." } }, "request": { "method": "POST", "url": "Immunization" } }, { "fullUrl": "urn:uuid:645f8f16-459e-1b18-8482-5194b2536017", "resource": { "resourceType": "DiagnosticReport", "id": "645f8f16-459e-1b18-8482-5194b2536017", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T14:56:25-04:00", "issued": "2022-06-20T14:56:25.509-04:00", "result": [ { "reference": "urn:uuid:cd7b0c8e-e9ee-e620-b1ff-c1fd178376a9", "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:1788f6e2-d3fe-b0e0-c201-c24feb8debf3", "resource": { "resourceType": "DiagnosticReport", "id": "1788f6e2-d3fe-b0e0-c201-c24feb8debf3", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T15:35:12-04:00", "issued": "2022-06-20T15:35:12.509-04:00", "result": [ { "reference": "urn:uuid:72b332c6-8a45-6c94-a194-a596d6c4244f", "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:19c1b840-2c51-84c4-faa8-dcd8acabfec4", "resource": { "resourceType": "DiagnosticReport", "id": "19c1b840-2c51-84c4-faa8-dcd8acabfec4", "status": "final", "code": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T16:17:08-04:00", "issued": "2022-06-20T16:17:08.509-04:00", "result": [ { "reference": "urn:uuid:e54325c5-ac4b-f5c3-90d5-e4b21b9d9ccd", "display": "Total score [DAST-10]" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:19b2e119-19ec-d6f8-089d-a3c5b9100710", "resource": { "resourceType": "DiagnosticReport", "id": "19b2e119-19ec-d6f8-089d-a3c5b9100710", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, "effectiveDateTime": "2022-06-20T13:45:19-04:00", "issued": "2022-06-20T13:45:19.509-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:5a0db43a-7217-9fea-7396-73b1c82d04e3", "resource": { "resourceType": "DocumentReference", "id": "5a0db43a-7217-9fea-7396-73b1c82d04e3", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:19b2e119-19ec-d6f8-089d-a3c5b9100710" } ], "status": "superseded", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "2022-06-20T13:45:19.509-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492", "display": "Dr. Irene779 Kirlin939" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" } ], "period": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:e0c5a60e-5b9f-e888-0d55-087bfff3f5b5", "resource": { "resourceType": "Claim", "id": "e0c5a60e-5b9f-e888-0d55-087bfff3f5b5", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "created": "2022-06-20T14:29:06-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|cc400ddc-c38d-3604-8d89-cea21555719f", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] }, "valueReference": { "reference": "urn:uuid:87b2dd82-a224-baf7-aaa5-6ff7e56f993c" } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" } ] } } ], "procedure": [ { "sequence": 1, "procedureReference": { "reference": "urn:uuid:ba06a96e-c50e-fa81-32da-2297d8d76fff" } }, { "sequence": 2, "procedureReference": { "reference": "urn:uuid:f4c1d665-82a7-1843-5b5b-237dc8638004" } }, { "sequence": 3, "procedureReference": { "reference": "urn:uuid:814d3fc7-3b5f-f68d-64e4-bfbe35a2555a" } }, { "sequence": 4, "procedureReference": { "reference": "urn:uuid:b662d05a-dcd0-f0c1-7444-edf236135793" } }, { "sequence": 5, "procedureReference": { "reference": "urn:uuid:1fdab471-072e-233d-1aa8-e6e4efec3f92" } }, { "sequence": 6, "procedureReference": { "reference": "urn:uuid:e33cbae5-2c3c-ddff-a702-31b5a717686d" } }, { "sequence": 7, "procedureReference": { "reference": "urn:uuid:3fa6567a-3647-800c-7f72-323895c66b9d" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "encounter": [ { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "net": { "value": 136.00, "currency": "USD" } }, { "sequence": 3, "procedureSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "net": { "value": 488.90, "currency": "USD" } }, { "sequence": 4, "procedureSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 5, "procedureSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 6, "informationSequence": [ 2 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 7, "procedureSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 8, "procedureSequence": [ 5 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 9, "informationSequence": [ 3 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "net": { "value": 74.58, "currency": "USD" } }, { "sequence": 10, "procedureSequence": [ 6 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 11, "procedureSequence": [ 7 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "net": { "value": 431.40, "currency": "USD" } }, { "sequence": 12, "informationSequence": [ 4 ], "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "net": { "value": 74.58, "currency": "USD" } } ], "total": { "value": 1193.10, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:25104a6b-f55c-0974-3d70-061d06176627", "resource": { "resourceType": "ExplanationOfBenefit", "id": "25104a6b-f55c-0974-3d70-061d06176627", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "e0c5a60e-5b9f-e888-0d55-087bfff3f5b5" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "2022-06-20T14:29:06-04:00", "end": "2023-06-20T14:29:06-04:00" }, "created": "2022-06-20T14:29:06-04:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|8083d635-94b5-3bff-aba2-3c63cf91d1b0", "display": "NEEDHAM FAMILY PRACTICE ASSOC. P.C." }, "claim": { "reference": "urn:uuid:e0c5a60e-5b9f-e888-0d55-087bfff3f5b5" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999955492" }, "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": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "162673000", "display": "General examination of patient (procedure)" } ], "text": "General examination of patient (procedure)" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" } ] }, { "sequence": 2, "informationSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/sid/cvx", "code": "140", "display": "Influenza, seasonal, injectable, preservative free" } ], "text": "Influenza, seasonal, injectable, preservative free" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 136.00, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 27.200000000000003, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 108.80000000000001, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 136.00, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 3, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "430193006", "display": "Medication Reconciliation (procedure)" } ], "text": "Medication Reconciliation (procedure)" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 488.90, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 97.78, "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": 391.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 488.90, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 488.90, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 4, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710824005", "display": "Assessment of health and social care needs (procedure)" } ], "text": "Assessment of health and social care needs (procedure)" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 5, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "710841007", "display": "Assessment of anxiety (procedure)" } ], "text": "Assessment of anxiety (procedure)" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 6, "informationSequence": [ 2 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "69737-5", "display": "Generalized anxiety disorder 7 item (GAD-7)" } ], "text": "Generalized anxiety disorder 7 item (GAD-7)" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 7, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "171207006", "display": "Depression screening (procedure)" } ], "text": "Depression screening (procedure)" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 8, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "454711000124102", "display": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" } ], "text": "Depression screening using Patient Health Questionnaire Two-Item score (procedure)" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 9, "informationSequence": [ 3 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "55757-9", "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" } ], "text": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 74.58, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 14.916, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 59.664, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 74.58, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 10, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "428211000124100", "display": "Assessment of substance use (procedure)" } ], "text": "Assessment of substance use (procedure)" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 11, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "713106006", "display": "Screening for drug abuse (procedure)" } ], "text": "Screening for drug abuse (procedure)" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "19", "display": "Off Campus-Outpatient Hospital" } ] }, "net": { "value": 431.40, "currency": "USD" }, "adjudication": [ { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", "display": "Line Beneficiary Coinsurance Amount" } ] }, "amount": { "value": 86.28, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", "display": "Line Provider Payment Amount" } ] }, "amount": { "value": 345.12, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", "display": "Line Submitted Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", "display": "Line Allowed Charge Amount" } ] }, "amount": { "value": 431.40, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", "display": "Line Beneficiary Part B Deductible Amount" } ] }, "amount": { "value": 0, "currency": "USD" } }, { "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", "display": "Line Processing Indicator Code" } ] } } ] }, { "sequence": 12, "informationSequence": [ 4 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://loinc.org", "code": "82666-9", "display": "Drug Abuse Screening Test-10 [DAST-10]" } ], "text": "Drug Abuse Screening Test-10 [DAST-10]" }, "servicedPeriod": { "start": "2022-06-20T13:45:19-04:00", "end": "2022-06-20T14:29:06-04:00" }, "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": 1193.10, "currency": "USD" } } ], "payment": { "amount": { "value": 2749.632, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:9c6851d6-c98e-5ba7-b78c-5e5f78cbde82", "resource": { "resourceType": "Encounter", "id": "9c6851d6-c98e-5ba7-b78c-5e5f78cbde82", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter" ] }, "identifier": [ { "use": "official", "system": "https://github.com/synthetichealth/synthea", "value": "9c6851d6-c98e-5ba7-b78c-5e5f78cbde82" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Mr. Aaron697 Schmeler639" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "PPRF", "display": "primary performer" } ], "text": "primary performer" } ], "period": { "start": "2023-05-11T00:45:19-04:00", "end": "2023-05-11T01:00:19-04:00" }, "individual": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" } } ], "period": { "start": "2023-05-11T00:45:19-04:00", "end": "2023-05-11T01:00:19-04:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "444814009", "display": "Viral sinusitis (disorder)" } ] } ], "location": [ { "location": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." } } ], "serviceProvider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." } }, "request": { "method": "POST", "url": "Encounter" } }, { "fullUrl": "urn:uuid:cb578c3a-a606-d1d2-6ff1-1ddb4007816c", "resource": { "resourceType": "Condition", "id": "cb578c3a-a606-d1d2-6ff1-1ddb4007816c", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis" ] }, "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "resolved" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code": "confirmed" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "444814009", "display": "Viral sinusitis (disorder)" } ], "text": "Viral sinusitis (disorder)" }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:9c6851d6-c98e-5ba7-b78c-5e5f78cbde82" }, "onsetDateTime": "2023-05-11T00:45:19-04:00", "abatementDateTime": "2023-06-03T00:45:19-04:00", "recordedDate": "2023-05-11T00:45:19-04:00" }, "request": { "method": "POST", "url": "Condition" } }, { "fullUrl": "urn:uuid:1c04d19c-28ef-4a42-a8c9-3157d3f9fcbe", "resource": { "resourceType": "DiagnosticReport", "id": "1c04d19c-28ef-4a42-a8c9-3157d3f9fcbe", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note" ] }, "status": "final", "category": [ { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "encounter": { "reference": "urn:uuid:9c6851d6-c98e-5ba7-b78c-5e5f78cbde82" }, "effectiveDateTime": "2023-05-11T00:45:19-04:00", "issued": "2023-05-11T00:45:19.509-04:00", "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" } ], "presentedForm": [ { "contentType": "text/plain; charset=utf-8", "data": "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" } ] }, "request": { "method": "POST", "url": "DiagnosticReport" } }, { "fullUrl": "urn:uuid:f5ae7cad-9424-3bb2-4b42-6113b722190b", "resource": { "resourceType": "DocumentReference", "id": "f5ae7cad-9424-3bb2-4b42-6113b722190b", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ] }, "identifier": [ { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:1c04d19c-28ef-4a42-a8c9-3157d3f9fcbe" } ], "status": "current", "type": { "coding": [ { "system": "http://loinc.org", "code": "34117-2", "display": "History and physical note" }, { "system": "http://loinc.org", "code": "51847-2", "display": "Evaluation + Plan note" } ] }, "category": [ { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "code": "clinical-note", "display": "Clinical Note" } ] } ], "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "date": "2023-05-11T00:45:19.509-04:00", "author": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" } ], "custodian": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "content": [ { "attachment": { "contentType": "text/plain; charset=utf-8", "data": "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" }, "format": { "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode", "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient", "display": "mimeType Sufficient" } } ], "context": { "encounter": [ { "reference": "urn:uuid:9c6851d6-c98e-5ba7-b78c-5e5f78cbde82" } ], "period": { "start": "2023-05-11T00:45:19-04:00", "end": "2023-05-11T01:00:19-04:00" } } }, "request": { "method": "POST", "url": "DocumentReference" } }, { "fullUrl": "urn:uuid:c0c91559-17f5-fa87-a372-c609b00bdc89", "resource": { "resourceType": "Claim", "id": "c0c91559-17f5-fa87-a372-c609b00bdc89", "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60", "display": "Aaron697 Schmeler639" }, "billablePeriod": { "start": "2023-05-11T00:45:19-04:00", "end": "2023-05-11T01:00:19-04:00" }, "created": "2023-05-11T01:00:19-04:00", "provider": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" } ] }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:cb578c3a-a606-d1d2-6ff1-1ddb4007816c" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "display": "Humana" } } ], "item": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "encounter": [ { "reference": "urn:uuid:9c6851d6-c98e-5ba7-b78c-5e5f78cbde82" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "444814009", "display": "Viral sinusitis (disorder)" } ], "text": "Viral sinusitis (disorder)" } } ], "total": { "value": 85.55, "currency": "USD" } }, "request": { "method": "POST", "url": "Claim" } }, { "fullUrl": "urn:uuid:1f526ae0-6132-d5cd-96b4-c08e6015068c", "resource": { "resourceType": "ExplanationOfBenefit", "id": "1f526ae0-6132-d5cd-96b4-c08e6015068c", "contained": [ { "resourceType": "ServiceRequest", "id": "referral", "status": "completed", "intent": "order", "subject": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "requester": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" }, "performer": [ { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" } ] }, { "resourceType": "Coverage", "id": "coverage", "status": "active", "type": { "text": "Humana" }, "beneficiary": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "payor": [ { "display": "Humana" } ] } ], "identifier": [ { "system": "https://bluebutton.cms.gov/resources/variables/clm_id", "value": "c0c91559-17f5-fa87-a372-c609b00bdc89" }, { "system": "https://bluebutton.cms.gov/resources/identifier/claim-group", "value": "99999999999" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "use": "claim", "patient": { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, "billablePeriod": { "start": "2023-05-11T01:00:19-04:00", "end": "2024-05-11T01:00:19-04:00" }, "created": "2023-05-11T01:00:19-04:00", "insurer": { "display": "Humana" }, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" }, "referral": { "reference": "#referral" }, "facility": { "reference": "Location?identifier=https://github.com/synthetichealth/synthea|a21a0084-d268-3984-900c-fa19fb8edc37", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." }, "claim": { "reference": "urn:uuid:c0c91559-17f5-fa87-a372-c609b00bdc89" }, "outcome": "complete", "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397" }, "role": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole", "code": "primary", "display": "Primary provider" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisReference": { "reference": "urn:uuid:cb578c3a-a606-d1d2-6ff1-1ddb4007816c" }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "principal" } ] } ] } ], "insurance": [ { "focal": true, "coverage": { "reference": "#coverage", "display": "Humana" } } ], "item": [ { "sequence": 1, "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "185345009", "display": "Encounter for symptom" } ], "text": "Encounter for symptom" }, "servicedPeriod": { "start": "2023-05-11T00:45:19-04:00", "end": "2023-05-11T01:00:19-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] }, "encounter": [ { "reference": "urn:uuid:9c6851d6-c98e-5ba7-b78c-5e5f78cbde82" } ] }, { "sequence": 2, "diagnosisSequence": [ 1 ], "category": { "coding": [ { "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd", "code": "1", "display": "Medical care" } ] }, "productOrService": { "coding": [ { "system": "http://snomed.info/sct", "code": "444814009", "display": "Viral sinusitis (disorder)" } ], "text": "Viral sinusitis (disorder)" }, "servicedPeriod": { "start": "2023-05-11T00:45:19-04:00", "end": "2023-05-11T01:00:19-04:00" }, "locationCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", "code": "21", "display": "Inpatient Hospital" } ] } } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted", "display": "Submitted Amount" } ], "text": "Submitted Amount" }, "amount": { "value": 85.55, "currency": "USD" } } ], "payment": { "amount": { "value": 0.0, "currency": "USD" } } }, "request": { "method": "POST", "url": "ExplanationOfBenefit" } }, { "fullUrl": "urn:uuid:d519b0f7-a049-7620-04f7-86f8cd45ffad", "resource": { "resourceType": "Provenance", "id": "d519b0f7-a049-7620-04f7-86f8cd45ffad", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance" ] }, "target": [ { "reference": "urn:uuid:df9d5c4b-07dc-d4cd-9237-a320d5b40a60" }, { "reference": "urn:uuid:b0fabdc6-e7cf-47cd-cf01-876eaa231d4e" }, { "reference": "urn:uuid:b5dd1976-9402-4e4a-9b5b-c0a108a2c4f3" }, { "reference": "urn:uuid:42a8985b-d3f6-b785-bf3f-10ef24c4d851" }, { "reference": "urn:uuid:1fd0f059-8f93-45ff-b796-5201011979f7" }, { "reference": "urn:uuid:4606e34a-9d4e-0d28-771e-d2355ffaac4b" }, { "reference": "urn:uuid:4784358d-7d38-3749-ac7d-4f163caf8d5e" }, { "reference": "urn:uuid:a546ce0c-b4a8-ce92-a595-fd2dfa18d079" }, { "reference": "urn:uuid:110b37c4-8ac8-285d-9d3b-159b98a26cb6" }, { "reference": "urn:uuid:46c60cce-53a9-ecee-100f-1db9eb60ed26" }, { "reference": "urn:uuid:478021dc-b9f0-59cc-2025-e0577e2e682e" }, { "reference": "urn:uuid:749384ab-616d-35c1-9791-6203b7011a27" }, { "reference": "urn:uuid:4d0c76fe-054c-86e6-ec2f-a715f4374992" }, { "reference": "urn:uuid:b629ab27-f6f3-99f6-d496-b1941eb4c98a" }, { "reference": "urn:uuid:a0b4c4af-2ce4-5344-0070-72e8bbca565d" }, { "reference": "urn:uuid:bcfd0116-4d3a-655d-ec45-debbdcd23739" }, { "reference": "urn:uuid:24dc1c29-1d80-a2bb-0a9f-b7c95932a7d1" }, { "reference": "urn:uuid:13cee4fd-e4f4-663d-905b-a95da09f70ef" }, { "reference": "urn:uuid:14ad450a-4492-57ff-6d02-d8eeaab555dc" }, { "reference": "urn:uuid:e181f4e7-7d85-11d6-56b8-09458850764a" }, { "reference": "urn:uuid:827ce1dc-3f15-8733-e051-ba77854646aa" }, { "reference": "urn:uuid:cc086787-9a86-e3f4-deb0-acf85a15a8ea" }, { "reference": "urn:uuid:31de59de-7c1d-d910-d695-7fc9e31cc376" }, { "reference": "urn:uuid:afa0a15e-b0a7-2244-0f5c-4c696323af09" }, { "reference": "urn:uuid:a4df938c-6961-30e1-8945-b68a46b98675" }, { "reference": "urn:uuid:9e69ad31-e310-565d-062d-ae6292d28141" }, { "reference": "urn:uuid:be399156-f222-8930-3d28-4f9709529592" }, { "reference": "urn:uuid:5829398c-1d46-bab2-7adf-554a551eaddb" }, { "reference": "urn:uuid:7a8bde87-683e-05cf-7120-24d1d7f949f6" }, { "reference": "urn:uuid:e38922bd-6a77-c050-d80b-4109a1c9a105" }, { "reference": "urn:uuid:3a637b70-89bc-bf53-bb3d-7312c33a3cc4" }, { "reference": "urn:uuid:46df47f0-878e-ba68-d445-32f187dc351c" }, { "reference": "urn:uuid:2f1d5bb3-57cc-0cba-04f3-3dd2458670c9" }, { "reference": "urn:uuid:de1339b2-f662-fbfe-0218-1fc96cf99449" }, { "reference": "urn:uuid:318ac40f-0957-5b2d-933e-b072c7cc1511" }, { "reference": "urn:uuid:0c660630-000f-14d0-661b-edceddd21975" }, { "reference": "urn:uuid:e6b66ab3-3b82-edc5-922b-e4a980d5974f" }, { "reference": "urn:uuid:5f34a96e-5267-de4d-985b-0584042c8ea9" }, { "reference": "urn:uuid:9fda4e41-774f-7063-1ea9-f2a81925ed6d" }, { "reference": "urn:uuid:7abc523e-b379-eb7b-6415-0412ec3b0a59" }, { "reference": "urn:uuid:5cfc622c-1e42-e9b2-48f4-4b2c1cbb2152" }, { "reference": "urn:uuid:1f65cd96-dc81-da0d-7d81-bfcf83c9f23b" }, { "reference": "urn:uuid:b8156fcc-3258-8fab-6a99-504ab6b0e48b" }, { "reference": "urn:uuid:ced12cea-5e69-15b6-30b7-c92a83fe563a" }, { "reference": "urn:uuid:66820935-2a1d-ea5f-8a4a-58c3c05627ed" }, { "reference": "urn:uuid:27842654-16a3-1ec6-55ad-9d0111727a55" }, { "reference": "urn:uuid:c614611e-daa9-6414-e98f-f68357e53342" }, { "reference": "urn:uuid:827e357d-607c-cbc5-864c-276a147f37e0" }, { "reference": "urn:uuid:fc9e973d-a22c-b05d-35ec-7287019ddac5" }, { "reference": "urn:uuid:8c2056a5-1ade-cae5-8395-b7fb6a706371" }, { "reference": "urn:uuid:7000d434-cb24-9464-fcc5-33f0762f46e0" }, { "reference": "urn:uuid:dc3aee27-5d33-b9bc-7283-d52c3d63324c" }, { "reference": "urn:uuid:443f6ef3-70c0-baca-e0a2-7aeae6ca3fad" }, { "reference": "urn:uuid:05b95eb2-277c-36c5-19bd-b07839b3f2cb" }, { "reference": "urn:uuid:9c423796-39e9-18cb-c56a-d93a8186ae37" }, { "reference": "urn:uuid:c6da5831-0b9f-0033-3081-0862edad6ad5" }, { "reference": "urn:uuid:f75eb560-275c-1904-c6b7-6fb98e0bc86f" }, { "reference": "urn:uuid:2827b707-af4f-9bfd-77b5-351ed6a62ce5" }, { "reference": "urn:uuid:2c278663-be81-919f-ecc0-82655da19061" }, { "reference": "urn:uuid:34abaa70-7fbd-9eb4-fae4-5edd693eaa7a" }, { "reference": "urn:uuid:30ffe145-b90b-6f66-b5b1-66a0907dd5c4" }, { "reference": "urn:uuid:f8d4ed7a-e111-3af5-a7c5-6b91b4034afa" }, { "reference": "urn:uuid:67e0ff54-135b-b329-906a-94aaed22a3a7" }, { "reference": "urn:uuid:2be37bc0-a666-04d0-2153-33047e5f0cc6" }, { "reference": "urn:uuid:00e9230d-8bbe-4c46-c984-8444ae6e5731" }, { "reference": "urn:uuid:72edfd7f-abcb-f645-c4e5-b13e61f345f3" }, { "reference": "urn:uuid:75f04b0e-5f74-9455-a74b-2f8c3f7f1c4f" }, { "reference": "urn:uuid:8a7f56f1-906b-4113-1493-21310000b79e" }, { "reference": "urn:uuid:3a2c25b9-f799-8d1f-cccd-86a78762fd39" }, { "reference": "urn:uuid:472171ba-d768-57a2-8373-37297896e420" }, { "reference": "urn:uuid:149a8af9-5326-9da7-4eca-b5e5e8ebe45d" }, { "reference": "urn:uuid:c5e3c6d9-6d30-b1b6-6637-045d6bc60656" }, { "reference": "urn:uuid:b26b8937-2615-817a-f433-51188773ba8b" }, { "reference": "urn:uuid:dbd663c0-a343-2158-1551-2771da9b1e6f" }, { "reference": "urn:uuid:1e3d6032-0289-ed61-0bf9-ae187bca1040" }, { "reference": "urn:uuid:2ae068ed-599c-45be-9db8-54b44d5de11c" }, { "reference": "urn:uuid:c26f21db-bc7a-8a7f-c2c0-f7d8b79b78e3" }, { "reference": "urn:uuid:4e494637-c922-5a16-5ca9-86994d99ab8c" }, { "reference": "urn:uuid:f99978fa-2029-3ee4-a909-44415c9f93a4" }, { "reference": "urn:uuid:a4efb9e2-3db1-c920-67c6-309aa8b8ae95" }, { "reference": "urn:uuid:edc9c588-3b0f-0446-6887-eae326e1a47b" }, { "reference": "urn:uuid:9edca4bd-5a27-d402-d92b-d42d6e6424f4" }, { "reference": "urn:uuid:a9bf808e-4481-add0-1164-e56b84303672" }, { "reference": "urn:uuid:74212e23-8307-7399-0514-0ecd2cc0b643" }, { "reference": "urn:uuid:0fd8a571-f376-0bdd-01ac-77f994427c69" }, { "reference": "urn:uuid:3dfbe2bd-1bb9-e233-4ab6-3b3765efdcc1" }, { "reference": "urn:uuid:632f70a7-5d67-847f-7cab-408a5d9d3dd0" }, { "reference": "urn:uuid:b6ffe42b-1361-d4da-9db8-759dbefedd7d" }, { "reference": "urn:uuid:16842539-dde7-4dce-b1de-e2ce74310dfb" }, { "reference": "urn:uuid:bdf43caf-44dc-2b45-e29e-31a14b464661" }, { "reference": "urn:uuid:9e6c4939-042d-603c-cefa-a19c59ecd639" }, { "reference": "urn:uuid:963363a7-c459-d8e5-1838-2ce1c80c111d" }, { "reference": "urn:uuid:7ead457b-c9f0-6e6f-2348-0501c73fe2d9" }, { "reference": "urn:uuid:3aee4ead-bd9c-317c-7097-b13442b8d5f7" }, { "reference": "urn:uuid:df7deb82-9d8e-937c-da9d-94641b2b83b3" }, { "reference": "urn:uuid:626a5795-643a-62bd-c763-711e23b1b8d2" }, { "reference": "urn:uuid:424261cc-2a57-5651-fcf3-0cf3f3239c4c" }, { "reference": "urn:uuid:8d1e4a5c-9a66-07b3-f877-ae9826f519eb" }, { "reference": "urn:uuid:cfe7032f-ee75-767b-6c79-e7f5066462a2" }, { "reference": "urn:uuid:e17cd50f-0fbe-ec59-84f5-8accebac0f52" }, { "reference": "urn:uuid:9cfb5a95-6147-726d-f85f-c91ab4b5bf73" }, { "reference": "urn:uuid:90fa79e7-bdb3-e6d4-a663-13d8c5667496" }, { "reference": "urn:uuid:1ac83a2b-bfe9-0d63-aae4-5ec78438a867" }, { "reference": "urn:uuid:038dd596-6bd9-81c8-2edd-35228d5c95c9" }, { "reference": "urn:uuid:ec23a3fa-48ff-1de0-346e-db6ca072ffc5" }, { "reference": "urn:uuid:b6e1254d-0227-26d9-b881-e000cc061187" }, { "reference": "urn:uuid:7e612fc0-bf1e-96a5-e4a6-2404f9753162" }, { "reference": "urn:uuid:7801c2cb-7d5f-b95b-b9fd-8d0fed650ffa" }, { "reference": "urn:uuid:d08cf092-1ee3-5ad3-06ff-86ef2820df3a" }, { "reference": "urn:uuid:dc5b6dbb-981e-76ab-a504-066c0148de2a" }, { "reference": "urn:uuid:2ef9b892-6f77-fb8a-e653-249ea662ef99" }, { "reference": "urn:uuid:b40a8590-a4dd-778a-fe87-6a2f339edd17" }, { "reference": "urn:uuid:2c878b03-17fb-5d8b-91e7-bf85a1030c24" }, { "reference": "urn:uuid:a75293b1-a97d-7576-12f2-060aae36223a" }, { "reference": "urn:uuid:913d1c8c-4eac-cbff-6dd9-9973bb9a7d5b" }, { "reference": "urn:uuid:80b28e32-6404-88d3-4cdb-5bbf64d660a6" }, { "reference": "urn:uuid:597823a2-8357-abfd-1a40-d7d1888221bc" }, { "reference": "urn:uuid:0371a707-7f04-bd87-6037-59a9d084ec2d" }, { "reference": "urn:uuid:cf2495b6-8998-1389-6876-f89a04b029bc" }, { "reference": "urn:uuid:a35e0787-1c0c-c67e-710e-6eb9cff39a6b" }, { "reference": "urn:uuid:27f29ea7-66a0-d58b-c242-2c61ce8cb3a0" }, { "reference": "urn:uuid:a63402b7-f9e7-d42b-97ff-0e3ec5bef613" }, { "reference": "urn:uuid:bb05abcf-d61d-3cc4-b818-096c10d4798b" }, { "reference": "urn:uuid:b831587d-fefa-0b44-eb42-d76cab24d536" }, { "reference": "urn:uuid:bdcbd4f7-7062-40a8-141b-668ffc59b60a" }, { "reference": "urn:uuid:3a37b874-2e0f-9005-4b21-a5f9f5b05f09" }, { "reference": "urn:uuid:3d791269-dc92-0bec-c425-c90af55509c9" }, { "reference": "urn:uuid:21490684-55e2-0d76-ffdc-e77adc7e5056" }, { "reference": "urn:uuid:302afc8c-ae88-2bd2-d1ba-6f49ead28a7b" }, { "reference": "urn:uuid:1a4f1790-b8d5-baf5-e31b-5d8c7386661c" }, { "reference": "urn:uuid:178d6f8f-5106-d100-9ce6-add5b336aed5" }, { "reference": "urn:uuid:faee8869-8983-d014-a738-6fa98a6de67b" }, { "reference": "urn:uuid:7501454e-6001-2f99-37ff-22d5a16b7132" }, { "reference": "urn:uuid:d87b3639-58ca-6a40-4336-f6093e80773e" }, { "reference": "urn:uuid:c49cb70d-9f9d-7f78-b851-5d146ed7849a" }, { "reference": "urn:uuid:74eef158-5ea1-e879-97ec-ceb0b435ccdf" }, { "reference": "urn:uuid:f2a237fe-b49e-7bcf-91c5-6816a3893e7c" }, { "reference": "urn:uuid:c59f0d6c-8557-7b38-fa2e-41e14b0b7d38" }, { "reference": "urn:uuid:263bac23-fbea-60ef-e1ec-96920c5d794e" }, { "reference": "urn:uuid:632dec1c-5a26-1dcc-4cfd-42637bef0a98" }, { "reference": "urn:uuid:c69dd53e-c1dd-af36-0bad-4c3d022174d7" }, { "reference": "urn:uuid:fb7296c7-52fa-90fa-7fec-de4a67a0b621" }, { "reference": "urn:uuid:e5a0f4ba-8c7d-f792-954f-7dcb47e21e77" }, { "reference": "urn:uuid:0ffda297-d16f-bd12-13bd-2be91b6e5ef9" }, { "reference": "urn:uuid:ae1adbc7-db81-38ec-5f0f-1b4e2e2670ef" }, { "reference": "urn:uuid:c16fecef-45b5-b30f-dcb6-5356c4678c32" }, { "reference": "urn:uuid:5f538484-e454-25a5-13f8-14b5fa2f4d07" }, { "reference": "urn:uuid:f0e746b4-ebff-e0a2-7fb4-d70e18172f5c" }, { "reference": "urn:uuid:9ea0c7ae-a444-6c7e-e0b8-7c212fd1ffad" }, { "reference": "urn:uuid:cd7b0c8e-e9ee-e620-b1ff-c1fd178376a9" }, { "reference": "urn:uuid:72b332c6-8a45-6c94-a194-a596d6c4244f" }, { "reference": "urn:uuid:e54325c5-ac4b-f5c3-90d5-e4b21b9d9ccd" }, { "reference": "urn:uuid:ba06a96e-c50e-fa81-32da-2297d8d76fff" }, { "reference": "urn:uuid:f4c1d665-82a7-1843-5b5b-237dc8638004" }, { "reference": "urn:uuid:814d3fc7-3b5f-f68d-64e4-bfbe35a2555a" }, { "reference": "urn:uuid:b662d05a-dcd0-f0c1-7444-edf236135793" }, { "reference": "urn:uuid:1fdab471-072e-233d-1aa8-e6e4efec3f92" }, { "reference": "urn:uuid:e33cbae5-2c3c-ddff-a702-31b5a717686d" }, { "reference": "urn:uuid:3fa6567a-3647-800c-7f72-323895c66b9d" }, { "reference": "urn:uuid:87b2dd82-a224-baf7-aaa5-6ff7e56f993c" }, { "reference": "urn:uuid:645f8f16-459e-1b18-8482-5194b2536017" }, { "reference": "urn:uuid:1788f6e2-d3fe-b0e0-c201-c24feb8debf3" }, { "reference": "urn:uuid:19c1b840-2c51-84c4-faa8-dcd8acabfec4" }, { "reference": "urn:uuid:19b2e119-19ec-d6f8-089d-a3c5b9100710" }, { "reference": "urn:uuid:5a0db43a-7217-9fea-7396-73b1c82d04e3" }, { "reference": "urn:uuid:e0c5a60e-5b9f-e888-0d55-087bfff3f5b5" }, { "reference": "urn:uuid:25104a6b-f55c-0974-3d70-061d06176627" }, { "reference": "urn:uuid:9c6851d6-c98e-5ba7-b78c-5e5f78cbde82" }, { "reference": "urn:uuid:cb578c3a-a606-d1d2-6ff1-1ddb4007816c" }, { "reference": "urn:uuid:1c04d19c-28ef-4a42-a8c9-3157d3f9fcbe" }, { "reference": "urn:uuid:f5ae7cad-9424-3bb2-4b42-6113b722190b" }, { "reference": "urn:uuid:c0c91559-17f5-fa87-a372-c609b00bdc89" }, { "reference": "urn:uuid:1f526ae0-6132-d5cd-96b4-c08e6015068c" } ], "recorded": "2023-06-26T13:45:19.509-04:00", "agent": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type", "code": "author", "display": "Author" } ], "text": "Author" }, "who": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" }, "onBehalfOf": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." } }, { "type": { "coding": [ { "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type", "code": "transmitter", "display": "Transmitter" } ], "text": "Transmitter" }, "who": { "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999996397", "display": "Dr. Gerry91 Block661" }, "onBehalfOf": { "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|1e11392b-1278-3e70-93cd-f396cbd0c265", "display": "VHS ACQUISITION SUBSIDIARY NUMBER 9, INC." } } ] }, "request": { "method": "POST", "url": "Provenance" } } ] }